Ectropion / Entropion

Ectropion is the outward turning of the eyelid margin, causing the inner conjunctival surface to become exposed. This prevents proper tear drainage and leaves the eye inadequately protected. The condition is most commonly age related (involutional), resulting from horizontal eyelid laxity and weakening of the eyelid retractors. It can also result from scarring (cicatricial), facial nerve palsy (paralytic), or mechanical factors such as eyelid tumours.

Entropion is the inward rolling of the eyelid margin, causing the eyelashes and skin to rub painfully against the cornea and conjunctiva. This constant abrasion can lead to corneal epithelial defects, ulceration, scarring, and potentially permanent vision loss. Entropion is most commonly age related due to eyelid laxity and disinsertion of the lower eyelid retractors. It may also be cicatricial (due to scarring from trauma, surgery, or inflammation) or spastic (due to involuntary eyelid muscle contraction).

Ectropion:

• Excessive tearing (epiphora) due to the punctum being pulled away from the eye
• Redness and irritation of the exposed conjunctiva
• A gritty or foreign body sensation
• Dryness and burning, particularly with exposure to wind or air conditioning
• Crusting of the eyelid margin
• Mucous discharge
• Red, thickened, or roughened conjunctiva

Entropion symptoms

• Painful foreign body sensation from eyelashes rubbing against the eye
• Redness and irritation
• Excessive tearing (reflex tearing)
• Light sensitivity (photophobia)
• Mucous discharge
• Feeling that there is something constantly in the eye
• Corneal abrasion or ulceration in severe cases

When you visit us at Sutherland Eye Surgeons, some of the tests that we perform may include:

• External eyelid examination
  Assessment of eyelid position, laxity, and symmetry, including measurement of the eyelid margin relative to the pupil and cornea

• Slit lamp examination
  Evaluation of the conjunctiva, cornea, and eyelid margin for signs of exposure keratopathy, corneal epithelial defects, scarring, or ulceration

• Schirmer's test
  Assessment of tear production, which may be reduced in patients with eyelid malposition

• Corneal fluorescein staining
  Application of yellow dye to highlight corneal abrasions or ulceration caused by rubbing eyelashes or exposure

• Eyelid laxity assessment
  Gentle pulling of the eyelid to assess horizontal and vertical laxity, which guides surgical technique

• Punctal assessment
  Evaluation of the position of the punctum (tear drainage opening), which may be malpositioned in ectropion

• Snap back test
  Assessment of eyelid tone by pulling the eyelid down and observing how quickly it returns to its normal position; delayed return indicates significant laxity

The specific technique depends on the type and cause of the eyelid malposition.

For ectropion, the most common procedure for age related cases is the lateral tarsal strip, which tightens the eyelid horizontally. A medial spindle procedure may be used when the inner portion of the eyelid is particularly lax, while retractor reattachment addresses cases where muscle disinsertion is contributing to the malposition. For cicatricial ectropion caused by scarring, a full thickness skin graft may be required, and severe cases may need a tarsal strip with a spacer graft.

For entropion, the most common surgical approach for age related cases is retractor advancement, which reattaches and advances the lower eyelid retractors to evert the eyelid margin. Horizontal lid shortening is often combined with this procedure to address both laxity and inturning. A full thickness eyelid wedge excision may be performed to tighten the eyelid, while posterior lamellar grafts are used for cicatricial entropion where scarring is the cause. For mild or temporary correction, an everting suture technique may be used.