Eyelid ectropion

Specialty: Ophthalmology.

• lower eyelid everted
• eyelid edge outward
• external eyelid laxity

Why it occurs

• Senile or involutional ectropion (secondary to chronic horizontal laxity of the medial and lateral palpebral tendons)
• Cscarring ectropion (due to eyelid skin retraction after trauma, chemical or thermal burns, chronic dermatitis or previous plastic surgery)
• Paralytic ectropion (associated with loss of tone of the orbicularis muscle due to facial nerve paralysis)
• Mechanical ectropion (secondary to the downward traction effect due to tumors or lower eyelid masses)

Initial workup

Slit lamp examination with corneal fluorescein staining to evaluate the lower surface and rule out depolishing of the epithelium; Horizontal eyelid distraction test (pulling the lower eyelid forward by measuring the distance with the globe, pathological if it exceeds 6-8 mm); Eyelid return test or snapback test (evaluates the speed of spontaneous repositioning of the eyelid after traction); Assessment of the Bell reflex and the motor function of the facial nerve.

Standard management

• Sodium hyaluronate — 0.4% eye drops or 1% carboxymethylcellulose without preservatives, apply 1 drop every 1-2 hours to moisturize the exposed ocular surface
• Ointment of wool alcohols and neutral Vaseline — apply liberally to the lower conjunctival fornix before sleeping to provide nocturnal physical protection against desiccation
• Eye patch or moist night chamber (as a non-pharmacological physical barrier in severe paralytic cases). The decisive treatment is surgical (lateral tarsal strip, pentagonal wedge resection or skin grafts).