Oculoplastics


 

Ectropion

Ectropion means that the lower eyelid is “rolled out” away from the eye, or is sagging away from the eye. The sagging lower eyelid leaves the eye exposed and dry. If ectropion is not treated, the condition can lead to chronic tearing, eye irritation, redness, pain, a gritty feeling, crusting of the eyelid, mucous discharge, and breakdown of the cornea due to exposure.

What Causes Ectropion? 

Generally, the condition is the result of tissue relaxation associated with aging, although it may also occur as a result of facial nerve paralysis (due to Bell’s palsy,stroke or other neurologic conditions), trauma, scarring, previous surgeries or skin cancer.

What Are The Symptoms? 

The wet, inner, conjunctival surface is exposed and visible. Normally, the upper and lower eyelids close tightly, protecting the eye from damage and preventing tear evaporation. If the edge of one eyelid turns outward, the two eyelids cannot meet properly and tears are not spread evenly over the eye. Symptoms may include excessive tearing, chronic irritation, redness, pain, a gritty feeling, crusting of the eyelid and mucous discharge.
Ectropion. A patient with involutional ectropion of the left lower eyelid.

Keratinization of the palpebral conjunctiva is present.

Ectropion: repair of the turning out of the lower eyelid

Ectropion can be repaired surgically. Most patients experience immediate resolution of the problem once the surgery is completed with little if any, post-operative discomfort. After your eyelid heals, your eye will feel comfortable and be protected from corneal scarring, infection, and loss of vision.

Entropion

Entropion is a malposition resulting in inversion of the eyelid margin. The morbidity of the condition is a result of ocular surface irritation and damage. Successful management of this condition depends on appropriate classification and a procedural choice that adequately addresses the underlying abnormality.

Multiple surgical procedures have been described for the management of entropion. The procedure chosen must be appropriate for the class of entropion being treated. The most common procedures utilized in the management are discussed below.

Temporizing Quickert-Rathbun sutures

They are effective for many cases of spastic entropion, as well as for some cases of involutional entropion in which the patient refuses or is medically unable to undergo more definitive procedures.

Full-thickness eyelid sutures (usually gut suture) from the inferior fornix anteriorly toward the lashes are used to torque the eyelid margin away from the globe. Tissue reaction to the gut suture helps to create a cicatrix in the eyelid that maintains the eyelid in the everted position.

Repair of involutional entropion

It may require repair of the horizontal laxity via medial and/or lateral canthal tightening.

The vertical component is best repaired by vertically shortening or reattaching the lower eyelid retractors to the inferior border of the tarsus via a lower eyelid transcutaneous approach.

A small amount of the pretarsal orbicularis oculi can be resected concurrently to prevent further overriding of the tarsus.

Procedures for the repair of cicatricial entropion
They will depend on the degree of scarring and entropion, the etiology of the cicatricial changes, and the status of the tarsal plate.

Mild cases can be treated with a transverse blepharotomy with marginal rotation (Wies procedure).

More extensive scarring may require oral mucous membrane (eg, buccal mucosa) or cadaveric dermis (eg, Alloderm) grafts.

It is important that the inflammatory process is in a quiescent state in OCP patients prior to any procedure that violates the conjunctiva. Any manipulation of the conjunctiva in these patients may cause a recurrence of inflammation with failure of the procedure.

Assess the status of the tarsal plate in all cases of cicatricial entropion. If it is distorted, place a facsimile of tarsus following excision of the distorted portions of the tarsal plate. Materials such as autologous tarsus, hard palate grafts, and chondromucosal grafts have been used successfully for this purpose.

Blepharoplasty

Blepharoplasty (BLEF-uh-roe-plas-tee) includes surgery to repair droopy eyelids that may involve removing excess skin, muscle and fat.

As you age, your eyelids stretch, and the muscles supporting them weaken. As a result, excess fat may gather above and below your eyelids, causing sagging eyebrows, droopy upper lids and bags under your eyes.


Besides making you look older, severely sagging skin around your eyes can reduce your side vision (peripheral vision), especially the upper and outer parts of your field of vision. Blepharoplasty can reduce or eliminate these vision problems and make your eyes appear younger and more alert.

Blepharoplasty is usually done on an outpatient basis. To help decide if blepharoplasty is right for you, find out what you can realistically expect and explore the benefits and risks of blepharoplasty.

Location
Hawaii Vision Specialists
76 Kalanianaole Avenue
Hilo, HI 96720
Phone: 808-333-3233
Fax: 808-315-7663
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808-333-3233