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Symptoms ⬇

Tearing, irritation, redness, and mucous discharge. May be asymptomatic.

Signs ⬆ ⬇

(See Figure 6.3.1.)

Critical

Outward turning of the eyelid margin.

Other

Superficial punctate keratopathy (SPK) from corneal exposure; conjunctival injection and thickening and eventual keratinization from chronic dryness. Eyelid scarring may be seen in cicatricial cases. Facial hemiparesis and lagophthalmos may be seen in paralytic cases.

6-3.1 Ectropion.

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Etiology ⬆ ⬇

  • Involutional: Horizontal eyelid laxity related to aging. Most common.
  • Paralytic: CN VII palsy.
  • Cicatricial: Anterior lamellar shortening from burn injury, prior surgery or trauma, actinic damage, chronic inflammation, skin diseases (e.g., eczema and ichthyosis), and others.
  • Mechanical: Due to herniated orbital fat, eyelid tumor, and others.
  • Allergic: Contact dermatitis.
  • Congenital: Facial dysmorphic syndromes (e.g., Treacher Collins syndrome), Down syndrome, or isolated abnormality.

Work Up ⬆ ⬇

Workup
  1. History: Previous surgery, trauma, chemical burn, or CN VII palsy?
  2. External examination: Check orbicularis oculi function and assess horizontal eyelid laxity and punctal location. Look for an eyelid tumor, scarring, herniated orbital fat, and so on. If there is concomitant CN VII palsy and CN VIII deficit (hearing loss), consider CT or MRI brain to rule out acoustic neuroma.
  3. Slit lamp examination: Evaluate for exposure keratopathy and conjunctival inflammation.

Treatment ⬆ ⬇

  1. Treat exposure keratopathy with lubricating agents. See 4.5, EXPOSURE KERATOPATHY.
  2. Treat an inflamed, exposed eyelid margin with warm compresses and antibiotic ointment (e.g., bacitracin or erythromycin q.i.d.). A short course of combination antibiotic–steroid ointment (e.g., neomycin/polymyxin B/dexamethasone) may be helpful if close follow up is ensured.
  3. Taping the eyelids into position may be a temporizing measure.
  4. Definitive treatment usually requires surgery. Surgery is delayed for 3 to 6 months in patients with CN VII palsy because the ectropion may resolve spontaneously (see 10.9, ISOLATED SEVENTH CRANIAL NERVE PALSY). Corneal exposure may make the repair more urgent.

Follow Up ⬆

Patients with corneal or conjunctival exposure are examined as needed based on the severity of signs and symptoms. If the tissues are relatively healthy, follow up is not urgent. Patients using topical steroids need to be followed up routinely for steroid-induced side effects.