Case 25 Lower Eyelid Ectropion (Cicatricial)
25.1 Description
Cicatricial ectropion of the left lower eyelid: Evidence of previous Mustarde flap
Scarring of the anterior lamella
Loss of apposition of the eyelid and lower punctum to the eye
Tearing of the lower eyelid and conjunctival injection
Right side with senile (involutional) ectropion and scleral show (see Chapter 26)
25.2 Work-Up
25.2.1 History
History of ocular irritation, conjunctival infection (eye redness), keratopathy, epiphora (excessive tearing), ocular trauma, eye or eyelid surgery, or facial paralysis
Past medical history: History of inflammatory/rheumatic conditions, dermatitis, zoster, skin malignancy, or eyedrops
History of eyelid or facial surgery
25.2.2 Physical Examination
Evaluate the lower eyelid and assess for sites of scarring
Assess the mobility and adequacy of the lower eyelid skin
Snap back test for eyelid laxity
Pull lower eyelid down and away from globe
Observe length of time to return to original position
Ectropion is significant if:
Eyelid does not immediately snap back
Eyelid does not return to original position
Careful examination of the eyelid margin to evaluate for blepharitis, rosacea, and any inflammatory etiologies
Also evaluate for signs of eyelid malignancy such as loss of eyelashes (madarosis)
Assess orbicularis oculi strength
Bell’s phenomenon (palpebral oculogyric reflex)
Ask patient to close eyes while holding eyelids open
Observe for upward and outward movement of eye upon eye closing
This reflex protects the cornea when the eyes are closed
Schirmer’s test (Dry eye test):
Tetracaine drops are applied in eyes for numbing
Filter paper is placed in inferior fornix and eyes are closed for 5 minutes
Normal >15 mm
Slit lamp examination with fluorescein to evaluate for corneal epithelial disease
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