Case 25 Lower Eyelid Ectropion (Cicatricial)



Jason Chow and Michael E. Migliori

Case 25 Lower Eyelid Ectropion (Cicatricial)

Case 25 A 72-year-old male patient presents for evaluation of persistent tearing and ocular irritation of the left eye after Mohs surgery and reconstruction of the left lower eyelid.


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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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 25 Lower Eyelid Ectropion (Cicatricial)
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