Case 26 Lower Eyelid Ectropion (Involutional and Paralytic)



Jason Chow and Michael E. Migliori

Case 26 Lower Eyelid Ectropion (Involutional and Paralytic)

Fig. 26.1 A 68-year-old male patient presents for evaluation of left eye irritation and persistent tearing.



26.1 Description




  • Sagging and eversion of the left lower eyelid margin



  • Loss of apposition of the eyelid and lower punctum to the eye



  • Tearing and some evidence of ocular irritation



26.2 Work-Up



26.2.1 History




  • History of ocular irritation, conjunctival irritation (eye redness), keratopathy, epiphora (excessive tearing), ocular trauma, eye or eyelid surgery, or facial paralysis



  • History of chronic eye irritation



26.2.2 Physical Examination




  • Evidence of sagging or eversion of the lower eyelid margin




    • Search findings to classify etiology of ectropion



    • Involutional, cicatricial, paralytic, mechanical



  • Evaluate lateral canthal tendon




    • Can be lax or detached



    • Occasionally associated with medial canthal tendon laxity and/or dehiscence or detachment of the lower eyelid retractors



  • Snap back test




    • Pull lower eyelid down and away from globe and observe length of time to return to original position



    • Ectropion is significant if the eyelid does not immediately snap back or does not return to original position



  • Eyelid distraction test




    • Laxity: Lower eyelid can be pulled away from the eye by more than 6 mm



  • Medial canthal laxity test




    • Pull lower eyelid laterally



    • Punctum should not move laterally by more than 1 mm



  • Lateral canthal laxity test




    • Pull lower eyelid medially



    • Lateral canthal angle should not move medially by more than 2 mm



  • 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 protects the cornea when the eyes are closed



  • 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 26 Lower Eyelid Ectropion (Involutional and Paralytic)

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