Guidelines for preventing and slowing myopia progression in Brazilian children.

This document on myopia control is derived from a compilation of medical literature and the collective clinical expertise of an expert committee comprising members from the Brazilian Society of Pediatric Ophthalmology and the Brazilian Society of Contact Lenses and Cornea. To manage myopia in children, the committee recommends corneal topography and biannual visits with cycloplegic refraction, along with annual optical biometry. For fast-progressing myopia, biannual biometry should be considered. Myopic progression is defined as an annual increase in spherical equivalent greater than 0.50 D/year or in axial length greater than 0.3 mm (until 10 years old) or 0.2 mm (above 11 years). The proposed treatments for myopia progression include environmental control, low concentration atropine, defocus glasses, contact lenses, or Ortho-K lenses, and combinations of these methods may be necessary for uncontrolled cases. Treatment should be sustained for at least 2 years. This document serves as a comprehensive guideline for diagnosing, treating, and monitoring pre-myopic and myopic children in Brazil.

Reliability of the Mendonça Strabismus Forceps in Locating the Insertion of Extraocular Rectus Muscles in Patients Undergoing Strabismus Surgery.

PURPOSE: To evaluate the reliability of Mendonça strabismus forceps in locating the extraocular rectus muscles in patients undergoing primary strabismus surgery or reoperation. The study also compared the method's efficacy in primary surgeries versus reoperations. The overall goal was to avoid unnecessary surgical exploration, thereby enabling more effective planning and safer surgery. METHODS: The study included 41 patients with strabismus undergoing surgical correction. The reliability of the Mendonça strabismus forceps in locating the extraocular rectus muscles was evaluated by comparing preoperative measurements using Mendonça strabismus forceps and Castroviejo forceps to intraoperative measurements made by direct muscle visualization. Differences of 1 mm or less were deemed acceptable. RESULTS: In patients without prior surgery, Mendonça strabismus forceps reliably located all muscles, with measurements consistently within the 1-mm limit. All muscles with previous surgeries were successfully grasped by the forceps, except for one medial rectus muscle with multiple interventions. In reoperations with satisfactory muscle grasp, 88.8% showed coincident measurements. Non-coincidence cases were attributed to anomalous scarring. The method demonstrated simplicity, cost-effectiveness, and no complications in this study. CONCLUSIONS: The Mendonça strabismus forceps proved to be a reliable and non-invasive method for locating extraocular rectus muscles insertions without the need for additional imaging. It is a cost-effective, simple, and easily executed method that provides valuable information for surgical decision-making and planning. The method enhances surgical outcomes while reducing risks. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Guidelines for preventing and slowing myopia progression in Brazilian children / Diretrizes brasileiras para prevenir e retardar a progressão da miopia em crianças brasileiras

ABSTRACT This document on myopia control is derived from a compilation of medical literature and the collective clinical expertise of an expert committee comprising members from the Brazilian Society of Pediatric Ophthalmology and the Brazilian Society of Contact Lenses and Cornea. To manage myopia in children, the committee recommends corneal topography and biannual visits with cycloplegic refraction, along with annual optical biometry. For fast-progressing myopia, biannual biometry should be considered. Myopic progression is defined as an annual increase in spherical equivalent greater than 0.50 D/year or in axial length greater than 0.3 mm (until 10 years old) or 0.2 mm (above 11 years). The proposed treatments for myopia progression include environmental control, low concentration atropine, defocus glasses, contact lenses, or Ortho-K lenses, and combinations of these methods may be necessary for uncontrolled cases. Treatment should be sustained for at least 2 years. This document serves as a comprehensive guideline for diagnosing, treating, and monitoring pre-myopic and myopic children in Brazil.

RESUMO Esta revisão foi baseada na literatura médica e na experiência clínica de um comitê de especialistas membros da Sociedade Brasileira de Oftalmologia Pediátrica e da Sociedade Brasileira de Lentes de Contato e Córnea. Rotineiramente as crianças devem ser submetidas a topografia da córnea no primeiro exame e visitas semestrais com refração cicloplegiada e biometria óptica anual. A progressão da miopia foi definida como um aumento anual no equivalente esférico maior que 0,50 D/ano ou do comprimento axial maior que 0,3 mm (até 10 anos) ou 0,2 mm (mais de 11 anos). Os tratamentos propostos para a progressão são controle ambiental, atropina em baixa concentração, óculos com defocus, lentes de contato ou ortoceratologia, devendo-se considerar associações para casos não controlados. O tratamento deve ser realizado por pelo menos 2 anos. O presente documento é uma diretriz para diagnóstico, tratamento e acompanhamento de crianças pré-míopes e míopes no Brasil.

New Surgical Double Interlacing Technique for Correction of Sixth Cranial Nerve Palsy.

This interventional case series presents a novel surgical procedure involving double interlacing for the correction of esotropia in individuals with sixth cranial nerve palsy. The technique involves first splitting the tendons of the superior rectus, inferior rectus, and lateral rectus muscles. Subsequently, the superior half of the lateral rectus muscle is passed through the undisinserted superior rectus muscle, and the inferior half of the lateral rectus muscle is passed through the undisinserted inferior rectus muscle. Finally, the two halves of the lateral rectus muscle are sutured together and reattached at the original insertion point. The surgical outcomes demonstrate a significant improvement in alignment, abduction, and binocular vision. [J Pediatr Ophthalmol Strabismus. 2023;60(5):e58-e64.].

Brazilian guideline for pediatric cycloplegia and mydriasis / Diretrizes brasileiras para cicloplegia e midríase em crianças

ABSTRACT Cycloplegia is crucial for reliable pediatric ophthalmology examinations. This document provides a re­commendation for pediatric cycloplegia and mydriasis for Brazilian ophthalmologists. This article was developed based on literature reviews; the clinical experience of Brazilian specialists, as obtained through questionnaires; and the consensus of the Expert Committee of the Brazilian Pediatric Ophthalmology Society. According to the best evidence and formulations available in Brazil, this committee recommends the use of one drop of 1% cyclopentolate plus one drop of 1% tropicamide in children older than 6 months and two drops of 1% tropicamide 0-5 minutes apart for those younger than 6 months. Mydriasis may be increased by a single drop of 2.5% phenylephrine. For retinopathy of prematurity screening, the recommendation is 0.5% or 1% tropicamide, administered two or three times, 5 minutes apart, and 2.5% phenylephrine, used preferably once. In all scenarios, we recommend the use of a prior drop of 0.5% proxymetacaine.

RESUMO A cicloplegia é crucial para um exame oftalmológico pediátrico acurado. Este documento visa a fornecer uma recomendação para cicloplegia e midríase pediátrica para oftalmologistas brasileiros. Foi desenvolvido com base em revisão literária, na experiência clínica de especialistas brasileiros, por meio de questionários, e no consenso do comitê de especialistas da Sociedade Brasileira de Oftalmologia Pediátrica (SBOP). De acordo com as melhores evidências, este comitê recomenda o uso de uma gota de ciclopentolato 1%, mais uma gota de tropicamida 1% em crianças maiores de 6 meses e duas gotas de tropicamida 1% com intervalo de 0-5 minutos para menores de 6 meses. A midríase pode ser potencializada por uma gota de fenilefrina 2,5%. Para o rastreamento da retinopatia da prematuridade, a recomendação é tropicamida 0,5 ou 1%, duas ou três vezes, com 5 minutos de intervalo, e 2,5% de fenilefrina, preferencialmente uma vez. O uso prévio de proxymetacaína 0,5% é sempre recomendado.

Current practices and profiles of ophthalmologists involved in retinopathy of prematurity care in Brazil.

Retinopathy of prematurity (ROP) care in Brazil varies in availability of resources and infrastructure. A cross-sectional survey was conducted among ophthalmologists of the Brazilian ROP Group (BRA-ROP) to assess the profiles and practices of ophthalmologists involved in ROP care. A total of 78 responses of BRA-ROP participants (79%) were included. Participants were mostly retina experts (64.1%), female (65.4%), and over 40 years of age (60.2%). Eighty-six percent reported following Brazil's ROP screening criteria. Retinal imaging is available to 16.9% of respondents; fluorescein angiography, to 1.4%. For ROP stage 3 zone II (with plus disease), laser treatment was the preferred treatment (78.9%); for aggressive ROP, anti-VEGF was favored (66.2%). There were significant regional differences in treatment choice. Not all respondents continued to follow treated patients after discharge from the neonatal intensive care unit, highlighting an aspect of ROP care in need of improvement.

Brazilian guideline for pediatric cycloplegia and mydriasis.

Cycloplegia is crucial for reliable pediatric ophthalmology examinations. This document provides a re-commendation for pediatric cycloplegia and mydriasis for Brazilian ophthalmologists. This article was developed based on literature reviews; the clinical experience of Brazilian specialists, as obtained through questionnaires; and the consensus of the Expert Committee of the Brazilian Pediatric Ophthalmology Society. According to the best evidence and formulations available in Brazil, this committee recommends the use of one drop of 1% cyclopentolate plus one drop of 1% tropicamide in children older than 6 months and two drops of 1% tropicamide 0-5 minutes apart for those younger than 6 months. Mydriasis may be increased by a single drop of 2.5% phenylephrine. For retinopathy of prematurity screening, the recommendation is 0.5% or 1% tropicamide, administered two or three times, 5 minutes apart, and 2.5% phenylephrine, used preferably once. In all scenarios, we recommend the use of a prior drop of 0.5% proxymetacaine.

Brazilian guidelines for the monitoring and treatment of pediatric allergic conjunctivitis / Diretrizes brasileiras sobre o monitoramento e tratamento da conjuntivite alérgica pediátrica

ABSTRACT Allergic conjunctivitis is an increasingly frequent condition with a higher prevalence in children. It can be debilitating and is responsible for a great economic burden. These guidelines were developed on the basis of the medical literature (PubMed/Medline database) and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology, the Brazilian Council of Ophthalmology, the Brazilian Society of Pediatrics, and the Brazilian Association of Allergy and Immunology. Allergic conjunctivitis is considered to be controlled when the ocular symptoms are not uncomfortable or are present, at most, on 2 days a week; the visual analog scale score is below 5; and the degree of conjunctival hyperemia is graded 0 or 1 on the Efron scale. Allergic conjunctivitis should be classified as mild, moderate, severe, and vision-threatening for adequate treatment and monitoring of frequency. The present document is a guideline for diagnosing, treating, and monitoring pediatric allergic conjunctivitis considering the clinical and demographic aspects of allergic conditions in Brazil.

RESUMO A conjuntivite alérgica (CA) é uma condição frequente, debilitante e responsável por grande impacto econômico, proporcionalmente maior quando acomete crianças. Essas diretrizes foram desenvolvidas com base na literatura científica (PubMed/Medline) e na experiência de um Comitê de Especialistas composto por membros da Sociedade Brasileira de Oftalmologia Pediátrica, do Conselho Brasileiro de Oftalmologia, da Sociedade Brasileira de Pediatria e da Associação Brasileira de Alergia e Imunologia. A conjuntivite alérgica é considerada controlada quando os sintomas não são desconfortáveis ou estão presentes por dois dias na semana; o escore visual pela escala analógica é inferior a 5 e o grau de hiperemia conjuntival é de 0-1 pela escala de Efron. A conjuntivite alérgica deve ser classificada em leve, moderada, grave e com risco de perda visual para tratamento e frequência de monitoramento adequados. Esta diretriz orienta o diagnóstico, tratamento e monitoramento da conjuntivite alérgica pediátrica, considerando aspectos clínicos e demográficos das condições alérgicas no Brasil.

New Surgical Interlacing Technique for Correction of Highly Myopic Strabismus.

This interventional case series describes a new surgical interlacing procedure for esotropia correction in patients with high myopia. The technique consists of superior and lateral rectus tendon splitting, lateral rectus superior half passage within the undisinserted superior rectus muscle, and its reattachment at the original insertion. Surgical results showed marked improvement in alignment and abduction. [J Pediatr Ophthalmol Strabismus. 2022;59(1):e1-e6.].

Brazilian guidelines for the monitoring and treatment of pediatric allergic conjunctivitis.

Allergic conjunctivitis is an increasingly frequent condition with a higher prevalence in children. It can be debilitating and is responsible for a great economic burden. These guidelines were developed on the basis of the medical literature (PubMed/Medline database) and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology, the Brazilian Council of Ophthalmology, the Brazilian Society of Pediatrics, and the Brazilian Association of Allergy and Immunology. Allergic conjunctivitis is considered to be controlled when the ocular symptoms are not uncomfortable or are present, at most, on 2 days a week; the visual analog scale score is below 5; and the degree of conjunctival hyperemia is graded 0 or 1 on the Efron scale. Allergic conjunctivitis should be classified as mild, moderate, severe, and vision-threatening for adequate treatment and monitoring of frequency. The present document is a guideline for diagnosing, treating, and monitoring pediatric allergic conjunctivitis considering the clinical and demographic aspects of allergic conditions in Brazil.

Brazilian guidelines on the frequency of ophthalmic assessment and recommended examinations in healthy children younger than 5 years / Diretrizes brasileiras sobre avaliação oftalmológica de crianças saudáveis menores de 5 anos: exames recomendados e frequência

ABSTRACT Purpose: To provide guidance on the frequency and components of eye examinations for healthy children aged 0 to 5 years. Methods: These guidelines were developed based on the medical literature and clinical experience of an expert committee. PubMed/Medline searches were performed, with selected publications not restricted to systematic reviews, randomized controlled trials, or observational studies. The Grading of Recommendations Assessment, Development, and Evaluation profile was applied when suitable, and for issues without scientific evidence, recommendations were based on expert consensus. Recommendations by the American Academy of Pediatrics, American Association of Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, Royal College of Ophthalmologists, and Canadian Ophthalmological Society were also reviewed. The final guideline document was approved by the Brazilian Pediatric Ophthalmology Society and by the Brazilian Pediatric Society. Results: Newborns must undergo the red reflex test and inspection of the eyes and adnexa by a pediatrician within 72 hours of life. The red reflex test should be repeated by the pediatrician during childcare consultations at least three times per year during the first 3 years of life. If feasible, a comprehensive ophthalmologic examination may be performed between 6 and 12 months of age. Until 36 months of age, the pediatrician should assess the infant's visual development milestones, age-appropriate assessment of visual function, ocular fixation, and eye alignment. At least one comprehensive ophthalmologic examination should be performed at 3 to 5 years of age. The examination should minimally include inspection of the eyes and adnexa, age-appropriate visual function assessment, evaluations of ocular motility and alignment (cover tests), cycloplegic refraction, and dilated fundus. Conclusions: Guidelines concerning the frequency of ophthalmic assessment are important tools for directing physicians regarding best practices that avoid treatable vision problems that affect children's development, school, and social performance and cause unnecessary permanent vision loss.

RESUMO Objetivo: Fornecer orientações sobre a frequência e os componentes dos exames oftalmológicos para crianças saudáveis de 0 a 5 anos. Métodos: Essas diretrizes foram desenvolvidas com base em revisão bibliográfica e experiência clínica de um comitê de especialistas. Foram realizadas buscas PubMed/Medline; documentos selecionados não se restringiram a revisões sistemáticas, ensaios clínicos randomizados e estudos observacionais. Quando adequado, o perfil GRADE foi aplicado para graduá-los e o consenso de especialistas foi usado nos tópicos sem evidência científica. Também foram revisadas as recomendações pela Academia Americana de Pediatria, Associação Americana de Oftalmologia Pediátrica e Estrabismo, Academia Americana de Oftalmologia, Royal College of Ophthalmologist e Sociedade Canadense de Oftalmologia. O documento final foi aprovado pela Sociedade Brasileira de Oftalmologia Pediátrica e Sociedade Brasileira de Pediatria. Resultados: Os recém-nascidos devem ser submetidos ao teste do reflexo vermelho e inspeção dos olhos e anexos pelo pediatra dentro de 72 horas de vida ou antes da alta da maternidade. O teste do reflexo vermelho deve ser repetido pelo pediatra durante as consultas de puericultura pelo menos três vezes ao ano durante os primeiros 3 anos de vida. Se factível, um exame oftalmológico completo pode ser feito entre 6 a 12 meses de vida. Até os 36 meses de idade, os marcos visuais, função visual apropriada para a idade, fixação e alinhamento ocular também devem ser avaliados pelo pediatra ou médico da família. Pelo menos um exame oftalmológico completo deve ser realizados entre 3 e 5 anos de idade. O exame deve conter pelo menos inspeção dos olhos e anexos, avaliação da função visual apropriada para a idade, avaliação da motilidade e alinhamento ocular (testes de cobertura), refração sob cicloplegia e avaliação do fundo de olho dilatado. Conclusões: As diretrizes sobre a frequência da avaliação oftalmológica são ferramentas importantes para orientar os médicos sobre a melhor prática a fim de evitar problemas visuais tratáveis na infância, que poderiam comprometer seu desenvolvimento social, escolar e global, além de causar perda permanente da visão.

Brazilian guidelines on the frequency of ophthalmic assessment and recommended examinations in healthy children younger than 5 years.

PURPOSE: To provide guidance on the frequency and components of eye examinations for healthy children aged 0 to 5 years. METHODS: These guidelines were developed based on the medical literature and clinical experience of an expert committee. PubMed/Medline searches were performed, with selected publications not restricted to systematic reviews, randomized controlled trials, or observational studies. The Grading of Recommendations Assessment, Development, and Evaluation profile was applied when suitable, and for issues without scientific evidence, recommendations were based on expert consensus. Recommendations by the American Academy of Pediatrics, American Association of Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, Royal College of Ophthalmologists, and Canadian Ophthalmological Society were also reviewed. The final guideline document was approved by the Brazilian Pediatric Ophthalmology Society and by the Brazilian Pediatric Society. RESULTS: Newborns must undergo the red reflex test and inspection of the eyes and adnexa by a pediatrician within 72 hours of life. The red reflex test should be repeated by the pediatrician during childcare consultations at least three times per year during the first 3 years of life. If feasible, a comprehensive ophthalmologic examination may be performed between 6 and 12 months of age. Until 36 months of age, the pediatrician should assess the infant's visual development milestones, age-appropriate assessment of visual function, ocular fixation, and eye alignment. At least one comprehensive ophthalmologic examination should be performed at 3 to 5 years of age. The examination should minimally include inspection of the eyes and adnexa, age-appropriate visual function assessment, evaluations of ocular motility and alignment (cover tests), cycloplegic refraction, and dilated fundus. CONCLUSIONS: Guidelines concerning the frequency of ophthalmic assessment are important tools for directing physicians regarding best practices that avoid treatable vision problems that affect children's development, school, and social performance and cause unnecessary permanent vision loss.

Upper Eyelid Necrosis Secondary to Hordeolum: A Case Report.

We reported a case of upper eyelid necrosis initially misdiagnosed as a preseptal cellulitis following a hordeolum externum resulting in great damage to the upper eyelid (anterior lamella). The infection was successfully treated with surgical cleansing, drainage, and endovenous antibiotics. Early treatment may avoid severe complications such as eyelid deformity, systemic involvement, and blindness.

Autoimmune Retinopathy, Testing, and Its Controversies.

Purpose of review: The purpose of this revision is to sumarize the most important clinical features of the autoimune retinopathies (AIRs). Recent findings: AIRs are a group of inflammatory conditions affecting the retina characterized by progressive unexplained visual loss, abnormalities and contraction in visual fields, photoreceptor and electroretinographic dysfunction, and the presence of circulating anti-retinal antibodies. The pathogenesis of AIR remains unclear and various antiretinal antibodies have been associated to the disease. The diagnosis of AIR is based on a particular clinical presentation along with the detection of serum antiretinal antibodies. Numerous anti-inflammatory therapeutic alternatives have been described for the treatment of AIR, nevertheless there is no consensus on treatment protocol. Summary: Because of its association with different types of malignant tumors, the early diagnosis, multi-disciplinary approach and prompt treatment should be warranted.

Extensive bulbar conjunctival Kaposi's sarcoma as initial symptom of human immunodeficiency virus / Sarcoma de Kaposi extenso na conjuntival bulbar como apresentação inicial do vírus da imunodeficiência humana

ABSTRACT Here, we present a case in which extensive bulbar conjunctival Kaposi's sarcoma was the initial presentation of human immunodeficiency virus in a 36-year-old man. The patient had a 3-month history of recurrent self-limited inferior conjunctiva hyperemia in the right eye, and presented with a painless bullous lesion in the right inferior bulbar conjunctiva persisting for 15 days. Surgical incision biopsy was performed at five locations and revealed a pattern compatible with Kaposi's sarcoma. Serologic testing was positive for human immunodeficiency virus; however, the patient had no other symptoms, or knowledge of human immunodeficiency virus infection. This case highlights the need to consider Kaposi's sarcoma as an early presentation of human immunodeficiency virus even if the patient denies infection.

RESUMO Este relato de caso apresenta um sarcoma de Kaposi extenso na conjuntival bulbar como a apresentação inicial do vírus da imunodeficiência humana em um homem de 36 anos de idade. O paciente tinha história de hiperemia na conjuntiva inferior do olho direito há 3 meses, autolimitada e recorrente e de surgimento de uma lesão bolhosa indolor no mesmo local 15 dias antes da sua apresentação. Uma biópsia incisional cirúrgica foi realizada e revelou um padrão compatível com sarcoma de Kaposi. Teste sorológico posterior revelou positividade para o vírus da imunodeficiência humana, no entanto, o paciente não apresentou outros sintomas, sinais ou conhecimento prévio sobre a infecção. Como conclusão deste caso, deve se ressaltar que a suspeita do diagnóstico do sarcoma de Kaposi deve ser levantada ainda que na apresentação inicial do vírus da imunodeficiência humana ou mesmo naqueles ainda sem este diagnóstico.

Extensive bulbar conjunctival Kaposi's sarcoma as initial symptom of human immunodeficiency virus.

Here, we present a case in which extensive bulbar conjunctival Kaposi's sarcoma was the initial presentation of human immunodeficiency virus in a 36-year-old man. The patient had a 3-month history of recurrent self-limited inferior conjunctiva hyperemia in the right eye, and presented with a painless bullous lesion in the right inferior bulbar conjunctiva persisting for 15 days. Surgical incision biopsy was performed at five locations and revealed a pattern compatible with Kaposi's sarcoma. Serologic testing was positive for human immunodeficiency virus; however, the patient had no other symptoms, or knowledge of human immunodeficiency virus infection. This case highlights the need to consider Kaposi's sarcoma as an early presentation of human immunodeficiency virus even if the patient denies infection.

Diseases, conditions, and drugs associated with cicatricial ectropion / Doenças, condições e drogas associadas ao ectrópio cicatricial

ABSTRACT Cicatricial ectropion may be a consequence of certain systemic diseases as well as the result of drug use. Our goal here was to research the different causes of this condition as reported in the literature, including more recently suspected etiologies. A detailed PubMed literature search indicated many different etiologies were associated with cicatricial ectropion development, from severe cases of systemic diseases, such as ichthyosis and lupus erythematosus, to reversible scenarios secondary to anti-glaucomatous drug use. More recently reported connections include periorbital necrotizing fasciitis, frontal osteomyelitis, and antineoplastic agents. Indeed, cicatricial ectropion may be highly symptomatic; being able to determine its real etiology is imperative to managing patients properly. In this investigation, we felt that an explicitly multidisciplinary approach was essential, especially for cases associated with systemic conditions.

RESUMO O ectrópio cicatricial pode ser uma consequência de certas doenças sistêmicas, bem como o resultado do uso de drogas. Nosso objetivo aqui foi pesquisar as diferentes causas desta condição, conforme relatado na literatura, incluindo mais recentemente suspeitas de etiologias. Uma pesquisa bibliográfica detalhada do PubMed indicou que muitas etiologias diferentes estavam associadas ao desenvolvimento do ectrópio cicatricial, desde casos graves de doenças sistêmicas, como ictiose e lúpus eritematoso, até cenários reversíveis secundários ao uso de drogas antiglaucomatosas. Conexões relatadas mais recentemente incluem fasceíte necrosante periorbitária, osteomielite frontal e agentes antineoplásicos. De fato, o ectrópio cicatricial pode ser altamente sintomático; ser capaz de determinar sua etiologia real é imperativo para o manejo adequado dos pacientes. Nesta investigação, sentimos que uma abordagem explicitamente multidisciplinar era essencial, especialmente para casos associados a doenças sistêmicas.

Diseases, conditions, and drugs associated with cicatricial ectropion.

Cicatricial ectropion may be a consequence of certain systemic diseases as well as the result of drug use. Our goal here was to research the different causes of this condition as reported in the literature, including more recently suspected etiologies. A detailed PubMed literature search indicated many different etiologies were associated with cicatricial ectropion development, from severe cases of systemic diseases, such as ichthyosis and lupus erythematosus, to reversible scenarios secondary to anti-glaucomatous drug use. More recently reported connections include periorbital necrotizing fasciitis, frontal osteomyelitis, and antineoplastic agents. Indeed, cicatricial ectropion may be highly symptomatic; being able to determine its real etiology is imperative to managing patients properly. In this investigation, we felt that an explicitly multidisciplinary approach was essential, especially for cases associated with systemic conditions.