The tarsal belt procedure for the correction of ectropion: description and outcome in 42 cases.

BACKGROUND/AIMS: Ectropion correction is a challenge in plastic surgery. Correction of the lower lid area, including restoration of the shape and position of lid margin, is the surgical goal. In this study, we describe a new surgical technique, the tarsal belt, for the correction of ectropion and evaluation of the effective outcome and complications of this procedure. METHODS: Between January 2008 and January 2012, a total of 42 patients aged between 48 and 75 years (average age 61.5 years) were treated with this technique. This procedure consists in a trans-tarsal mattress non-absorbable suture anchored to the periosteum of the lateral orbital rim, combined with a small wedge excision of a lateral portion of the tarsus close to the lateral canthal tendon. During the same period, 66 patients were treated with the standard lateral tarsal strip technique. Preoperative and postoperative Ectropion Grading Scale (EGS) was recorded to evaluate anatomical improvement. The average follow-up period was 24 months. RESULTS: Rate of success was 100% for involutional and cicatricial ectropions, 90% for lid retraction and 87.5% for paralytic ectropions. Anatomical success according to EGS scale was obtained in 41 patients. Recurrence of ectropion occurred in only one patient 6 months after the first surgery and required a further operation with a larger posterior lamella resection and new tarsal belt suture. CONCLUSIONS: The tarsal belt seems to be effective to correct the horizontal and vertical instability of the lid. The suture supports the lower eyelid along the entire tarsal plate length and corrects the outward buckling of the tarsal plate.

Lower eyelid suspension using polypropylene suture for the correction of punctal ectropion.

OBJECTIVE: To evaluate the efficacy and complications of lower eyelid suspension with the modified Safdarjung hospital technique using 5:0 polypropylene suture for punctal ectropion. STUDY DESIGN: Prospective case series. METHOD: Thirty one eyelids in 19 patients with mild and moderate ectropion and all types of laxity including involutional and paralytic were included. All patients underwent lower eyelid suspension with the modified Safdarjung hospital technique. A 5:0 polypropylene suture was passed in the pre-tarsal plane between the attachments of the lateral and medial canthal tendons near their insertion at the orbital rim. Successful outcome was judged by the anatomical restoration of the apposition of the punctum to the globe in the upward gaze and the physiological relief of epiphora. The recurrence of lid laxity, overall lid/globe apposition and complications were also noted. RESULTS: At 1 year follow up anatomical success was achieved in 28 (90%) patients and functional success noted in 27 (87%) patients. Recurrence of lid laxity was noted in 2 patients. There was a suture exposure in one case and a suture granuloma in another case. The results did not correlate to the degree of ectropion and type of laxity. CONCLUSION: Lower eyelid suspension using 5:0 polypropylene suture is a useful procedure for the treatment of involutional and paralytic punctal ectropion. It is simple and effective with minimal complications. However, the effect on scleral show and the concern related to suture material biodegradation over years needs to be further evaluated.

A bilateral cicatricial ectropion and bilateral upper lid shortening caused by 5-fluorouracil toxicity in a patient with dihydropyrimidine dehydrogenase deficiency.

CONTEXT: Well-known causes of a cicatrizing ectropion are chemical/thermal injuries, dermatitis, cutaneous diseases, malignancies, and trauma. We add to this preceding list a systemic cause of a cicatrizing ectropion as a result of a rare side effect of 5-fluorouracil (5-FU), a common and frequently used chemotherapeutic agent. METHODS: A case report demonstrating the clinical presentation of a cicatricial ectropion caused by (5-FU) chemotherapy toxicity in a patient with dihydropyrimidine dehydrogenase deficiency. We also describe the subsequent investigations and management of this case. RESULTS: A bilateral cicatrizing lower lid ectropion, bilateral upper lid shortening, cicatrizing and sclerosing facial skin changes occurred in an 80-year-old male, undergoing preoperative chemoradiotherapy, incorporating Capecitabine, an oral 5-FU prodrug for a locally advanced rectal carcinoma. Severe 5-FU toxicity ultimately proved fatal but in addition to typical 5-FU related adverse effects, the patient developed bilateral incomplete lid closure, secondary corneal exposure and keratopathy. Due to the patient's extreme ill health, he was managed conservatively with a moist chamber. CONCLUSION: 5-fluorouracil chemotherapy in patients with dihydropyrimidine dehydrogenase deficiency, can give rise to ocular and cutaneous toxicity. We also present the complex management problems that have to be anticipated in treating such systemically compromised patients.

[Eyelid ectropium prevalence and carriers characteristics in a population from the Center-Western region of São Paulo State]. / Prevalência do ectrópio palpebral e características dos portadores na população da região Centro-Oeste do Estado de São Paulo.

PURPOSE: To present the characteristics of individuals and the prevalence of ectropium eyelid in a random sample of the state of São Paulo, Brazil. METHODS: Data were collected during the Project on Prevention of Blindness, Faculty of Medicine of Botucatu - UNESP, a systematic random household sample was obtained. We evaluated 10,432 individuals, residents in 11 cities of the health regional located in the Central-Western region of the state of São Paulo. The results were submitted to statistical analysis to evaluate descriptive variables and the prevalence of ectropium eyelid. RESULTS: Seventy-one ectropium eyelid patients were detected, with an estimated prevalence of 0.68%. The prevalence was not similar in all the studied municipalities. Most people with ectropium eyelid presented age over 70 years and were male. Cataract was concurrently present in 28.0% of them. CONCLUSION: The prevalence of ectropium population in the Central-Western region of São Paulo state is 0.68%. The ectropium eyelid affect mainly male, over 70 years relating sun light exposition and with normal visual acuity.

Prevalência do ectrópio palpebral e características dos portadores na população da região Centro-Oeste do Estado de São Paulo / Eyelid ectropium prevalence and carriers characteristics in a population from the Center-Western region of São Paulo State

OBJETIVO: Apresentar as características dos portadores e a prevalência do ectrópio em uma amostra populacional aleatória do Estado de São Paulo, Brasil. MATERIAL E MÉTODOS: Os dados foram colhidos durante a realização do Projeto de Prevenção da Cegueira da Faculdade de Medicina de Botucatu-UNESP, com amostra domiciliar sistemática aleatória. Foram avaliados 10.432 indivíduos, residentes em 11 municípios da regional de saúde localizada na região Centro-Oeste do Estado de São Paulo. Os resultados obtidos foram submetidos a análise estatística para avaliação de variáveis descritivas e da prevalência do ectrópio palpebral. RESULTADOS: Foram detectados 71 portadores de ectrópio palpebral, com prevalência estimada de 0,68 por cento. A prevalência não foi semelhante nos Municípios estudados. A maioria dos portadores de ectrópio apresentava idade acima dos 70 anos e era do sexo masculino. Vinte e oito por cento dos portadores de ectrópio apresentavam catarata concomitantemente. CONCLUSÃO: A prevalência do ectrópio na população Centro-Oeste do Estado de São Paulo é de 0,68 por cento. O ectrópio palpebral ocorre mais frequentemente em homens, geralmente idosos, expostos ao sol, mais na pálpebra inferior e com acuidade visual corrigida normal.

PURPOSE: To present the characteristics of individuals and the prevalence of ectropium eyelid in a random sample of the state of São Paulo, Brazil. METHODS: Data were collected during the Project on Prevention of Blindness, Faculty of Medicine of Botucatu - UNESP, a systematic random household sample was obtained. We evaluated 10,432 individuals, residents in 11 cities of the health regional located in the Central-Western region of the state of São Paulo. The results were submitted to statistical analysis to evaluate descriptive variables and the prevalence of ectropium eyelid. RESULTS: Seventy-one ectropium eyelid patients were detected, with an estimated prevalence of 0.68 percent. The prevalence was not similar in all the studied municipalities. Most people with ectropium eyelid presented age over 70 years and were male. Cataract was concurrently present in 28.0 percent of them. CONCLUSION: The prevalence of ectropium population in the Central-Western region of São Paulo state is 0.68 percent. The ectropium eyelid affect mainly male, over 70 years relating sun light exposition and with normal visual acuity.

[Congenital ectropion: three case reports and literature review]. / Ectrópio congênito: relato de três casos e revisão de literatura.

To report 3 cases of congenital ectropion because of their rarity and confusing classification. Case 1: JPT, 2 days old, male, negro. Left upper eyelid eversion with chemosis was present, passive to mechanic reduction. Compressive occlusion was done with ectropion regression in 48 hours. Case 2: AJL, 6 years old, female, Caucasian, with Down syndrome. The left eye had hyperemia, lagophthalmos and inferior leucoma. She received horizontal shortening (superior and inferior tarsal strip) and skin grafts, and after 2 months the patient did not return. Case 3: GSD, 4 years old, male, Caucasian, with Down syndrome. His signs and treatment were the same as in case 2. According to Picó's classification the first case is classified as grade II due to eyelid eversion during the passage through the birth canal, more frequent in black people. Cases 2 and 3 represent grade III that is due to eyelid skin alteration, and the association with Down syndrome is observed. Treatment for ectropion grade III is always surgical, as it was done in these cases. We do not agree with Picó's classification, the only one found in medline, because there are no articles confirming the existence of grade I (absent tarsus), grade II should be called congenital upper eyelid eversion, grade IV (microphthalmos and orbital cyst) is a disease of the orbit. Grade III refers to true ectropion, because horizontal enlargement of superior and inferior eyelids (megaloblepharon).

Eyelid malposition: lower lid entropion and ectropion.

Correcting entropion and ectropion successfully requires knowledge of the eyelid problems, because understanding of these abnormalities is a key to planning a successful surgical procedure. Entropion is a condition in which the eyelid margin turns inwards against the globe. It is divided into following categories: congenital and acquired, which may be involutional or cicatricial. Ectropion is a malposition in which the lid falls away or is pulled away from its normal apposition to the globe. The condition is classified as congenital and acquired, which is divided into following categories: involutional, cicatricial, paralytic, and mechanical. Therefore, there are some common anatomic changes for both entropion and ectropion as well as specific changes that are unique to each eyelid malposition. Typically, instability of the eyelid is caused by either horizontal laxity or disinsertion or attenuation of the lower eyelid retractors to the inferior tarsal border, so surgical procedures should be directed at correcting the horizontal and vertical instability of the lid. Classification, etiology, underlying anatomic changes in the lid, principles of surgical treatment of entropion and ectropion are reviewed in this article.

[Primary congenital ectropion. Apropos of 2 cases]. / L'ectropion congénital primitif. A propos de 2 cas.

PURPOSE: Congenital lid ectropion is a rare anomaly. In the usual classification, primary ectropion caused by tightening of the anterior lamella may sometimes be confused with secondary ectropion, especially with blepharophimosis syndrome or euryblepharon. METHODS: Through analysis of two representative cases of congenital ectropion and review of literature we discuss similarities and differences between primary and secondary ectropion including blepharophimosis and euryblepharon. RESULTS: Horizontal narrowing of palpebral fissure and inversus epicanthal folds are the main clinical feature to be considered when differential diagnosis is difficult between primary forms and blepharophimosis, as ptosis is often an underlying abnormaly in both cases. CONCLUSION: To be effective, the surgical management of congenital lid ectropion requires precise clinical examination, clear understanding of causative factors and several procedures.

Congenital iris ectropion and a new classification for anterior segment dysgenesis.

Congenital iris ectropion has recently been added to the spectrum of neural-crest-derived anterior segment dysgenesis syndromes. Major features include a nonprogressive ectropion of the iris pigment epithelium, a glassy smooth cryptless iris surface, a high iris insertion, dysgenesis of the drainage angle, glaucoma, and in many cases, ipsilateral ptosis. Anterior segment dysgenesis syndromes have been subdivided into disorders of neural crest cell migration, proliferation, or differentiation. The congenital iris ectropion syndrome does not clearly fit into this classification. A new classification based on a theory of developmental arrest is presented which is more consistent with current knowledge of embryologic development and with recent clinical and histopathologic findings. The new classification links the congenital iris ectropion syndrome with the Axenfeld-Rieger spectrum but separates it from classic congenital glaucoma and the irido-corneal endothelial (ICE) syndromes. In addition, a histopathologically-supported etiologic theory for congenital iris ectropion is presented that supports the new classification.

Ectropio e entrópio: classificaçäo clínica e tratamento / Oftalmologia da doença de Graves / Ectropion and entropion: clinical classification and treatment

As diversas formas de apresentaçäo de 2 patologias freqüentes na clínica de oculoplástia (ectrópio e entrópio) säo aqui agrupadas e classificadas clinicamente, assim como as técnicas utilizadas na correçäo de cada caso especialmente. Ilustram ainda este trabalho pacientes atendidos no ambulatório de oculoplástica da Universidade Federal do Paraná e que tiveram suas patologias corrigidas segundo as técnicas aqui preconizadas