Unilateral advanced glaucoma in isolated congenital ectropion uveae with ipsilateral ptosis: A pictorial description of five children.

Aim: To report the cases of five children with unilateral advanced glaucoma in isolated congenital ectropion uveae (CEU) with ipsilateral ptosis and myopia. Methods: This is an ambispective observational case series. After diagnosing one patient with CEU and glaucoma, consecutive patients presenting with unilateral ptosis, congenital iris anomaly, and glaucoma between 2014 to 2020, and had completed a minimum one-year postoperative follow-up, were analyzed. Results: Of the 1421 newly registered pediatric glaucoma patients in the period under review, five children were diagnosed with CEU. All patients presented with gradual painless diminution of vision in the left eye in early adolescence. The left eye of all patients had peculiar clinical features: mild congenital ptosis, high iris insertion, crypt-less smooth iris surface, congenital ectropion uveae, pigments over anterior lens capsule, high myopia, advanced glaucomatous optic disc cupping, and very high intraocular pressure (IOP), which was > 45 mmHg in all cases. The right eye showed signs of angle dysgenesis with mild anterior iris insertion and numerous fine iris processes. Antiglaucoma medications and angle surgery failed to control the IOP, and all children required glaucoma filtration surgery, resulting in reasonable IOP control. Despite the older age, postoperative strict amblyopia treatment resulted in significant improvement in vision. Conclusions: Although ectropion uveae and ptosis have been present since birth, unilaterality, and the asymptomatic nature of the disease led to the late presentation with irreversible damage. Early surgical management and amblyopia therapy are the cornerstones of management. Abbreviations: CEU = Congenital ectropion uvea, CIES = Congenital Iris Ectropion Syndrome, ASD = Anterior segment dysgenesis syndrome, BCVA = Best-corrected visual acuity, IOP = Intraocular pressure.

Laser therapy in the treatment of cicatricial ectropion.

INTRODUCTION: The objective of this study was to investigate the clinical effects of laser therapy in treating cicatricial ectropion. METHODS: Seven patients with cicatricial ectropion were entered into this clinical study. The ectropions were pretreated with the 595-nm pulsed dye laser if the scar color was red. If there was no red, the UltraPulse fractional CO2 laser was used and parameters were adapted according to the height of scar. MEBT/MEBO was used after laser treatment for wound healing. The degree of ectropion was measured for changes before and after treatment, and the scars were evaluated for changes in melanin, height, vascularity, and pliability using the Vancouver Scar Scale (VSS) before and after treatment. RESULTS: All seven patients with cicatricial ectropion entered into this protocol were completely corrected after 1-2 treatment sessions. The total VSS score, as well as the score for melanin and pliability in 7 patients, showed a decrease following the treatments, and this was statistically significant (P < 0.05). The scores for height and vascularity showed a decrease following the treatments, but there was no significant difference by statistical analysis (P ≥ 0.05). There were no adverse reactions reported. CONCLUSIONS: The treatment of cicatricial ectropion with laser therapy can not only correct the ectropion, but also improve the scars in the treatment area. Compared with the traditional repair of cicatricial ectropion, the use of fractional CO2 laser provides surgical precision and the advantage of a timely treatment without the need to wait for the scar to stabilize.

Congenital Bilateral Eyelid Eversion and Chemosis: A Case Study.

This case reports the findings and management of a late preterm female infant born with congenital bilateral eyelid eversion with chemosis. The pathogenic process remains unknown but typically presents at birth, predominantly affecting the upper eyelid of both eyes. Black males, patients with trisomy 21, and collodion infants have a higher incidence of eyelid eversion. Treatment modalities range from conservative therapy including eye patching with antibiotic and lubricating ointment to invasive surgical eyelid suturing. In this case report, successful resolution of chemosis and eyelid inversion occurred with conservative management.

Inverting sutures for tarsal ectropion (the leicester modified suture technique).

PURPOSE: To describe a simple technique to correct tarsal lower eyelid ectropion with or without marked eyelid laxity (The Leicester Modified Suture technique). METHODS: A retrospective interventional case series of patients undergoing correction of tarsal ectropion with inverting sutures. The study adhered to the principles of the Declaration of Helsinki. RESULTS: Twenty patients (25 eyelids) met the inclusion criteria. The success of the procedure was assessed by improvement of symptoms, eyelid position, and the need for reoperation. The mean postoperative follow up was 3.6 months (range 2-15 months). Eighteen patients (90%) had a successful outcome, while in 2 patients (10%) the outcome was satisfactory, as there was mild residual eversion of the eyelids. None of the patients required reoperation. CONCLUSIONS: Tarsal lower eyelid ectropion can be surgically challenging to correct via the transconjunctival plication or subciliary reattachment of retractors. This method is simple to use, resulting in an excellent outcome with no tissue dissection. This technique is easy to learn and implement for oculoplastic surgeons at all levels of experience.

[Use of topical cutaneous N-acetylcysteine in the treatment of major bilateral ectropion in an infant with lamellar ichthyosis]. / Utilisation de la N-acétylcystéine en application topique cutanée dans le traitement d'un ectropion bilatéral chez un enfant atteint d'ichthyose lamellaire.

PURPOSE: To report for the first time bilateral ectropion treatment in an infant with severe lamellar ichthyosis associating N-acetylcysteine applied directly to the skin and oral acitretin. METHODS: An 8-week-old male child with major bilateral ectropion due to lamellar ichthyosis was given treatment associating oral acitretin (Soriatane) and topical N-acetylcysteine. Though the precorneal tear film quality could be maintained, after 1 month of initial treatment with acitretin only, bilateral upper eyelid ectropion remained threatening for the child's cornea. The adjunction of topical N-acetylcysteine enabled a complete regression of ectropion. No complementary surgery was needed and the eyelids remained well positioned. CONCLUSION: Topical N-acetylcysteine has been proved to have an antiproliferative effect on keratinocytes in vitro and in vivo. It may be useful in the treatment of major forms of ectropion in children with lamellar ichthyosis. Its association with conventional acitretin treatment may prevent unnecessary surgery.

Lamellar ichthyosis

Lamellar ichthyosis is an inherited autosomal recessive disorder characterized by non-bullous erythroderma and scaling at birth. We report a patient born encased in a collodion membrane, who later developed generalized, brownish, plate-like scales, anhidrotic skin, scarring alopecia, bilateral ectropion, with a family history of similar-looking skin condition. Skin biopsy demonstrated marked lamellated orthohyperkeratosis and areas of hypergranulosis. Therapeutic trial of four topical agents (extravirgin coconut oil, urea lotion, mineral oil and petroleum jelly) was done which gave minimal improvement of scaling and dryness. Oral retinoids (Acitretin) was then initiated and yielded better results.

Piel y ojo / Skin and eye

Piel y ojo comparten un origen común a partir del neuroectodermo (en el ojo, estructurales pricilpalmente esclerocorneanas) (1). La similitud de los epitelios de superficie y de sitios pigmentarios, la contiguidad palpebroconjuntival, la exposición idéntica a microorganismos o alergenos y factores del medio ambiente, los mecanismos de defensa similares, y mecanismos autoinmunes (escleroconjuntiva y úvea), son factores que pueden explicar la patologías comunes, llevando a una sintomatología a la vez dermatológica y oftalmológica; así, enfermedades tales como neurofibromatosis, dermatosis bulosa, vasculitis, Behcet, dermatis atópica y rosácea, son ejemplos de patologías compartidas. El objetivo de esta revisión es definir y explicar cuándo el dermatólogo debe solicitar la evaluación de un oftalmologo

Anthrax as the cause of preseptal cellulitis and cicatricial ectropion.

A 54-year-old female farmer with anthrax infection of the eyelids is presented. She was initially managed with high dose intravenous penicillin G treatment. Following complete healing of the eyelid lesions, significant cicatricial ectropion resulted. Her right lower eyelid ectropion was corrected by surgical reconstruction using full thickness skin graft after a period of 6 months during which the cicatrization process stabilized. Satisfactory cosmetic and functional improvement was achieved. Anthrax of the eyelid must be considered in the differential diagnosis of preseptal or orbital cellulitis and any reconstructive procedure should be attempted only after the cessation of the healing process.

A CASE REPORT ON THE SURGICAL TREATMENT FOR THE ECTROPION AS A COMPLICATION OF RECONSTRUCTION OF BLOW-OUT FRACTURE

Ectropion is a drooping or eversion of the lower eyelid as a result of lower lid laxity, canthal tendon laxity, or cicatrix formation from scarring. Ectropion can also be congenital or develop with aging. This complication can arise from primary trauma to the lower lid apparatus or as a result of unfavorable healing and scar contracture. To prevent development of ectropion, a careful attention in case of operation for orbital frature repair or blepharoplasty is necessary. Especially, excessive dissection or retraction of skin and orbicularis muscle should be avoided, and formation of edema and hematoma should be prevented by complete hemostasis. It might be helpful to massage on the eyelid frequently. In spite of endeavors mentioned above, lareral canthoplasty or skin graft must be performed when postoperative ectropion is occurred. With literature review the authors present a case report that good clinical result is achieved by lateral tarsal strip procedure on cicatricial ectropion caused by a complication of reconstruction of blow-out fracture.

Rehabilitación oculopalpebral post-parálisis facial periférica por sección completa del tronco: colocación de implante de oro y kinesioterapia / Treatment of complete facial paralysis with early gold weight lid implant

La tarsorrafia fue el método alternativo para el tratamiento de las complicaciones post-lesión completa del nervio facial. El implante de una lámina de oro en el párpado permite obtener una solución funcional y cosmética a la falta de oclusión palpebral. Cuando la lesión lleva mucho tiempo de evolución, se suele agregar ectropion de párpado inferior que puede ser resuelto con la técnica de Kuhnt-Szymanovsky en el mismo momento quirúrgico en que se coloca el implante. En nuestra experiencia de 10 pacientes tratados desde Marzo del '93 a Diciembre del '96, hemos colocado en 9 de ellos el injerto de oro, en un caso corregido el ectropion quirúrgicamente y en otro solo se realizó kinesioterapia de rehabilitación (por negativa de la paciente a colocarse el implante quirúrgicamente). En todos realizamos kinesioterapia de rehabilitación precoz. Igual que otros autores, este es un método sencillo y eficaz, alternativo a la tarsorrafia

Rehabilitación oculopalpebral post-parálisis facial periférica por sección completa del tronco: colocación de implante de oro y kinesioterapia / Treatment of complete facial paralysis with early gold weight lid implant

La tarsorrafia fue el método alternativo para el tratamiento de las complicaciones post-lesión completa del nervio facial. El implante de una lámina de oro en el párpado permite obtener una solución funcional y cosmética a la falta de oclusión palpebral. Cuando la lesión lleva mucho tiempo de evolución, se suele agregar ectropion de párpado inferior que puede ser resuelto con la técnica de Kuhnt-Szymanovsky en el mismo momento quirúrgico en que se coloca el implante. En nuestra experiencia de 10 pacientes tratados desde Marzo del 93 a Diciembre del 96, hemos colocado en 9 de ellos el injerto de oro, en un caso corregido el ectropion quirúrgicamente y en otro solo se realizó kinesioterapia de rehabilitación (por negativa de la paciente a colocarse el implante quirúrgicamente). En todos realizamos kinesioterapia de rehabilitación precoz. Igual que otros autores, este es un método sencillo y eficaz, alternativo a la tarsorrafia (AU)

Low-dose methotrexate as an adjunctive therapy with surgery for ectropion complicating dermatomyositis.

We describe the clinical and histopathologic features of a 44-year-old woman who developed bilateral lower eyelid ectropion and upper lid entropion presumably secondary to dermatomyositis. A variety of inflammatory, infiltrative and/or scarring dermatoses have been associated with ectropion. Chronic inflammation, poikilodermatous change and mucinous infiltration of the eyelids due to dermatomyositis are the postulated mechanisms leading to ectropion in our patient. This case is unique in that neither dermatomyositis nor papular mucinosis has previously been reported as a cause of ectropion. Also interesting was the adjunctive effect of methotrexate therapy.

[Painless infiltration anesthesia in eyelid surgery. An intraindividual randomized prospective study]. / Schmerzarme Infiltrationsanästhesie in der Lidchirurgie. Eine intraindividuell randomisierte prospektive Studie.

BACKGROUND: Local anesthetic infiltration before lid surgery causes pain of varying degrees. To reduce the patient discomfort we have tested the effect of an initial injection of deluted anesthetic prior to the infiltration anesthesia. PATIENTS AND METHODS: During August 1993 and April 1994 thirteen patients, 21 to 81 years of age had bilateral lid surgery (4 female; 9 male). Two injection techniques were studied in disease patients intraindividually. Part of the local anesthetic was deluted 1:10 with saline and initially injected on one side only. Three minutes later infiltration with 2-5 ml of full-strength 2% mepivacaine with adrenaline 1:200,000 was performed on both sides. Obvious signs of pain were documented and patients were questioned about their discomfort (score 0-3). RESULTS: Five patients were operated for bilateral ectropium (lateral canthal sling procedure 4, Lazy-T 1), seven patients for dermatochalasis and one patient for brow ptosis. All thirteen patients ranked the technique with the initial injection of deluted local anesthetic significantly less painful. 9 of 13 patients had painless local anesthetic infiltration. Only 4 patients reported minor discomfort during injection of the diluted anesthetic. Onset time and duration of anesthesia was identical in both groups. CONCLUSION: The initial injection of a 1:10 diluted local anesthetic allows a significant reduction of pain during infiltration anesthesia before lidsurgical procedures. While pH buffering with bicarbonate may cause permanent skin pigmentation, dilution with physiological saline is an effective and inexpensive alternative. With this technique even in children local anesthesia becomes possible.

The prevention and treatment of lower lid ectropion following blepharoplasty.

Ectropion and scleral show are the most common complications following lower lid blepharoplasty. Certain conditions predispose patients to ectropion, and these should be evaluated. In some cases, the addition of a wedge tarsectomy or tarsal strip procedure to a blepharoplasty in association with careful technique and postoperative measures is important in prevention of postblepharoplasty ectropion. Postoperative ectropion should initially be treated conservatively with massage. This may be effective up to 6 months postoperatively. If conservative measures fail, the etiology of the ectropion should be addressed. Laxity of the tarsus and canthal ligaments benefit from a horizontal lid-shortening procedure. Where there is vertical shortening from excessive skin resection or scarring of the orbital septum, there should be release and grafting of the deficiency.

Nonsurgical management of postoperative cicatricial lower lid ectropion.

Two patients with postoperative cicatricial lower lid ectropion were managed by having the patient massage the lower lid in an upward direction over a methyl-methacrylate scleral ring. The ectropion was corrected. Such nonsurgical management may be attempted as an alternate initial therapy for the patient who refuses or should not immediately undergo additional surgery.