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Axial length linked to involutional eye lid malposition in patients with ectropion
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Axial globe length in patients with ectropion correlated with involutional eyelid malposition and may influence its onset, a study found.
“Involutional eyelid malposition directly correlates with axial globe length, with the ectropion group having lengthier eyes compared with the entropion group. Hence, axial globe length could be an influential factor in the onset of involutional eyelid malposition,” the study authors said.
The prospective study included 57 eyelids of 52 patients with symptomatic involutional lower eye lid malposition: 28 lids with ectropion and 29 with entropion.
Patients with secondary lower eye lid malposition related to cicatrix, mechanical or thyroid disorders were excluded.
The IOLMaster (Carl Zeiss Meditec) and Hertel’s exophthalmometer were used to obtain preoperative biometry measurements. Keratometry, cylinder length and cylinder axis were also assessed.
Mean axial globe length was 23.5 mm in the ectropion group and 22.7 mm in the entropion group; the difference was statistically significant (P = .008).
Entropion was significantly more common in women, and ectropion was more prevalent in men (P = .03). Results showed no significant differences in terms of age, keratometry, degree of astigmatism or cylinder axis.
Further study with a large patient sample is warranted, the authors said.
Perspective
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Julian D. Perry, MD
That axial globe length may help predict whether a horizontally unstable eyelid develops ectropion or entropion is not surprising, given its high correlation with axial globe projection, which has been previously reported. I do not believe that one factor ultimately determines which direction the eyelid will rotate. Each of the factors the authors discuss, including tarsus and orbicularis configuration, lower eyelid retraction, volume considerations, histopathologic changes, as well as axial globe length/projection, contribute differently for each individual patient. Importantly, entropion is a more dynamic process, while ectropion represents a more static one. I believe that fat compartment changes, such as deep fat atrophy and anterior fat herniation, contribute significantly in some patients. For a given patient, I attempt to order the above contributing factors and tailor the surgery to address each factor in graded fashion.
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