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Clinical assessment of retraction, ectropion key to surgical plan

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Andrew R. Harrison

WAILEA, Hawaii — Ectropion and lower eyelid retraction are clinically distinct entities that may coexist.

There are new surgical treatments for lower eyelid retraction and ectropion. Among them are transblepharoplasty canthopexy, skin grafting for cosmetic ectropion and retraction, and transconjunctival lower lid retraction repair. But first, a thorough clinical assessment is key to making the surgical plan, according to Andrew R. Harrison, MD.

The plan must be based on anatomic abnormalities, Harrison said at Hawaiian Eye 2018.

Whereas lower eyelid ectropion is an eversion of the eyelid margin, lower eyelid retraction is an abnormal downward displacement of the eyelid.

“You can have ectropion and retraction, especially in trauma and especially in post-blepharoplasty patients that make them very difficult to treat,” Harrison said.

Horizontal laxity is a key component of involutional ectropion, which is the most common type. In involutional retraction, there is horizontal laxity as well as midface descent, intact capsulopalpebral fascia and negative vector.

In cicatricial ectropion, which can be caused by trauma, burn, chronic dermatitis or excess excision or surface ablation, a shortened anterior lamella is the key component. Whereas in cicatricial lid retraction, horizontal laxity, orbicularis weakness and middle lamella scarring are features, he said.

In paralytic ectropion, loss of orbicularis tone is the key component, whereas in lid retraction caused by proptosis, lid shortening and tightening are seen.

“The problem with tightening patients with a proptotic eye is that you get this ‘belt under the beer belly’ where you push the eye forward and the lid pulls down lower,” Harrison said, so beware of lid shortening/tightening in this setting. – by Patricia Nale, ELS

Reference:

Source: Harrison A. Stop flipping out! Ectropion vs. retraction. Diagnosis and management. Presented at: Hawaiian Eye/Retina 2018; Jan. 13-19, 2018; Wailea, Hawaii.

Disclosure: Harrison reports no relevant financial disclosures.