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Entropion/Ectropion Elizabeth J. Rosen, MD Karen H. Calhoun, MD 1/17/02 Eyelid Anatomy Eyelid Anatomy Tarsal plates Length 25mm Thickness 1mm Height Upper 10mm Lower 4mm Eyelid Anatomy Orbicularis Oculi Orbital Palpebral Preseptal Pretarsal Eyelid Anatomy Medial canthal tendon Anterior reflection Posterior reflection Vertical fascial support Eyelid Anatomy Lateral canthal tendon Lateral retinaculum Eyelid Anatomy Orbital septum Origin Arcus marginalis Insertion Medial: posterior lacrimal crest Lateral: orbital tubercle Superior: levator aponeurosis Inferior: inferior tarsal border Eyelid Anatomy Upper lid levators Levator palpebrae superioris Whitnall’s ligament Muller’s muscle Eyelid Anatomy Lower lid retractors Capsulopalpebral fascia Lockwood’s ligament Inferior palpebral muscle Eyelid Anatomy Lacrimal apparatus Gland Punctum Canaliculus Sac Duct Entropion Congenital Hypertrophy of pretarsal orbicularis Deficiency or absence of tarsal plate Dehiscence of eyelid retractors Involutional (senile) Loss of orbital volume—enopthalmos Upward migration of preseptal orbicularis Laxity or dehiscence of eyelid retractors Thinning of tarsal plate Cicatricial Shortening of internal lamella Entropion Congenital Entropion Extremely rare Inversion of entire tarsus and lid margin Horizontal tarsal kink Epiblepharon In-rolling of lid margin and lashes over superior tarsal edge More common; bilateral Lack of adhesion between lid retractors and anterior lamella Entropion Correction of congenital entropion or epiblepharon Observation Eyelid taping Suture correction--Snellen Excision of redundant tissue Entropion Correction of involutional entropion Temporary taping Suture correction—Snellen Surgical techniques Horizontal laxity— enopthalmos, tarsal thinning Laxity of eyelid retractors Vertical mobility preseptal orbicularis Entropion Correction of involutional entropion Horizontal tightening Entropion Correction of involutional entropion Horizontal shortening— modified Bick procedure Entropion Correction of involutional entropion Weis procedure Full-thickness horizontal lid incision Entropion Correction of involutional entropion Quickert procedure Combination of horizontal tightening and Weis procedure Entropion Correction of involutional entropion Inferior retractor plication Entropion Correction of involutional entropion Orbicularis fixation Beyer modification of Hill procedure Wheeler orbicularis transplantation Entropion Correction of cicatricial entropion Wedge excision of tarsal plate Entropion Correction of cicatricial entropion Marginal incision and grafting Entropion Correction of cicatricial entropion Tarsal fracture and margin rotation—Tenzel procedure Entropion Correction of cicatricial entropion Posterior lamella grafting Conchal cartilage Nasal chondromucosa Palatal mucoperichondrium Buccal mucosa Tarsoconjunctival composite graft Ectropion Congenital Insufficient anterior lamella Decreased tarsal rigidity Poor development of canthal tendons Cicatricial Involutional Paralytic Orbicularis denervation Widened palpebral fissure Lagopthalmos Contraction of anterior lamella Laxity of tarsoligamentous sling Generalized loss of elastin Orbicularis atrophy Ectropion Congenital Rare Association with other anomalies Euryblepharon Blepharophimosis Correction of congenital ectropion Horizontal lid tightening/shortening Grafting of anterior lamella Ectropion Paralytic ectropion Correction of paralytic ectropion Tarsorrhaphy Ectropion Correction of paralytic ectropion Horizontal lid tightening Ectropion Correction of paralytic ectropion Fascial sling Ectropion Correction of cicatricial ectropion Horizontal tightening Fascial sling Full thickness skin graft Ectropion Correction of cicatricial ectropion Horizontal tightening Fascial sling Full thickness skin graft Transposition graft Ectropion Correction of cicatricial ectropion Horizontal tightening Fascial sling Full thickness skin graft Transposition graft Split level graft Ectropion Correction of involutional ectropion Transverse blepharotomy and rotational sutures Ectropion Correction of involutional ectropion Cathopexy Ectropion Correction of involutional ectropion Lateral Tarsal Strip Ectropion Correction of involutional ectropion Horizontal lid tightening/shortening Medial Ectropion Correction of involutional ectropion Horizontal lid tightening/shortening Lateral Ectropion Correction of involutional ectropion Horizontal lid tightening/shortening Both