|LETTER TO EDITOR
|Year : 2006 | Volume
| Issue : 3 | Page : 212-214
Acute idiopathic bilateral lower lid ectropion
Bhaskar Gupta1, Bina Parmar2, Jyoti Raina1, JS Chawla2
1 North Middlesex University Hospital, London, United Kingdom
2 Harold Wood Hospital,Romford, Essex RM3 0BE, United Kingdom
Ophthalmology Department, North Middlesex University Hospital, Sterling Way, London N18 1QX
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta B, Parmar B, Raina J, Chawla J S. Acute idiopathic bilateral lower lid ectropion. Indian J Ophthalmol 2006;54:212-4
A 46-year-old gentleman of African origin presented to our hospital with complaints of sudden onset of red eyes, the right eye worse than left. He gave no history of other associated ocular or systemic conditions. A year ago, he had one episode of non-granulomatous iritis in the right eye, which responded well to topical steroids. The past medical and family histories were not significant .
Visual acuity was 20/17 in both eyes. He had complete tarsal ectropion of the right and a minimal ectropion of left lower lid [Figure - 1]. There was no evidence of blepharitis, lid ulcers, horizontal lid laxity, lid deformity, surgical scars, enophthalmos or floppy eye lid syndrome. Bell's phenomenon and ocular motility was normal. The rest of the ocular, local and systemic examination was unremarkable.
All blood tests and the immunology profile were normal. Ultrasound of the anterior part of the orbits did not reveal any abnormality, though inferior retractors were difficult to visualize in either eye [Figure - 2],[Figure - 3],[Figure - 4]. Lid biopsy was reported as acute inflammation that surrounded the glandular structure within the dermis. No granuloma or malignancy was seen.
Open plication of inferior retractors (Hargis's modification of Jones Wobig procedure) was undertaken on the right lower eyelid, under local anesthesia. Surgery involved tucking of inferior retractors, 8 mm below the lower border of the tarsus, with multiple 6-O-Vicryl absorbable stitches. Adequate alignment was achieved without requiring additional excision of skin or strips of pretarsal or preseptal orbicularis muscle. He achieved a good outcome [Figure - 5].
Lower-eyelid tarsal ectropion is an unusual form of eyelid malposition, in which the entire lid is everted. The cause is disinsertion of the lower-eyelid retractors. Patients with ectropion have larger-than-average tarsal plates for their ages. Ectropion results from normal or larger-than-normal tarsal plate vector forces, mechanically overcoming the normal or decreased tone of the preseptal/pretarsal orbicularis muscle, in combination with medial/lateral canthal tendon laxity. Males have larger tarsal plates than females and a higher incidence of ectropion.,
Racial variations in the bony architecture of the lower rim are recognized. Black patients have less prominent malar bones and the inferior orbital rim is posterior in relation to the eyeball. These patients have less support for the lower lid, which may predispose to lower lid retraction or ectropion.
In addition to demonstrating malar hypoplasia, our patient had a larger tarsal plate and probably inherent retractor weakness. These features should be considered as a cause of acute onset of ectropion in young patients.
| References|| |
Tse DT, Kronish JW, Buus D. Surgical correction of lower-eyelid tarsal ectropion by reinsertion of the retractors. Arch Ophthalmol
Shah-Desai S, Collin R. Role of lower lid retractors in involutional ectropion repair. Orbit
Bashour M, Harvey J. Causes of involutional ectropion and entropion age-related tarsal changes are the key. Ophthal Plast Reconstr Surg
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]