Ectropion is an anomaly of the location of the ciliated edge, which is accompanied by its separation from the eyeball and the exposure of the palpebral and bulbar conjunctiva. Clinically, this pathology is manifested by increased lacrimation, foreign body sensation, frequent blinking, hyperemia of the skin, followed by the development of symptoms of conjunctivitis, keratitis and lagophthalmos. Diagnosis of the disease is reduced to external examination, visometry, biomicroscopy, perimetry, as well as general clinical analyses. Blepharoplasty is a specific method of treating the ectropion.
Eversion of the lower eyelid (ectropion) is a polyethological eye disease in which the fit of the free edge of the lower eyelid to the eyeball is disturbed, followed by the eversion of the eyelid outward. This pathology occurs with the same frequency among men and women, mainly in old age. Congenital ectropion is a rare anomaly and occurs with a frequency of 1:1000. In addition to structural changes, the disease is characterized by a pronounced cosmetic defect. In this regard, back in 1818, German ophthalmologists introduced a technique of surgical treatment called reconstructive blepharoplasty. To date, surgical interventions for the elimination of ectropion have an excellent cosmetic effect.
The most common ectropion develops with a decrease in the tone of the circular muscle of the eye and the elasticity of the skin. Progressive atrophy of subcutaneous tissue contributes to the occurrence of ectropion. At the same time, inflammatory diseases (blepharitis, conjunctivitis) lead to spasm of the periorbital muscle, increasing the risk of developing this pathology. The etiological factor of the abnormal position of the lower eyelid can be paralysis or paresis of the facial nerve. Diseases accompanied by a decrease in cerebral circulation lead to a violation of the innervation of facial muscles. Losing its former tone, the ciliated edge gradually separates from the eye socket and turns outwards.
Congenital ectropion can act as an isolated disease, the cause of which is a violation of the embryonic development of the eyelids. Also, eversion of the ciliated margin occurs in Down syndrome, blepharophimosis, dermal hypoplasia, cranio-fascial syndrome, lamellar ichthyosis and Miller syndrome. This pathology often accompanies autoimmune diseases of connective tissue: systemic lupus erythematosus, scleroderma and dermatomyositis.
The presence of tuberculous periostitis of the edge of the eye socket, actinomycosis, benign and malignant neoplasms, burns and traumatic injuries leads to the formation of a scar that tightens the ciliated edge of the lower eyelid and contributes to the development of lagophthalmos. Cicatricial eversion can develop in patients who have undergone plastic surgery to remove a large skin flap, as well as placing an implant in the buccal region.
Depending on the etiology, the ectropion is classified into senile, paralytic, scar, congenital and mechanical forms. There are also medial, lateral and generalized ectoropion. This pathology can be mono- or binocular.
Clinical manifestations of all forms of the disease are constant lacrimation, frequent blinking, hyperemia and maceration of the skin in the periorbital zone. Normally, tears moisturize the conjunctiva, perform a protective function and participate in the metabolic processes of the eyes. With ectropion, keratinization of the palpebral part of the conjunctiva, displacement of the lacrimal point and deformation of the physiological pathways of fluid outflow are observed. Patients complain of constant lacrimation with increased dryness of the conjunctiva. The production of lacrimal fluid increases compensatorily with its further accumulation in the eversion zone.
One of the symptoms of ectropion is the sensation of a foreign body (“sand”) in the eyes, which leads to increased blinking and stimulates the production of secretions by the meibomian glands. Constant mechanical removal of tears and attempts to eliminate discomfort contribute to the attachment of infection. In patients with conjunctivitis, vasodilation, burning sensation and hyperemia of the eyes are observed against the background of the ectropion.
The senile form is characterized by a gradual progression of clinical manifestations of the disease. As a rule, an incomplete fit of the palpebral edge of the lower eyelid to the eyeball develops at first. Next, a partial eversion is diagnosed, in which there is a detachment of 1/3 of the ciliated edge, which gradually turns into a complete ectropion. Trying to remove excessive tears against the background of reduced elasticity of the skin and atony of the circular eye muscle, patients aggravate the process of eversion development. With complete ectropion, more often of scar origin, the lagophthalmos clinic joins. Patients complain about the inability to completely close their eyes. Over time, dystrophic and erosive lesions of the cornea, keratitis develop.
Paralytic ectropion is a one-sided process. In addition to the clinical manifestations of the ectropion, patients have ptosis of the eyebrow, asymmetry of the lips and cheeks, and there is also no facial expressions on the affected half of the face. With an isolated form of congenital inversion of the eyelid, a low degree of maladaptation is often observed, so the disease may occur latently or have minimal manifestations.
Ectropion belongs to the number of diseases of external localization, so it is not difficult to establish a preliminary diagnosis.
During an external examination of the anterior part of the eye, an ophthalmologist evaluates the function of the circular muscle. Patients with an ectropion often have a decrease in tone or hypotrophy of the periorbital muscle. It is recommended to check the degree of atony of the lower eyelid using samples with pulling down in the area of the outer and inner corners. When examining the eyelids, it is necessary to pay attention to the presence of benign or malignant neoplasms and scarring, which will allow to establish the etiology of the disease. Hyperemia and maceration of the skin are also visualized in patients. Sensitivity in the periorbital zone is palpated, and in the presence of scars, their density and extent are determined. The patient is asked to close his eyes to detect lagophthalmos and change facial expressions to exclude paresis or paralysis of the facial nerve.
Biomicroscopy of the eye using a slit lamp allows you to assess the condition of the tear film, the ciliated edge of the eyelids, cornea, palpebral and bulbar conjunctiva. For a more detailed biomicroscopic examination, it is recommended to use fluorescein, which allows you to study the nature and size of the lesion.
Visual acuity is measured by visometry. To determine the boundaries of the field of view, a perimeter should be drawn. Additional studies are necessary only for the clinical picture of conjunctivitis or keratitis (computer keratometry, bacteriological seeding, cytological examination of conjunctival scraping, cornea, etc.). According to the diagnostic protocol, laboratory tests are carried out (blood test, urine test, blood for RW, HBs antigen, coagulogram), but they are not informative, because of specific changes they are not observed.
The specific treatment of ectropion is blepharoplasty. Surgical correction of the eversion of the eyelid is reduced to strengthening the ligamentous apparatus. If necessary, reconstruction is performed with a skin flap. In patients with paralytic ectropion, surgical intervention is indicated only after treatment of the underlying pathology.
The appointment of drug treatment is advisable for minor manifestations of the disease or the presence of a history of contraindications to surgery. To eliminate dryness of the conjunctiva, moisturizing drops or gel are used. In order to prevent inflammatory processes, nonsteroidal anti-inflammatory drugs of local action (indomethacin) are prescribed.
Prognosis and prevention
The surgical treatment of the ectropion provides a favorable prognosis for life and work capacity. Paralytic ectropion and all forms of the disease complicated by lagophthalmos are characterized by a relatively favorable prognosis. The progression of complications of this pathology leads to a decrease in visual acuity up to complete blindness, which leads to disability of the patient.
Specific measures for the prevention of the disease in ophthalmology have not been developed. Patients are recommended to undergo an annual examination by an ophthalmologist for early detection of the ectropion and the appointment of timely treatment. After blepharoplasty, the patient should be registered at the dispensary and visit the attending physician 2 times a year.