From the Guidelines
Ectropion treatment should prioritize frequent ocular lubricants as a first-line treatment to prevent lagophthalmos and maintain ocular surface integrity, as recommended by the British Journal of Dermatology in 2019 1. The primary goal of treating ectropion is to alleviate symptoms, prevent complications, and improve quality of life.
Key Considerations
- Ectropion predisposes to lagophthalmos, making ocular lubrication essential for long-term management 1.
- Preservative-free topical lubrication, such as carboxymethylcellulose 0.5–1%, carmellose sodium, or hyaluronic acid, is strongly recommended for patients requiring long-term eye-drop administration 1.
- Lipid-containing eye drops can improve symptoms and signs of dry eye, particularly in the presence of meibomian gland dysfunction 1.
- Eyelid emollients and massage (vertical lid massage and stretching) may also improve lagophthalmos and ectropion, as evidenced by case reports 1.
Treatment Options
- For mild cases, artificial tears and lubricating ointments can provide relief from dryness and irritation.
- For moderate to severe ectropion, surgical correction, such as ectropion repair (lateral tarsal strip procedure), may be necessary to restore normal eyelid position and prevent complications like corneal damage.
- Eyelid skin grafting is a third-line therapy that may be considered for symptomatic corneal exposure or epiphora persisting despite conservative treatments, as reported in the British Journal of Dermatology in 2019 1.
Important Notes
- Treatment should be individualized based on the severity of ectropion and the presence of underlying conditions, such as facial nerve paralysis or scarring.
- Regular ophthalmic examinations are crucial to monitor the effectiveness of treatment and prevent complications, as recommended by the British Journal of Dermatology in 2019 1.
From the Research
Treatment Options for Ectropion
- Surgical correction is a common treatment for ectropion, with a complete correction rate of 79% in patients with cicatricial ectropion 2
- Minimally invasive techniques, such as hyaluronic acid injections, may provide an alternative to surgery, with a complete response rate of 63% in patients with cicatricial ectropion 2
- However, hyaluronic acid injections may have a higher recurrence rate compared to surgical correction 2
- Other minimally invasive treatments, such as canthopexy, may also be effective in managing ectropion, particularly in cases of traumatic upper eyelid ectropion 3
Management of Drug-Induced Ectropion
- Discontinuation of the offending topical agent is the first step in managing drug-induced ectropion, with partial or complete resolution of the condition in all 13 patients in one study 4
- Topical steroids may be a necessary adjunct in the management of drug-induced ectropion, particularly in cases where discontinuation of the offending agent is not sufficient to resolve the condition 4
- Surgical correction may be necessary in some cases of drug-induced ectropion, particularly where there is significant cicatricial change or tissue edema 4
Prevention of Ectropion
- Limiting skin resection in lower lid blepharoplasty to a wedge of 4-6 mm below the subciliary incision line can help prevent ectropion 5
- Lateral superior tensioning of the skin and relaxed orbicularis muscle underneath can also help prevent ectropion, even in cases of baggy lids in elderly patients 5