From the Guidelines
Surgical correction, specifically full-thickness skin grafting, is the recommended treatment for ectropion that does not respond to conservative measures. Treatment of ectropion involves addressing the outward turning of the eyelid, which exposes the inner conjunctival surface. Initial management includes artificial tears and lubricating ointments to protect the exposed conjunctiva and prevent corneal damage. For mild cases, regular application of preservative-free artificial tears during the day and lubricating ointment at night is recommended. However, for moderate to severe cases that don't respond to conservative measures, surgical intervention is necessary. According to a study published in the British Journal of Dermatology in 2019 1, eyelid skin grafting is a third-line therapy that may be considered when symptomatic corneal exposure or epiphora persists despite adequate conservative treatments.
Key Considerations
- The main issue with surgical intervention is relapse, which may occur rapidly, and subsequent topical therapy remains necessary 1.
- Autologous skin grafts are the most commonly reported surgical interventions, with both full-thickness and split-thickness autologous skin grafts being used successfully 1.
- Harvest sites for full-thickness grafts are varied, and oral buccal mucosa may be considered in preference to skin for grafts where skin is unavailable 1.
- A recent case report suggested the combination of inverting sutures in addition to systemic retinoids and lubrication, and another report suggested that apremilast may minimize the recurrence of eyelid ectropion after surgery 1.
Treatment Approach
- Initial management with artificial tears and lubricating ointments
- Topical antibiotics for secondary infection
- Surgical correction for moderate to severe cases, with the specific approach depending on the underlying cause
- Full-thickness skin grafting for cicatricial ectropion
- Prompt treatment to prevent chronic ectropion and its complications, such as exposure keratopathy, corneal ulceration, and vision loss.
From the Research
Treatment Options for Ectropion
The treatment for ectropion can vary depending on the cause and severity of the condition. Some common treatment options include:
- Horizontal tightening of the lid with lateral tarsal strip or Bick procedure 2
- Lateral tarsorraphy 2
- Inverting sutures 2, 3
- Sub-orbicularis oculi fat lift 2
- Medial and lateral canthopexy 4
- Superotemporal skin transposition (STS) 2
- Adhesive taping for temporary treatment of paralytic ectropion 5
Surgical Techniques
Surgical techniques for ectropion repair can be combined to achieve the best results. For example:
- The STS can be combined with a lateral tarsal strip or Bick procedure 2
- Inverting sutures can be used in combination with other techniques 2, 3
- Skin grafts can be used for cicatricial cases 2
Prevention of Ectropion
Prevention of ectropion is also important, especially in patients undergoing blepharoplasty. Some tips for preventing ectropion include: