From the Guidelines
The everted eyelid is medically termed "ectropion" or more specifically, in the context of the provided evidence, "floppy eyelid syndrome" which is characterized by eyelid swelling, ptosis, and an easily everted upper eyelid, often associated with obesity, sleep apnea, and thyroid disease 1.
Causes and Symptoms
The condition occurs when the eyelid margin turns outward and away from the eye, exposing the inner conjunctival surface, and can be caused by various factors including aging, facial paralysis, scarring, or congenital factors. Symptoms typically include eye dryness, irritation, excessive tearing, redness, and a gritty sensation due to inadequate lid closure and tear film distribution.
Treatment and Management
Treatment depends on the cause and severity but may include artificial tears for mild cases to lubricate the exposed tissues, and more severe cases often require surgical correction to tighten the eyelid or release scar tissue, as well as management of associated conditions such as sleep apnea and thyroid disease 1.
Potential Complications
Without treatment, ectropion can lead to chronic irritation, corneal damage, and infection due to improper protection and lubrication of the eye surface, highlighting the importance of prompt and effective management 1.
Key Considerations
It is essential to prioritize the management of ectropion to prevent long-term complications and ensure the best possible outcomes in terms of morbidity, mortality, and quality of life, with a focus on addressing the underlying causes and providing appropriate supportive care, including regular ophthalmic examinations and the use of preservative-free topical lubrication 1.
From the Research
Definition and Classification of Everted Eyelid
- Ectropion is a common eyelid problem defined as eversion of the eyelid margin, typically involving the lower eyelid 2.
- It is classified as congenital or acquired, with acquired ectropion further divided into involutional, cicatricial, paralytic, and mechanical subtypes 3, 4.
- Involutional ectropion is the most common subtype, characterized by no patient population bias 4.
Causes and Symptoms of Everted Eyelid
- The main acquired causes of ectropion include involutional, cicatricial, paralytic, and mechanical factors 2.
- Ectropion can cause symptoms such as exposure keratopathy, ocular synkinesis, and crocodile tears, especially in cases of facial paralysis 5.
- Severe manifestations of ectropion include tarsal ectropion, where much of the tarsal conjunctiva is visible, often with keratinization of the conjunctiva 2.
Treatment and Management of Everted Eyelid
- Common techniques for ectropion repair include horizontal tightening of the lid with lateral tarsal strip or Bick procedure, lateral tarsorraphy, inverting sutures, and the sub-orbicularis oculi fat lift 2.
- A novel adjunctive technique called the superotemporal skin transposition (STS) has been described, which is well-suited for patients with recurrent or tarsal ectropion 2.
- Temporary measures such as lubricating and covering the eye, including scleral lenses, can be used to manage lagophthalmos or ectropion 5.
- Surgical interventions, including lateral tarsorrhaphy, weighted eyelid implants, and lateral canthoplasty, can be used to tighten or lift the eyelid or surrounding tissues 5, 6.