What is the Ectropion?
Ectopion is a condition in which the eyelid margin is facing outward; this involves the exposure of the conjunctiva, which for this reason is subject to irritation.
Ectopion primarily affects the lower eyelid and can occur in one or both eyes. The extent of the disorder is variable: in the most serious cases, the entire palpebral line is affected, whereas when it is light only a small segment can distance itself from the eyeball.
Artificial tears can help temporarily relieve symptoms, pending corrective surgery.
Symptoms
The eyelids play a fundamental role in protecting the eyes: in addition to providing a mechanical barrier, their intermittent movements distribute the tears over the entire surface of the eye, keeping it lubricated and free from dust and other particles. The tears constantly moisten the ocular surface and flow through a system of tear ducts, near the lower inner corner of the eyelids. Normally, the upper and lower eyelids close hermetically, protecting the eye from damage and preventing tear evaporation.
In the case of ectropion, the eyelids cannot fully perform their function. If the eyelid margin is facing outwards, the internal conjunctival surface (normally moist) is visible and exposure to air can cause redness and chronic irritation. The tear film is not evenly distributed over the ocular surface and the normal drainage process can be interrupted. Furthermore, if the tears are unable to flow properly, they make the eye vulnerable to infections, such as conjunctivitis.
The symptoms of ectropion include:
- Redness and irritation;
- Excessive tearing;
- Eye dryness;
- Burning in the eye;
- Infection.
The patient may also present: mild eye pain, eye discharge, and scabs on the eyelids. Chronic irritation, excessive dryness and exposure of the anterior surface of the eye can lead to corneal de-epithelialisation (ie damage to the most superficial layer of the cornea). In the case of ectropion, reduced vision, rapid increase in pain and sensitivity to light require immediate medical attention.
Causes
In most cases, ectropion is age-related. The condition is the result of muscle weakness and relaxation of tissues, associated with aging, which produce the hyper-lids of the eyelids.
Other less common causes of ectropion include:
- Bell's palsy (damages the nerve that controls the facial muscles), stroke or other neurological conditions that cause facial paralysis;
- Damage to eyelids caused by trauma or burns;
- Rapid weight loss;
- Nodules and cysts that develop in the eyelid (both cancerous and benign lesions);
- Previous surgery or radiation therapy of the eyelids;
- Scar tissue, as a result of injury or previous surgery;
- Complication of a skin condition (example: contact dermatitis).
Congenital ectropion
In rare cases, ectropion is present from birth, due to inadequate development of the eyelid muscles. This can be associated with an underlying disorder, such as, for example, Down syndrome or Harlequin ichthyosis (rare congenital skin dysfunction).
Diagnosis
Ectopropion is diagnosed by an eye examination and a physical examination. Facial inspection and assessment of muscle strength can help identify the signs of paralysis (example: paralysis of the facial nerve).
The horizontal eyelid laxity test determines whether the affected tissues are weakened or damaged. The doctor places a thumb under the outer palpebral chant and pushes him sideways and towards the top. If the edge of the eyelid does not come back into place again, it is possible to suspect a scar component.
The examination of the cornea allows the identification of epithelial changes, secondary to the exposure of the anterior ocular surface.
Treatment
The management of the condition depends on its severity and the underlying cause.
In the case of mild ectropion, treatment may not be necessary. Usually, eye drops or ointments can be recommended to reduce inflammation and help keep the eye lubricated.
Sometimes, it is possible to resort to a small operation to correct the position of the eyelid. The procedure involves a horizontal stiffening of a small section of the eyelid ligament, so that it can better support the tissue. This is a relatively simple procedure, which lasts about 45 minutes and involves the administration of a local anesthetic.
In cases where ectropion is caused by scarring resulting from a wound or previous surgery, a more complex operation may be needed, such as a skin graft. This can involve the removal of a section of skin from the upper eyelid or from the back of the ear and the consequent transfer to the seat. Surgery is generally associated with a positive outcome and is often the only effective treatment.
Complications
In general, ectropion does not lead to complications, as it is usually identified and treated at an early stage. However, if the symptoms are severe and neglected, additional problems such as keratitis, abrasion or corneal ulcer may arise. These consequences are serious and can impair vision.
