Ординатура / Офтальмология / Английские материалы / Illustrated Tutorials in Ophthalmology Kanski, Bolton 2001
.pdf
Preoperative assessment
Postition of maximal ectropion |
Horizontal lid laxity |
Medial canthal tendon laxity Lateral canthal tendon laxity
Treatment of medial ectropion
Mild |
Medial conjunctivoplasty |
|
|
|
|
|
|
|
|
b |
|
|
a |
|
|
|
|
|
|
Severe |
Lazy-T procedure |
Treatment of extensive ectropion
a |
|
b |
|
|
|
Without marked excess skin |
Horizontal lid shortening |
|
||
|
|
|
|
|
|
a |
|
|
b |
|
|
|
||
|
|
|
|
|
|
|
|
||
With marked excess skin |
Kuhnt-Szymanowski procedure |
|
||
Causes of cicatricial ectropion
•Contracture of skin pulling lid away from globe
•Unilateral or bilateral, depending on cause
|
|
Unilateral ectropion due to |
Bilateral ectropion due to severe |
traumatic scarring |
dermatitis |
|
|
Treatment of cicatricial ectropion
Method depends on severity
|
|
Mild localized cases are treated |
Severe cases require transposition flaps |
by excision of scar tissue |
or free skin grafts |
combined with ‘Z’-plasty |
|
|
|
Paralytic ectropion
Caused by facial nerve palsy which,
if severe, may give rise to the following:
Exposure keratopathy caused by lagophthalmos
Epiphora caused by combination of:
•Failure of lacrimal pump mechanism
•Increase in tear production resulting from corneal exposure
Treatment Options for Paralytic Ectropion
1.Temporary treatment
•Lubrication with tear substitutes in mild cases
•Botulinum toxin injection into levator muscle for corneal exposure
•Temporary tarsorrhaphy in patients with poor Bell’s phenomenon
2.Permanent treatment
•Medial canthoplasty if medial canthal tendon is intact
•Medial wedge resection to correct medial ectropion associated with medial canthal laxity
•Lateral canthal sling to correct residual ectropion and raise lateral canthus
Mechanical ectropion
Mechanical lid eversion by tumour
Treatment
•Removal of the cause, if possible
•Correction of significant horizontal lid laxity
Involutional entropion
Affects lower lid because upper lid has wider tarsus and is more stable
If longstanding may result in corneal ulceration
Pathogenesis of involutional entropion
•Horizontal lid laxity
•Canthal tendon laxity
•Overriding of preseptal over pretarsal orbicularis during lid closure
•Weakness of lower lid retractors
- #
- #
- #
- #
- #
- #
- #
- #
- #28.03.202657.44 Mб0Jakobiec's Principles & Practice of Ophthalmology volume 1 3rd edition_Albert, Miller, Azar, Blodi_2008.pdf
- #28.03.202655.16 Mб0Jakobiec's Principles & Practice of Ophthalmology volume 2 3rd edition_Albert, Miller, Azar, Blodi_2008.pdf
- #28.03.202671.38 Mб0Jakobiec's Principles & Practice of Ophthalmology volume 4 3rd edition_Albert, Miller, Azar, Blodi_2008.pdf