UPPER AND LOWER EYELIDS AFFECTION

- V- Ectropion of the eyelid

Ectropion is an eversion or turning out of the eyelid margin.

Fig.22: Bilateral ectropion in a young Labrador retriever (David et al, 2008). 

Causes

Ectropion is classified according to the cause into:

1- Congenital ectropion

2- Acquired ectropion

a) Senile ectropion

               b) Cicatrical ectropion

               c) Intermittent ectropion

                d) ectropion may result in severe secondary corneoconjunctival lesions if severe  

                    enough  and left untreated.

Treatment

A-   Surgical correction when it causes conjunctivitis, keratitis, or exfoliative blepharitis due to epiphora or when it exacerbates keratoconjunctivitis sicca.

B-     Correction is required much less frequently than for entropion.

 Techniques used to correct different types of ectropion

1-     Wedge Resection

A-    The lower eyelid can be shortened by resection of a full-thickness wedge from the lateral end of the lower eyelid.

B-     A standard two-layer closure is then used to perfectly appose the sides of the eyelid margin.

C-   For ectropion due to either focal cicatricial contraction or a “notch” deformity in the lower eyelid, the wedge should be repositioned to remove the deformed or scarred tissue, the medial canthal area and nasolacrimal apparatus must be avoided.

2-    “V-to-Y” Blepharoplasty

A-   For cicatricial ectropion and in cases in which a small wedge resection is insufficient The V-to-Y (Wharton-Jones) blepharoplasty procedure is used.

B-    It is particularly well suited to correction of ectropion due to a broad, contracted scar.

C-   The V-to-Y blepharoplasty is begun with outlining of a triangular piece of skin with the base parallel and equal in length to the affected eyelid margin.

D-    A skin incision is made along the two lower sides of the triangle, and the skin between them is undermined to elevate a V-shaped flap.

E-    Scar tissue beneath the flap is excised.

F-    The ventral ends of the incisions then are sutured together with simple interrupted sutures of 3/0 to 5/0 braided nylon or silk to form a vertical line perpendicular to the eyelid margin.

G-   This vertical portion forces the triangle and eyelid margin superiorly.

H-   The length of the vertical portion depends on how much elevation/inversion of the eyelid margin is required to return it to its normal position.

I-      To allow for subsequent wound contraction, it should be about 2 to 3 mm longer than required.

J-     The remaining parts of the two incisions are sutured to the free edges of the flap so that the sutured skin forms a Y.

Fig.23:V-to-Y (Wharton-Jones) blepharoplasty (Moore and Constantinescu,1997).

A- A triangle of skin is outlined.

-   The base is determined by the extent (width) of the lid margin affected by ectropion.

-  The height of the triangle is determined by the extent of eversion to be corrected.

- A scalpel is used to incise the skin along the two sides but not the base of the triangle.

A-    The skin flap created is elevated and undermined, along with any scar tissue.

B-  The two sides of the triangle are sutured together to form the vertical portion of the Y.

-  The length of the vertical portion of the wound is determined by the extent of eyelid eversion. Arrows show the tissue forces created.

C-  The incisions are closed so as to form the two arms of the Y.