Involutional Ectropion

September 14, 2005
Leonid Skorin, Jr, DO
Leonid Skorin, Jr, DO

An 82-year-old man complained of dry, gritty eyes with chronic, bilateral tearing. He stated that friends tell him his eyes are always red.

An 82-year-old man complained of dry, gritty eyes with chronic, bilateral tearing. He stated that friends tell him his eyes are always red.

Involutional (senile) ectropion is relatively common in the elderly and frequently causes epiphora. Ectropion is a malposition of the eyelid in which the lid margin is turned away from the globe. This condition affects the lower lid more commonly than the upper one.

Ectropion can result from tissue relaxation-specifically, the orbicularis muscle, lower eyelid retractors, and the canthal tendons. Secondary punctal tendon laxity leads to more pronounced epiphora, since punctal stenosis may result.

In persons with long-standing ectropion, the tarsal conjunctiva becomes chronically inflamed, thickened, and sometimes keratinized, as in this patient. Dry eye syndrome–like changes may arise from inadequate lubrication and exposure of the corneal surface.

Very mild cases of ectropion may be managed with artificial tears and a lubricating eye ointment. This patient's more severe and symptomatic ectropion required surgical realignment of the lower eyelids. The precise method of surgical repair chiefly depends on the position of maximal ectropion, the extent of horizontal lid laxity, and the severity of canthal tendon laxity.