eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Reconstructive Surgery

Lower Eyelid Reconstruction, Ectropion: Workup

Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Contributor Information and Disclosures

Updated: Jul 14, 2009

Workup

Other Tests

  • Snap-back test
    • Pull the lower lid down and away from globe for several seconds and wait. Without the patient blinking, note the length of time required before the lower lid returns to its original position; the lid, in fact, may not return to its original position at all.
    • The snap-back test provides a good measure of relative lower lid laxity. A healthy lid should spring back into original position immediately; the longer that the lid takes to return to the original position, the more laxity that is present.
    • The snap-back test is graded from 0-IV, with a grade of 0 indicating normal laxity and a grade of IV indicating severe laxity.
  • Medial canthal laxity test
    • Pull the lower lid laterally away from the medial canthus and measure displacement of medial punctum; the greater the distance measured, the greater the laxity.
    • Normally, the displacement should only be 0-1 mm.
    • The medial canthal laxity test is graded from 0-IV, with a grade of 0 indicating normal laxity and a grade of IV indicating severe laxity.
  • Lateral canthal laxity test
    • Pull the lower lid medially away from the lateral canthus and measure displacement of the lateral canthal corner; the greater the distance measured, the greater the laxity.
    • Normally, the displacement should only be 0-2 mm.
    • The lateral canthal laxity test is graded from 0-IV, with a grade of 0 indicating normal laxity and a grade of IV indicating severe laxity.
  • Schirmer test: Note how dry the eyes are because ectropion is only one of several conditions among the differential diagnoses of epiphora. A filter paper is applied to the fornix, and the amount of moisture on the strip is noted and compared to the contralateral side.
  • Fluorescein test of cornea: Fluorescein is applied to the cornea and the corneal surface is analyzed with a black light to assess corneal changes or laceration.

Diagnostic Procedures

  • Slit lamp examination: The corneal status must be evaluated preoperatively to assess abrasion or evidence of dryness. Also, check for evidence of lagophthalmos.
  • Presence or absence of Bell phenomenon: Instruct the patient to attempt to close the eyes while the examiner is holding the patient's lids open; if the eye moves up, a positive Bell phenomenon is present.
  • Status of seventh nerve: With a lower motor neuron seventh nerve palsy (eg, Bell palsy), the ipsilateral brow and the lower facial musculature are weak. With an upper motor neuron seventh nerve palsy, brow elevation is relatively spared because of the bilateral innervation of the upper face. In patients in whom facial nerve palsy is suggested, test for orbicularis oris dysfunction by asking the patient to show the teeth rather than smile. Compare the elevation of the angles of the lips; often, ptosis of the lateral lip on the affected side is present.

More on Lower Eyelid Reconstruction, Ectropion

Overview: Lower Eyelid Reconstruction, Ectropion
Workup: Lower Eyelid Reconstruction, Ectropion
Treatment: Lower Eyelid Reconstruction, Ectropion
Follow-up: Lower Eyelid Reconstruction, Ectropion
Multimedia: Lower Eyelid Reconstruction, Ectropion
References
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References

  1. Neuhaus RW. Anatomical basis of "senile" ectropion. Ophthal Plast Reconstr Surg. 1985;1(2):87-9. [Medline].

  2. Bashour M, Harvey J. Causes of involutional ectropion and entropion--age-related tarsal changes are the key. Ophthal Plast Reconstr Surg. Mar 2000;16(2):131-41. [Medline].

  3. Sigurdsson H, Baldursson BT. [Case of the month. Ichthyosis with ectropion]. Laeknabladid. May 2009;95(5):357-8. [Medline].

  4. Xu JH, Tan WQ, Yao JM. Bipedicle orbicularis oculi flap in the reconstruction of the lower eyelid ectropion. Aesthetic Plast Surg. Mar-Apr 2007;31(2):161-6. [Medline].

  5. Adenis JP, Grivet D. Ectropion of the lacrimal point: The shoe lace technique. Eur J Ophthalmol. Mar-Apr 2005;15(2):267-70. [Medline].

  6. Benger RS, Frueh BR. Involutional ectropion: a review of the management. Ophthalmic Surg. Feb 1987;18(2):136-9. [Medline].

  7. Carter SR, Chang J, Aguilar GL, et al. Involutional entropion and ectropion of the Asian lower eyelid. Ophthal Plast Reconstr Surg. Jan 2000;16(1):45-9. [Medline].

  8. Cherubini TD. Entropion and ectropion of the eyelids. Clin Plast Surg. Oct 1978;5(4):583-91. [Medline].

  9. Detorakis ET, Ioannakis K, Kozobolis VP. Corneal topography in involutional ectropion of the lower eyelid: preoperative and postoperative evaluation. Cornea. May 2005;24(4):431-4. [Medline].

  10. Frueh BR, Schoengarth LD. Evaluation and treatment of the patient with ectropion. Ophthalmology. Sep 1982;89(9):1049-54. [Medline].

  11. Hsuan J, Selva D. The use of a polyglactin suture in the lateral tarsal strip procedure. Am J Ophthalmol. Oct 2004;138(4):588-91. [Medline].

  12. Kersten RC, Kulwin DR. Paralytic ectropion of the lower eyelid [letter; comment]. Plast Reconstr Surg. Sep 1995;96(4):991-2. [Medline].

  13. Pidde WJ. Cicatricial ectropion. Can J Ophthalmol. Oct 1976;11(4):350. [Medline].

  14. Piskiniene R. Eyelid malposition: lower lid entropion and ectropion. Medicina (Kaunas). 2006;42(11):881-4. [Medline].

  15. Rosenberg S, Goldfarb M. Management of paralytic ectropion. Ann Ophthalmol. Sep 1981;13(9):1063-5. [Medline].

  16. Sisler HA, Labay GR, Finlay JR. Senile ectropion and entropion: a comparative histopathological study. Ann Ophthalmol. Mar 1976;8(3):319-22. [Medline].

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Further Reading

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Keywords

lower lid ectropion, lower lid laxity, eyelid eversion, involutional, cicatricial, tarsal, congenital, neurogenic, paralytic, lower eyelid reconstruction, eyelid laxity

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Contributor Information and Disclosures

Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Richard V Smith, MD, Director of Clinical Affairs, Associate Professor, Department of Otolaryngology, Division of Head and Neck Surgery, Einstein College of Medicine, Montefiore Medical Center
Richard V Smith, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Rhinological and Otological Society, American Medical Association, American Medical Student Association/Foundation, Medical Society of the District of Columbia, New York Academy of Medicine, and Vermont State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

David W Stepnick, MD, Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center
David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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