Ectropion Lower Eyelid Reconstruction Workup

Updated: Sep 26, 2017
  • Author: Mounir Bashour, MD, PhD, CM, FRCSC, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

Other Tests

See the list below:

  • 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.

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Diagnostic Procedures

See the list below:

  • 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.

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