Cicatricial Ectropion

What is Cicatricial Ectropion?

Cicatricial Ectropion is the pulling of the upper or lower eyelid away from the eye because of scar formation or a shortage of the anterior lamella of the
eyelid. The scarring process can involve the skin, subcutaneous tissue, muscle or septum. This can result in drying of the cornea (exposure keratopathy).

How does it occur?

picture showing Cicatricial Ectropion
Cicatricial Ectropion can occur as a result of aging skin changes, sun damage and chronic dermatitis. Mechanical injuries such as lacerations and burns
- thermal, chemical and radiation can cause scarring resulting in ectropion. 
Eyelid surgery such as blepharoplasty or tumor removal can result in ectropion due to removal of too much skin. It can also be seen after ptosis surgery,
entropion repair and orbital surgery,such as blow-out fracture repair. Infections such as herpes zoster can cause contraction and ectropion of the eyelid.

It could also be caused by shortage of skin such as seen in certain conditions like blepharophimosis syndrome, euryblepharon and congenital ichthyosis.

How is it treated?

Protection of the cornea is vital. Ophthalmic lubricating drops and ointments should be applied frequently. Moisture chambers attached to eyeglasses or
the expa-bubble can be helpful. Room humidifiers may also help.

In the initial post operative stage such as following trauma repair or blepharoplasty, frequent digital message can be tried to relax the scar and stretch
the skin. If this does not work small amounts of steroids (0.1 - 0.5cc) of Triamcinolone (Kenalog) 10mg/cc in a 1 cc syringe can be injected into the scar.

What are the early management tips?

For early surgical management, it is best to wait at least six months following injuries for the scar to mature and soften before performing surgery. However,
when the cornea is showing evidence of significant exposure keratopathy, it may be necessary to operate earlier. Particularly in the management of severe
burns it may be necessary to protect the cornea.