Ectropion and Entropion
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The process of ageing brings about a multitude of changes in our body. Our skin, along with the tissue beneath becomes lax giving it a lose look. When this happens to the muscles around the eye, it may lead to the rotation of the eyelids, either inwards or outwards. This condition of rotation of the eyelids is called as ectropion or entropion, depending on the direction of rotation of the eyelids.

What are Ectropion and Entropion ?

Ectropion -- When the lower eyelid turns outwards, it hangs away from the eyeball forming a kind of a bucket or a pocket around the eye. Though it does not cause any problem in general, but when the tears start collecting, this bucket overflows making the lower eyes water continuously. On the other hand, this makes the middle part of the eye exposed, thereby making it dry and irritated and more prone to eye infections.

Entropion -- when both, upper and lower, lids turn inwards, the condition is called as an entropion. This leads to the eye lashes rubbing the eye ball, resulting in irritation in the eye, which may feel painful and watery. Entropion may also cause damage to the white part of the eye, i.e. the cornea, which might further turn into an ulcer resulting in the loss of vision.

Causes of Ectropion and Entropion

Ectropion is usually because of the process of ageing. When ageing is the cause, both the eyes will get affected by this condition. When only one eye is affected, it might be due to the scarring on the eyelid or the upper cheek. As the scar undergoes a healing process, it tightens and tugs at the lower eyelid, thus pulling it down.

Another reason for ectropion to occur is when the nerve serving the lower eyelid muscle gets damaged, it paralyses the muscle. Entropion too is an age related ailment. However, an infection affecting the inner surface of the eyelid may also cause an entropion. When this infection starts healing, it might leave a scar tissue on, which tugs at the outer border of the eyelid, thus turning it inwards. Just like ectropion, if left untreated, entropion might develop into an ulcer, impairing the vision of the patient.

How are Ectropion and Entropion Classified?

Ectropion is generally classified into five broad categories namely, congenital, mechanical, involutional, cicatricial and paralytic. Mechanical ectropion occurs due to the weight of the lump or tumor in the lid, which can be treated by extracting the tumor from the lid. Involutional ectropion occurs due to the horizontal laxity amongst the tissues of the lid.

This can be treated by shortening the lid in the area of maximum laxity. The scarring of the anterior lamella due to trauma, burns or facial dermatomes results in Cicatricial ectropion. This can be set right by performing a Z-plasty (if localized contracture) or a skin grafting (if generalized). A VIIth nerve palsy results into the paralytic ectropion. When it is seen that the recovery is possible, the treatment aims at simply protecting the globe. In the case when palsy is assumed permanent, lid shortening measures can be performed.

Entropion can be classified into three major types, namely congenital, involutional and ciciatrical. Congenital entropion occurs when there is hypertrophy of the anterior lamella. Usually the milder forms resolve themselves with time. Involutional entropion is an age-related entropion caused by the laxity of tarsus, its medial, lateral canthal tendons, lower lid retractors, along with the over-riding of the orbicularis.

While surgery is the permanent solution, taping of the lower lid can also provide with a temporary solution to the problem. Cicatricial entropion is a condition caused by the scarring disorders, which lead to the shortening of the posterior lamella. This is the only type of entropion to affect the upper lid of the eye.

This can be caused by chemical burns, chronic conjunctivitis, trachoma, mucous membrane pemphigoid and Stevens-Johnston syndrome. It requires surgical treatment to increase the length of the lid. But despite that, this is a recurring condition as the scarring progresses.

Treatment for Ectropion and Entropion

Cleansing the eye with boiled water cooled, daily or by washing eye with an eye wash solution prescribed by the doctor, will help keep the eye clean and free of germs and infections.

It will also help soothe the irritation and soreness caused by the entropion and ectropion. Antibiotics and ointments can further help in treating the eye infection. One can undergo minor surgery in order to treat the ectropion or entropion conditions by tightening the muscles and the skin. Earlier this measure is taken; the better it is for the eyes.

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