Ectropion

Ninety percent of victims claimed that sulfuric acid was the chemical involved [24]. Injured areas were confined to the head and neck. While most had their faces flushed with tap water, none had continuous effective flushing, especially of the eyes, before presentation to hospital. Most had half or more of then faces grossly disfigured by scars. Six patients (40%) had total bilateral blindness and one had partial loss of vision. Other common function sequelae were lower eyelid ectropion (14/15), microstomia (12/15), cervical flexion contracture (10/15), ear deformity (8/15), and nostril stenosis (6/15). Victims had severe psychological and social effects, and most lived as recluses. 

Severe burning sensation, redness, epiphora of the left eye, mild upper eyelid edema of the right eye, severe edema of the left eyelids, left eye inferior ectropion, blepharoconjunctivitis with severe hyperemia, papillary reaction, and chemosis occurred in a patient undergoing a face peeling procedure with a trichloroacetic acid-containing mask [31]. 

Even the classic genital manifestations of diethylstilbestrol in women who have been exposed to it in fetal life may be overlooked unless one is alert to them vaginal discharge with ectropion should cause one to enquire as to possible prenatal diethylstilbestrol exposure (45). 

Wingfield M. Not just a cervical ectropion. Three case reports of diethylstilbestrol (DES) exposed women presenting with vaginal discharge and cervical ectropion. J Obstet Gynaecol 1999 19(6) 649-51. 

The reduced penetrability of cervical mucus, which contributes to the contraceptive effect, may well provide some small degree of protection against pelvic inflammatory disease. However, this effect is likely to be less than that exerted by combined oral contraceptives, since the expanded cervical ectropion found among combined oral contraceptive users is not present in users of progestogen-only contraceptives. 

Although treatment of xerosis and scaling is a sine qua non in LI therapy, other skin symptoms also need to be taken care of. Thus, ectropion, alopecia, and finger contractions are usually unresponsive to medical treatment, and only occasional patients with anhidrosis will improve the sweating capacity when using potent oral drugs for LI.36... 

Other side effects include pain at the injection site, ecchymosis, increased tearing, ectropion, entropion, dry eye symptoms, and diplopia. Avoiding injection of the middle or the entire lower eyelid may alleviate some of these side effects. 

In patients with severe lid involvement, lubricating ointments should be instilled into the cul-de-sac to prevent complications arising from exposure or trichiasis. An oculoplastic surgeon should manage scarring and contraction of lid tissue that creates cicatricial ectropion, lid retraction, lid margin deformity, or severe corneal complications. 

The seventh cranial nerve is responsible for eyelid closure during the blink reflex. Partial or complete disturbance of cranial nerve VII can interrupt these impulses, resulting in incomplete lid closure. Loss of muscular tone can also lead to ectropion, disruption of the lacrimal pump, and ultimately impaired tear drainage. 

If clear fluid is expelled from the nose without any fluorescein present, it is likely that rather than a true obstruction of the lacrimal drainage system a punctal stenosis or ectropion is the culprit.This diagnosis can be assumed by the feet that no fluorescein ever entered the drainage system during the Jones I test, in contrast to the situation where fluorescein enters the system but gets lodged deep within the drainage apparatus (scenario 3 above). 

Punctal ectropion is the result of eyelid ectropion. Causes include mechanical (e.g., excess weight on the lid as the result of a lid growth), cicatricial (resulting from scar tissue formation), congenital, age-related, and allergic. 

If an underlying lid abnormality such as ectropion is the cause of exposure keratitis, then an oculoplastics consultation is appropriate. In extreme cases of exposure, a tarsorrhaphy may be performed to preserve corneal health. In the event that exposure keratitis has become compUcated by secondary infection, appropriate treatment must be initiated. 

Staphylococcal blepharitis Ectropion Entropion Lagophthalmos Exposure keratopathy Interpalpebral... 

Lid involvement in AKC includes dermatitis, found in 62.2% of cases, as well as blepharitis, meibomianitis, trichiasis, ectropion, entropion, and madarosis. The lids may be eczematous and may appear red, indurated, and crusted. Infraorbital lid edema may cause a skin crease known as Dennie-Morgan Une. 

For blepharospasm, injections of about 12.5-25 MU are made into the periocular muscles of each eye. When so used, adverse effects are seen in 20-50% of treatments. They consist of mild ptosis, increased or reduced tear function, diplopia, and ectropion. These effects are transient, most lasting about 2 weeks, and generally well tolerated. Occasionally ptosis is so severe as to be inconvenient for the patient. The blepharospasm is relieved for 2-A months. Systemic effects have not been reported (2). 

Tear duct fibrosis develops in one of six patients with excessive lacrimation from fluorouracil (66). The eversion of the lower eyelid is reversible with conservative management (68) while the tear duct fibrosis may not be (69). Persistent lacrimation has been described in six patients receiving intravenous fluorouracil weekly for 6-10 months (69). Lacrimation persisted in five patients after the withdrawal of fluorouracil, suggesting an irreversible dacryostenosis. Lacrimal duct stenosis has also been reported (70). Bilateral cicatricial ectropion was also reported in a patient after topical administration of fluorouracil for the treatment of multiple facial actinic keratoses (71). If ectropion and tear duct stenosis progress, surgical correction may be required. 

Straus DJ, Mausolf FA, Ellerby RA, McCracken JD. Cicatricial ectropion secondary to 5-fluorouracil therapy. Med Pediatr Oncol 1977 3(1) 15-19. 

Galentine P, Sloas H, Hargett N, Cupples HP. Bilateral cicatricial ectropion following topical administration of 5-fluorouracil. Ann Ophthalmol 1981 13(5) 575-7. 

Fluorouracil Topical antimitotic drug Telangiectasia bilateral cicatricial ectropion exacerbation of Herpes labialis pain, edema, livedo reticularis erosions (SEDA-7, 166) (SEDA-7, 166) (SEDA-5, 155)... 

Tretinoin Acne treatment Ectropion Eruptive pyogenic granuloma (SEDA-17, 185) (SEDA-15, 151)... 

Ocular adverse effects secondary to isotretinoin are generally benign in nature and reversible on reduction or withdrawal of therapy. However, papilledema necessitates withdrawal. Corneal opacities should be monitored closely. Although they do not usually interfere with vision, prudence dictates withdrawal of isotretinoin or reduction of the dosage when corneal opacities develop (48). Several cases of cataract have been (unconvincingly) ascribed to isotretinoin (SEDA-19, 157). Etretinate and isotretinoin have caused photophobia and reduced night vision (SEDA-17,183), and possibly ectropion (SEDA-16, 152). 

Aristodemou P+, Ophthal Plast Reconstr Surg 22(2), 134 Ectropion... 

---