Eyelids 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. 

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. 

Wojno T, Tenzel RR. Lower eyelid ectropion following chemical face peel. Ophthalmic Surg 1984 14 9-12. 

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]. 

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. 

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. 

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. 

Severe cases have also been reported after eyelid peels however, ectropion is not a specific complication of deep eyelid peels. 

Periocular skin is particularly delicate and prone to ectropion. After discussing what ectropion is, 1 discuss the risk factors for its occurrence. These include blepharoplasties and previous resurfacing procedures. 1 perform a simple snap test to determine the elasticity of the lower eyelids in patients who wish to reduce the wrinkling in that area. Lower eyelids which quickly return to the normal position after being pulled down may tolerate straight phenol without forming an ectropion. Patients whose eyelids very slowly return to full apposition should not receive phenolic peels of any kind on the lower lids. Loss of elasticity in the lower lid is common following blepharoplasty and in elderly patients. 

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