cicatricial ectropion

Cicatricial ectropion is a type of eyelid malposition that occurs due to scarring and shortening of the anterior lamella, which is comprised of the skin and orbicularis muscle [5]. This condition can be caused by various factors such as burns, dermatologic diseases like lamellar ichthyosis, or complications from lower eyelid blepharoplasty [2].

The description of cicatricial ectropion involves an outward turning of the eyelid margin, which exposes the inner eyelid surface and leads to symptoms of redness, tearing, and foreign body sensation due to inadequate tear film [3]. In severe cases, the cornea can develop punctate epithelial erosions.

Cicatricial ectropion is often associated with other conditions such as lagophthalmos, which is characterized by a difficulty in closing the eyelid completely. This condition can be caused by large skin retractions and is commonly seen in patients with ichthyosis [6].

The surgical management of cicatricial ectropion depends on the situation after the release of the scar traction in the lower lid area. Various techniques have been described for correcting cicatricial ectropion, including lengthening the anterior lamella with transposition flaps or full-thickness free skin grafts [7][8][9].

In summary, cicatricial ectropion is a condition characterized by scarring and shortening of the anterior lamella, leading to an outward turning of the eyelid margin and exposure of the inner eyelid surface. It can be caused by various factors such as burns, dermatologic diseases, or complications from lower eyelid blepharoplasty.

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To diagnose cicatricial ectropion, several tests can be performed to assess the condition and rule out other potential causes.

• Schirmer's test: This test helps evaluate the ocular surface by measuring tear production. It is useful in diagnosing cicatricial ectropion, as it can indicate dryness of the eye [1].
• Tear film break up time: This test measures the time taken for the tear film to break up, which can help diagnose cicatricial ectropion by indicating issues with the ocular surface [3].
• Snap-back test: This test involves pulling downward on the lower lid and upward on the upper lid to evaluate the speed at which the lid snaps back into its normal position. It is a useful diagnostic tool for ectropion, including cicatricial ectropion [12].
• Medial canthal laxity test and Lateral canthal laxity test: These tests assess the laxity of the eyelid tissues, which can be relevant in diagnosing cicatricial ectropion [8].

It's worth noting that a thorough eye exam is usually sufficient to diagnose ectropion, including cicatricial ectropion. Specialized eye tests are not always needed [7].

Treatment Options for Cicatricial Ectropion

Cicatricial ectropion, a condition characterized by eyelid drooping due to scarring and skin contraction, can be challenging to treat. While surgical options are often considered, drug treatment may also be explored in some cases.

• Hyaluronic Acid (HA) Injections: A study has reported the use of HA injections as an option for managing cicatricial ectropion [1]. The injections involve administering 0.2 ml of HA subcutaneously followed by an additional 0.3ml injection, which may help alleviate symptoms.
• Topical Retinoids: Topical retinoids have been suggested as a treatment for ectropion caused by ichthyosis [2].
• Steroid Treatment: In some cases, steroid treatment such as prednisone may be administered to reduce inflammation and swelling associated with cicatricial ectropion [3][10].

Important Considerations

It's essential to note that each case of cicatricial ectropion is unique, and the most effective treatment approach may vary depending on individual circumstances. Additionally, while drug treatment may provide some relief, it may not completely resolve the condition.

References:

[1] 0.2 ml injection of HA subcutaneously followed by an additional 0.3ml injection of HA has been reported as an option in the management of cicatricial ectropion. [2] Topical retinoids have been suggested as treatment for ectropion from ichthyosis. [3] Prednisone, natrium fusidate ointment, vaselin album, clobetasol propionate 0.05% cream were used in the treatment of cicatricial ectropion in a dermatovenereology clinic [10].

Cicatricial ectropion, a type of ectropion characterized by an outward turning of the eyelid margin due to scarring, has several differential diagnoses that must be considered for accurate diagnosis and treatment. Here are some of the key differential diagnoses:

• Eyelid malignancy: Certain types of eyelid cancers can cause cicatricial ectropion by invading and destroying the tissue around the eye.
• Eyelid retraction secondary to proptosis (e.g., thyroid eye disease): In this condition, the eyeball is pushed forward due to a tumor or other mass effect, causing the eyelid to retract and potentially leading to cicatricial ectropion.
• Paralytic ectropion: This type of ectropion occurs when there is weakness or paralysis of the facial nerve (cranial nerve VII), which can cause the eyelid to droop and turn outward.
• Punctal ectropion: A condition where the punctum, a small opening at the inner corner of the eye, becomes everted or turned outward, potentially leading to cicatricial ectropion.

These differential diagnoses are important to consider when evaluating patients with cicatricial ectropion, as they may require different treatment approaches. For example, eyelid malignancy would require surgical excision and possibly adjuvant therapy, while paralytic ectropion might be treated with botulinum toxin injections or other measures to improve facial nerve function.

According to [10], the surgical management of cicatricial ectropion depends on the situation after the release of the scar traction in the lower lid area. Various techniques have been described for correcting cicatricial ectropion by lengthening the anterior lamella with transposition flaps or with full-thickness free skin grafts.

It's worth noting that cicatricial ectropion can occur at any age and can be a result of a chemical burn, scar, or surgery [12]. A detailed examination and medical history are essential to determine the underlying cause of cicatricial ectropion and guide appropriate treatment.