Ectropion
The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care.
The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care.
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Outward rotation of the eyelid margin (usually lower). Occurs in approx. 4% of the population over 50 (bilateral in 70%). Various causes:
Lid laxity increases with age
Sore, red, watery eye
Symptoms variable depending on severity
Inferior lid margin not in contact with globe:
Lower punctum not in contact with tear meniscus:
Conjunctival hyperaemia
Exposure keratopathy
Epiphora
Mucus discharge
Distraction test
Snap-back test
Ectropion is a physical sign, rather than a disease entity
Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere
GRADE* Level of evidence and strength of recommendation always relates to the statement(s) immediately above
Mild cases require no treatment:
Taping the lids closed at night when there is a risk of corneal exposure
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Therapeutic contact lens where constant protection from corneal exposure is indicated
(GRADE*: Level of evidence=low, Strength of recommendation=weak)
Ocular lubricants for tear deficiency/instability related symptoms (drops for use during the day, unmedicated ointment for use at bedtime)
NB Patients on long-term medication may develop sensitivity reactions which may be to active ingredients or to preservative systems (see Clinical Management Guideline on Conjunctivitis Medicamentosa). They should be switched to unpreserved preparations
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Mild asymptomatic involutional cases
B2: alleviation/palliation: normally no referral. Monitor for deterioration
More severe cases possibly requiring surgery
B1: initial management followed by routine referral
Surgery:
Surgery is indicated for:
There are no available data from randomised trials to provide evidence for the most effective intervention for the correction of involutional ectropion
*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradingworkinggroup.org)
Sources of evidence
Hintschich C. Correction of entropion and ectropion. Dev Ophthalmol. 2008;41:85-102
Mitchell P, Hinchcliffe P, Wang JJ, Rochtchina E, Foran S. Prevalence and associations with ectropion in an older population: the Blue Mountains Eye Study. Clin Experiment Ophthalmol. 2001;29(3):108-10
Vallabhanath P, Carter SR. Ectropion and entropion. Curr Opin Ophthalmol. 2000;11(5):345-51
Ectropion is a condition in which the eyelid (usually the lower eyelid) becomes slack and is no longer in contact with the eyeball. The commonest cause is loss of elasticity and muscle tone of the eyelids which happens as part of the ageing process. The affected eye becomes sore, red and watery. Patients may be helped by artificial tears and unmedicated ointments. If the eye does not close fully at night, it may need to be taped shut. Sometimes a bandage contact lens is fitted to protect the eye surface from drying. If these measures do not help, one of a number of possible surgical operations, usually carried out under local anaesthetic, may solve the problem.
Ectropion
Version 6
Date of search 20.05.17
Date of revision 20.09.17
Date of publication 05.12.17
Date for review 19.05.19
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