1 Involutional Entropion vs Q Involutional Ectropion
What does the term Entropion mean? Ectropion 2 Involutional Entropion vs A Involutional Ectropion
What does the term Entropion mean? Ectropion It means the eyelid margin is turning inward 3 Involutional Entropion vs Q Involutional Ectropion
What does the term What does the term Entropion mean? Ectropion mean? It means the eyelid margin is turning inward 4 Involutional Entropion vs A Involutional Ectropion
What does the term What does the term Entropion mean? Ectropion mean? It means the eyelid margin is It means the eyelid margin is turning inward turning outward 5 Involutional Entropion vs Q Involutional Ectropion The Plastics book identifies six general causes of entropion and/or ectropion. What are they? (Note that while most apply to both entropion and ectropion, a few apply only to one or the other.) Entropion Categories Ectropion ?
?
?
?
?
? 6 Involutional Entropion vs A Involutional Ectropion The Plastics book identifies six general causes of entropion and/or ectropion. What are they? (Note that while most apply to both entropion and ectropion, a few apply only to one or the other.) Entropion Categories Ectropion Congenital
Involutional
Paralytic
Cicatricial
Mechanical
Acute Spastic 7 Involutional Entropion vs Q Involutional Ectropion
Of the six, which can result in entropion? Entropion Categories Ectropion ? Congenital
? Involutional
? Paralytic
? Cicatricial
? Mechanical
? Acute Spastic 8 Involutional Entropion vs A Involutional Ectropion
Of the six, which can result in entropion? Entropion Categories Ectropion Congenital Congenital
Involutional Involutional
Paralytic
Cicatricial Cicatricial
Mechanical
Acute Spastic Acute Spastic 9 Involutional Entropion vs Q Involutional Ectropion
Of the six, which can result in ectropion? Entropion Categories Ectropion Congenital Congenital ?
Involutional Involutional ?
Paralytic ?
Cicatricial Cicatricial ?
Mechanical ?
Acute Spastic Acute Spastic ? 10 Involutional Entropion vs A Involutional Ectropion
Of the six, which can result in ectropion? Entropion Categories Ectropion Congenital Congenital Congenital
Involutional Involutional Involutional
Paralytic Paralytic
Cicatricial Cicatricial Cicatricial
Mechanical Mechanical
Acute Spastic Acute Spastic 11 Involutional Entropion vs Involutional Ectropion
Entropion Categories Ectropion Congenital Congenital Congenital
InvolutionalInvolutional Involutional
Let’s take a closerParalytic look at involutionalParalytic entropion vs involutional ectropion… Cicatricial Cicatricial Cicatricial
Mechanical Mechanical
Acute Spastic Acute Spastic 12 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: 13 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity 14 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH 15 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH
How can you assess for horizontal laxity of the lower lid? 16 Involutional Entropion vs Q/A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH
How can you assess for horizontal laxity of the lower lid? Very simply: By pulling it away from the globe, ie, by distracting it. 17 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH
How can you assess for horizontal laxity of the lower lid? Very simply: By pulling it away from the globe, ie, by distracting it. 18 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH
How can you assess for horizontal laxity of the lower lid? Very simply: By pulling it away from the globe, ie, by distracting it. This allows assessment of lid tautness via two tests: 1) the snapback test which is based on the fact that…A taut lower lid will re-appose the globe quickly when released, like a rubber band snapping back into place. (Try it on yourself.) If clinically significant laxity is present, the lid will re-appose the surface in a much less brisk manner. 2) the distraction test 19 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH
How can you assess for horizontal laxity of the lower lid? Very simply: By pulling it away from the globe, ie, by distracting it. This allows assessment of lid tautness via two tests: 1) the snapback test which is based on the fact that…A taut lower lid will re-appose the globe quickly when released, like a rubber band snapping back into place. (Try it on yourself.) If clinically significant laxity is present, the lid will re-appose the surface in a much less brisk manner. 2) the distraction test 20 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH
How can you assess for horizontal laxity of the lower lid? Very simply: By pulling it away from the globe, ie, by distracting it. This allows assessment of lid tautness via two tests: 1) the snapback test, which is based on the fact that…A taut lower lid will re-appose the globe quickly when released, like a rubber band snapping back into place. (Try it on yourself.) If clinically significant laxity is present, the lid will re-appose the surface in a much less brisk manner. 2) the distraction test 21 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH
How can you assess for horizontal laxity of the lower lid? Very simply: By pulling it away from the globe, ie, by distracting it. This allows assessment of lid tautness via two tests: 1) the snapback test, which is based on the fact that…A taut lower lid will re-appose the globe quickly when released, like a rubber band snapping back into place. (Try it on yourself.) If clinically significant laxity is present, the lid will re-appose the surface in a much less brisk manner. 2) the distraction test 22 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH
How can you assess for horizontal laxity of the lower lid? Very simply: By pulling it away from the globe, ie, by distracting it. This allows assessment of lid tautness via two tests: 1) the snapback test, which is based on the fact that…A taut lower lid will re-appose the globe quickly when released, like a rubber band snapping back into place. (Try it on yourself.) If clinically significant laxity is present, the lid will re-appose the surface in a much less brisk manner. 2) the distraction test 23 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH
How can you assess for horizontal laxity of the lower lid? Very simply: By pulling it away from the globe, ie, by distracting it. This allows assessment of lid tautness via two tests: 1) the snapback test, which is based on the fact that…A taut lower lid will re-appose the globe quickly when released, like a rubber band snapping back into place. (Try it on yourself.) If clinically significant laxity is present, the lid will re-appose the surface in a much less brisk manner. 2) the distraction test: 24 Involutional Entropion vs Q/A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH
How can you assess for horizontal laxity of the lower lid? Very simply: By pulling it away from the globe, ie, by distracting it. This allows assessment of lid tautness via two tests: 1) the snapback test, which is based on the fact that…A taut lower lid will re-appose the globe quickly when released, like a rubber band snapping back into place. (Try it on yourself.) If clinically significant laxity is present, the lid will re-appose the surface in a much less brisk manner. 2) the distraction test: If the lid can be distracted more than 6distance mm from the ocular surface, it is lax to a clinically significant degree. 25 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH
How can you assess for horizontal laxity of the lower lid? Very simply: By pulling it away from the globe, ie, by distracting it. This allows assessment of lid tautness via two tests: 1) the snapback test, which is based on the fact that…A taut lower lid will re-appose the globe quickly when released, like a rubber band snapping back into place. (Try it on yourself.) If clinically significant laxity is present, the lid will re-appose the surface in a much less brisk manner. 2) the distraction test: If the lid can be distracted more than 6 mm from the ocular surface, it is lax to a clinically significant degree. 26 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors 27 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors Time out—before we answer this question, let’s take a minute to review the anatomy of the lid retractors 28 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction
Let’s start with the upper lid, as its anatomy is likely more familiar. 29 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Let’s start with the upper lid, as its anatomy is likely more familiar. What is the name of the muscle that is the prime retractor (elevator) of the upper lid? 30 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Let’s start with the upper lid, as its anatomy is likely more familiar. What is the name of the muscle that is the prime retractor (elevator) of the upper lid? The levator palpebrae superioris (levator for short) 31 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Let’s start with the upper lid, as its anatomy is likely more familiar. What is the name of the muscle that is the prime retractor (elevator) of the upper lid? The levator palpebrae superioris (levator for short)
What structural component of the lid is the primary recipient of the force exerted by the levator, the result of which is elevation of the lid margin?
??? 32 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Let’s start with the upper lid, as its anatomy is likely more familiar. What is the name of the muscle that is the prime retractor (elevator) of the upper lid? The levator palpebrae superioris (levator for short)
What structural component of the lid is the primary recipient of the force exerted by the levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 33 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Let’s start with the upper lid, as its anatomy is likely more familiar. …but from where does it originate? What is the name of the muscle that is the prime From the apex of the orbit retractor (elevator) of the upper lid? The levator palpebrae superioris (levator for short)
We know the levator will insert at What structural component of the lid is the primary (or near) the superior tarsal plate… recipient of the force exerted by the levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 34 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Let’s start with the upper lid, as its anatomy is likely more familiar. …but from where does it originate? What is the name of the muscle that is the prime From the apex of the orbit retractor (elevator) of the upper lid? The levator palpebrae superioris (levator for short)
We know the levator will insert at What structural component of the lid is the primary (or near) the superior tarsal plate… recipient of the force exerted by the levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 35 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Let’s start with the upper lid, as its anatomy is likely more familiar. …but from where does it originate? What is the name of the muscle that is the prime From the apex of the orbit retractor (elevator) of the upper lid? The levator palpebrae superioris (levator for short)
We know the levator will insert at What structural component of the lid is the primary (or near) the superior tarsal plate… recipient of the force exerted by the levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 36 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Let’s start with the upper lid, as its anatomy is likely more familiar. …but from where does it originateThere? isWhat a well-known is the name ring-shaped of the structuremuscle thatat the is apex the prime which is related to muscle origins. What is the eponymous From the apex of the orbit retractor (elevator) of the upper lid? name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 37 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Let’s start with the upper lid, as its anatomy is likely more familiar. …but from where does it originateThere? isWhat a well-known is the name ring-shaped of the structuremuscle thatat the is apex the prime which is related to muscle origins. What is the eponymous From the apex of the orbit retractor (elevator) of the upper lid? name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 38 Involutional Entropion vs Involutional Ectropion
Annulus of Zinn
The annulus of Zinn 39 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Let’s start with the upper lid, as its anatomy is likely more familiar. …but from where does it originateThere? isWhat a well-known is the name ring-shaped of the structuremuscle thatat the is apex the prime which is related to muscle origins. What is the eponymous From the apex of the orbit retractor (elevator) of the upper lid? name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 40 Involutional Entropion vs Q/A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Let’s start with the upper lid, as its anatomy is likely more familiar. …but from where does it originateThere? isWhat a well-known is the name ring-shaped of the structuremuscle thatat the is apex the prime which is related to muscle origins. What is the eponymous From the apex of the orbit retractor (elevator) of the upper lid? name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary No, therecipient levator originates of the force from justexerted aboveabove vby the the annulus levator, the (or near) the superior tarsal plate… below result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 41 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Let’s start with the upper lid, as its anatomy is likely more familiar. …but from where does it originateThere? isWhat a well-known is the name ring-shaped of the structuremuscle thatat the is apex the prime which is related to muscle origins. What is the eponymous From the apex of the orbit retractor (elevator) of the upper lid? name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 42 Involutional Entropion vs Involutional Ectropion
Origin of the levator
Annulus of Zinn
The annulus of Zinn 43 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction
Levator palpebrae superioris m. OK, if not the levator, which muscles do give Let’srise start to the with annulus the upper of Zinn? lid, as its anatomy is likely moreThe familiar. origins of the four recti muscles comprise …but from where does it originateThere? isWhat a thewell-known isannulus the name ring-shaped of the shapedmuscle structure that is the at the prime apex which is related to muscle origins. What is the From the apex of the orbit retractor (elevator) of the upper lid? eponymous name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 44 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction
Levator palpebrae superioris m. OK, if not the levator, which muscles do give Let’srise start to the with annulus the upper of Zinn? lid, as its anatomy is likely moreThe familiar. origins of the four recti muscles comprise …but from where does it originateThere? isWhat a thewell-known isannulus the name ring-shaped of the shapedmuscle structure that is the at the prime apex which is related to muscle origins. What is the From the apex of the orbit retractor (elevator) of the upper lid? eponymous name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 45 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction TheLevator annulus palpebrae encircles all superioris or part of two m. foramina at the orbital apex. Which two? A portion of the superior orbital fissure, and the OK,optic if forame not then levator, (encircled which in its muscles entirety) do give Let’srise start to the with annulus the upper of Zinn? lid, as its anatomy is likely moreThe familiar. origins of the four recti muscles comprise …but from where does it originateThere? isWhat a thewell-known isannulus the name ring-shaped of the shapedmuscle structure that is the at the prime apex which is related to muscle origins. What is the From the apex of the orbit retractor (elevator) of the upper lid? eponymous name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 46 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction TheLevator annulus palpebrae encircles all superioris or part of two m. foramina at the orbital apex. Which two? A portion of the superior orbital fissure, and the OK,optic if forame not then levator, (encircled which in its muscles entirety) do give Let’srise start to the with annulus the upper of Zinn? lid, as its anatomy is likely moreThe familiar. origins of the four recti muscles comprise …but from where does it originateThere? isWhat a thewell-known isannulus the name ring-shaped of the shapedmuscle structure that is the at the prime apex which is related to muscle origins. What is the From the apex of the orbit retractor (elevator) of the upper lid? eponymous name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 47 Involutional Entropion vs Involutional Ectropion
Optic canal
Superior orbital fissure Annulus of Zinn
(Inferior orbital fissure, if you’re wondering)
The superior orbital fissure and the optic canal 48 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in
the pathogenesisFive key ophthalmic of lower-lid structures pass involutional through these entropion, foramina—and the annulus—into the orbit. What are they? lower-lid involutional-- ectropion, or both: Enter orbit via the optic canal Horizontal-- lid laxity BOTH -- Disinsertion-- of the eyelid retractorsEnter orbit via the superior orbital fissure -- (a branch of the trigeminal nerve) (specifically, a branch Upper-lidof Retraction V1 , aka the ophthalmic division) TheLevator annulus palpebrae encircles all superioris or part of two m. foramina at the orbital apex. Which two? A portion of the superior orbital fissure, and the OK,optic if forame not then levator, (encircled which in its muscles entirety) do give Let’srise start to the with annulus the upper of Zinn? lid, as its anatomy is likely moreThe familiar. origins of the four recti muscles comprise …but from where does it originateThere? isWhat a thewell-known isannulus the name ring-shaped of the shapedmuscle structure that is the at the prime apex which is related to muscle origins. What is the From the apex of the orbit retractor (elevator) of the upper lid? eponymous name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 49 Involutional Entropion vs Q/A Involutional Ectropion
For each of the following, state whether it plays a role in
the pathogenesisFive key ophthalmic of lower-lid structures pass involutional through these entropion, foramina—and the annulus—into the orbit. What are they? lower-lid involutional--The optic nerve ectropion, or both: Enter orbit via the optic canal Horizontal--The lid ophthalmiclaxity BOTH artery --CN3 Disinsertion--CN6 of the eyelid retractorsEnter orbit via the superior orbital fissure --The nasociliary nerve (a branch of the trigeminal nerve) Upper-lid(specifically, Retraction a branch of V1 , aka the ophthalmic division) TheLevator annulus palpebrae encircles all superioris or part of two m. foramina at the orbital apex. Which two? A portion of the superior orbital fissure, and the OK,optic if forame not then levator, (encircled which in its muscles entirety) do give Let’srise start to the with annulus the upper of Zinn? lid, as its anatomy is likely moreThe familiar. origins of the four recti muscles comprise …but from where does it originateThere? isWhat a thewell-known isannulus the name ring-shaped of the shapedmuscle structure that is the at the prime apex which is related to muscle origins. What is the From the apex of the orbit retractor (elevator) of the upper lid? eponymous name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 50 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in
the pathogenesisFive key ophthalmic of lower-lid structures pass involutional through these entropion, foramina—and the annulus—into the orbit. What are they? lower-lid involutional--The optic nerve ectropion, or both: Enter orbit via the optic canal Horizontal--The lid ophthalmiclaxity BOTH artery --CN3 Disinsertion--CN6 of the eyelid retractorsEnter orbit via the superior orbital fissure --The nasociliary nerve (a branch of the trigeminal nerve) Upper-lid(specifically, Retraction a branch of V1 , aka the ophthalmic division) TheLevator annulus palpebrae encircles all superioris or part of two m. foramina at the orbital apex. Which two? A portion of the superior orbital fissure, and the OK,optic if forame not then levator, (encircled which in its muscles entirety) do give Let’srise start to the with annulus the upper of Zinn? lid, as its anatomy is likely moreThe familiar. origins of the four recti muscles comprise …but from where does it originateThere? isWhat a thewell-known isannulus the name ring-shaped of the shapedmuscle structure that is the at the prime apex which is related to muscle origins. What is the From the apex of the orbit retractor (elevator) of the upper lid? eponymous name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 51 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in
the pathogenesisFive key ophthalmic of lower-lid structures pass involutional through these entropion, foramina—and the annulus—into the orbit. What are they? lower-lid involutional--The optic nerve ectropion, or both: Horizontal--The lid ophthalmiclaxity BOTH artery --CN3 Disinsertion--CN6 of the eyelid retractors --The nasociliary nerve (a branch of the trigeminalcranial n. nerve) Upper-lid(specifically, Retraction a branch of V1 , aka the ophthalmic division) TheLevator annulus palpebrae encircles all superioris or part of two m. foramina at the orbital apex. Which two? A portion of the superior orbital fissure, and the OK,optic if forame not then levator, (encircled which in its muscles entirety) do give Let’srise start to the with annulus the upper of Zinn? lid, as its anatomy is likely moreThe familiar. origins of the four recti muscles comprise …but from where does it originateThere? isWhat a thewell-known isannulus the name ring-shaped of the shapedmuscle structure that is the at the prime apex which is related to muscle origins. What is the From the apex of the orbit retractor (elevator) of the upper lid? eponymous name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 52 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in
the pathogenesisFive key ophthalmic of lower-lid structures pass involutional through these entropion, foramina—and the annulus—into the orbit. What are they? lower-lid involutional--The optic nerve ectropion, or both: Horizontal--The lid ophthalmiclaxity BOTH artery --CN3 Disinsertion--CN6 of the eyelid retractors --The nasociliary nerve (a branch of the trigeminal nerve) Upper-lid(specifically, Retraction a branch of V1 , aka the ophthalmic division) TheLevator annulus palpebrae encircles all superioris or part of two m. foramina at the orbital apex. Which two? A portion of the superior orbital fissure, and the OK,optic if forame not then levator, (encircled which in its muscles entirety) do give Let’srise start to the with annulus the upper of Zinn? lid, as its anatomy is likely moreThe familiar. origins of the four recti muscles comprise …but from where does it originateThere? isWhat a thewell-known isannulus the name ring-shaped of the shapedmuscle structure that is the at the prime apex which is related to muscle origins. What is the From the apex of the orbit retractor (elevator) of the upper lid? eponymous name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 53 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in
the pathogenesisFive key ophthalmic of lower-lid structures pass involutional through these entropion, foramina—and the annulus—into the orbit. What are they? lower-lid involutional--The optic nerve ectropion, or both: Horizontal--The lid ophthalmiclaxity BOTH artery --CN3 Disinsertion--CN6 of the eyelid retractors --The nasociliary nerve (a branch of the trigeminal nerve) Upper-lid(specifically, Retraction a branch of V1# , aka the ophthalmic division) TheLevator annulus palpebrae encircles all superioris or part of two m. foramina at the orbital apex. Which two? A portion of the superior orbital fissure, and the OK,optic if forame not then levator, (encircled which in its muscles entirety) do give Let’srise start to the with annulus the upper of Zinn? lid, as its anatomy is likely moreThe familiar. origins of the four recti muscles comprise …but from where does it originateThere? isWhat a thewell-known isannulus the name ring-shaped of the shapedmuscle structure that is the at the prime apex which is related to muscle origins. What is the From the apex of the orbit retractor (elevator) of the upper lid? eponymous name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 54 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in
the pathogenesisFive key ophthalmic of lower-lid structures pass involutional through these entropion, foramina—and the annulus—into the orbit. What are they? lower-lid involutional--The optic nerve ectropion, or both: Horizontal--The lid ophthalmiclaxity BOTH artery --CN3 Disinsertion--CN6 of the eyelid retractors --The nasociliary nerve (a branch of the trigeminal nerve) Upper-lid(specifically, Retraction a branch of V1 , aka the ophthalmic division) TheLevator annulus palpebrae encircles all superioris or part of two m. foramina at the orbital apex. Which two? A portion of the superior orbital fissure, and the OK,optic if forame not then levator, (encircled which in its muscles entirety) do give Let’srise start to the with annulus the upper of Zinn? lid, as its anatomy is likely moreThe familiar. origins of the four recti muscles comprise …but from where does it originateThere? isWhat a thewell-known isannulus the name ring-shaped of the shapedmuscle structure that is the at the prime apex which is related to muscle origins. What is the From the apex of the orbit retractor (elevator) of the upper lid? eponymous name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 55 Involutional Entropion vs Involutional Ectropion
Optic nerve CN3 (superior div) Ophthalmic art. Nasociliary nerve
CN3 (inferior div) CN6 Annulus of Zinn
Key structures passing through the annulus of Zinn 56 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in
the pathogenesisFive key ophthalmic of lower-lid structures pass involutional through these entropion, lower-lid involutionalforamina—and the ecannulus—intotropion the, orbit.or both What are: they? Three--The optickey ophthalmic nerve structures pass through these Horizontalforamina,--The lid ophthalmiclaxity and the BOTH annulus,artery into the orbit. What are they? --CN3 Disinsertion--CN6 of the eyelid retractors --The nasociliary nerve (a branch of the trigeminal nerve) Upper-lid(specifically, Retraction a branch of V1 , aka the ophthalmic division) For more on the anatomy of the orbital apex, see slide-set N19 TheLevator annulus palpebrae encircles all superioris or part of two m. foramina at the orbital apex. Which two? A portion of the superior orbital fissure, and the OK,optic if forame not then levator, (encircled which in its muscles entirety) do give Let’srise start to the with annulus the upper of Zinn? lid, as its anatomy is likely moreThe familiar. origins of the four recti muscles comprise …but from where does it originateThere? isWhat a thewell-known isannulus the name ring-shaped of the shapedmuscle structure that is the at the prime apex which is related to muscle origins. What is the From the apex of the orbit retractor (elevator) of the upper lid? eponymous name of this structure? The annulusThe levator of Zinn palpebrae superioris (levator for short)
We know the levator will insert atIs the levator’sWhat structural origin a component component of the of annulusthe lid is of the Zinn? primary (or near) the superior tarsal plate…No, therecipient levator originates of the force from justexerted above by the the annulus levator, the result of which is elevation of the lid margin? The superior tarsal plate Superior tarsal plate 57 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. The levator itself doesn’t attach to the tarsal plate, rather, its ‘tendon’ does. What is the name of this tendinous structure?
???
Superior tarsal plate 58 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. The levator itself doesn’t attach to the tarsal plate, rather, its ‘tendon’ does. What is the name of this tendinous structure? The levator aponeurosis
Levator aponeurosis
Superior tarsal plate 59 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. The levator itself doesn’t attach to the tarsal plate, rather, its ‘tendon’ does. What is the name of this tendinous structure? The levator aponeurosis
Levator aponeurosis While it is the primary upper-lid retractor, the levator is not the only one. What other muscle ??? also retracts the upper lid?
Superior tarsal plate 60 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. The levator itself doesn’t attach to the tarsal plate, rather, its ‘tendon’ does. What is the name of this tendinous structure? The levator aponeurosis
Levator aponeurosis While it is the primary upper-lid retractor, the levator is not the only one. What other muscle Müeller m. also retracts the upper lid? Müller’s muscle Superior tarsal plate 61 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Note:The This levator diagram itself is doesn’t misleading attach into thatthe tarsal it suggests plate, the levatorrather, connectsits ‘tendon’ to does. the Whataponeurosis, is the name which of this in tendinous structure? turn connects to Müeller’s muscle, which then The levator aponeurosis connects to the tarsal plate. To be clear: At the point Levator aponeurosis whereWhile the levatorit is the primarytransitions upper-lid to become retractor, aponeurosis, the Müeller’slevator arises is not from the only its undersurface,one. What other and muscle both Müeller m. continuealso onretracts to the the tarsus upper inlid? parallel to one another. Müller’s muscle Superior tarsal plate 62 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Note:The This levator diagram itself is doesn’t misleading attach into thatthe tarsal it suggests plate, the levatorrather, connectsits ‘tendon’ to does. the Whataponeurosis, is the name which of this in tendinous structure? turn connects to Müeller’s muscle, which then The levator aponeurosis connects to the tarsal plate. To be clear: At the point Levator aponeurosis whereWhile the levatorit is the primarytransitions upper-lid to become retractor, aponeurosis, the Müeller’slevator arises is not from the only its undersurface,one. What other and muscle both Müeller m. continuealso onretracts to the the tarsus upper inlid? parallel to one another. Müller’s muscle Superior tarsal plate 63 Involutional Entropion vs Involutional Ectropion
Müller’s muscle, and the aponeurosis 64 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Where does Müller’s muscle originate? Where does it insert? Levator palpebrae superioris m. Deep to the distal tendon of the levator; it inserts at the superior border of the tarsal plate The levator itself doesn’t attach to the tarsal plate, Arerather, the fibers its ‘tendon’in Müller’s does. muscle What striated, is the or smooth?name of this Smoothtendinous structure? The levator aponeurosis Smooth muscle fibers…What does this indicate about the Levator aponeurosis innervation of Müller’s muscle? It indicatesWhile it itsis innervationthe primary is upper-lidvia the autonomic retractor, nervous the system (specificallylevator is in not this the case, only by one.the sympathetic What other branch) muscle Müeller m. also retracts the upper lid? Müller’s muscle Superior tarsal plate 65 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Where does Müller’s muscle originate? Where does it insert? Levator palpebrae superioris m. Deep to the distal tendon of the levator, as mentioned.; it inserts at the superior border of the tarsal plate The levator itself doesn’t attach to the tarsal plate, Arerather, the fibers its ‘tendon’in Müller’s does. muscle What striated, is the or smooth?name of this Smoothtendinous structure? The levator aponeurosis Smooth muscle fibers…What does this indicate about the Levator aponeurosis innervation of Müller’s muscle? It indicatesWhile it itsis innervationthe primary is upper-lidvia the autonomic retractor, nervous the system (specificallylevator is in not this the case, only by one.the sympathetic What other branch) muscle Müeller m. also retracts the upper lid? Müller’s muscle Superior tarsal plate 66 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Where does Müller’s muscle originate? Where does it insert? Levator palpebrae superioris m. Deep to the distal tendon of the levator, as mentioned.; it inserts at the superior border of the tarsal plate The levator itself doesn’t attach to the tarsal plate, Arerather, the fibers its ‘tendon’in Müller’s does. muscle What striated, is the or smooth?name of this Smoothtendinous structure? The levator aponeurosis Smooth muscle fibers…What does this indicate about the Levator aponeurosis innervation of Müller’s muscle? It indicatesWhile it itsis innervationthe primary is upper-lidvia the autonomic retractor, nervous the system (specificallylevator is in not this the case, only by one.the sympathetic What other branch) muscle Müeller m. also retracts the upper lid? Müller’s muscle Superior tarsal plate 67 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Where does Müller’s muscle originate? Where does it insert? Levator palpebrae superioris m. Deep to the distal tendon of the levator, as mentioned. It inserts at the superior border of the tarsal plate. The levator itself doesn’t attach to the tarsal plate, Arerather, the fibers its ‘tendon’in Müller’s does. muscle What striated, is the or smooth?name of this Smoothtendinous structure? The levator aponeurosis Smooth muscle fibers…What does this indicate about the Levator aponeurosis innervation of Müller’s muscle? It indicatesWhile it itsis innervationthe primary is upper-lidvia the autonomic retractor, nervous the system (specificallylevator is in not this the case, only by one.the sympathetic What other branch) muscle Müeller m. also retracts the upper lid? Müller’s muscle Superior tarsal plate 68 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Where does Müller’s muscle originate? Where does it insert? Levator palpebrae superioris m. Deep to the distal tendon of the levator, as mentioned. It inserts at the superior border of the tarsal plate. The levator itself doesn’t attach to the tarsal plate, Arerather, the fibers its ‘tendon’in Müller’s does. muscle What striated, is the or smooth?name of this Smoothtendinous structure? The levator aponeurosis Smooth muscle fibers…What does this indicate about the Levator aponeurosis innervation of Müller’s muscle? It indicatesWhile it itsis innervationthe primary is upper-lidvia the autonomic retractor, nervous the system (specificallylevator is in not this the case, only by one.the sympathetic What other branch) muscle Müeller m. also retracts the upper lid? Müller’s muscle Superior tarsal plate 69 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Where does Müller’s muscle originate? Where does it insert? Levator palpebrae superioris m. Deep to the distal tendon of the levator, as mentioned. It inserts at the superior border of the tarsal plate. The levator itself doesn’t attach to the tarsal plate, Arerather, the fibers its ‘tendon’in Müller’s does. muscle What striated, is the or smooth?name of this Smoothtendinous structure? The levator aponeurosis Smooth muscle fibers…What does this indicate about the Levator aponeurosis innervation of Müller’s muscle? It indicatesWhile it itsis innervationthe primary is upper-lidvia the autonomic retractor, nervous the system (specificallylevator is in not this the case, only by one.the sympathetic What other branch) muscle Müeller m. also retracts the upper lid? Müller’s muscle Superior tarsal plate 70 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Where does Müller’s muscle originate? Where does it insert? Levator palpebrae superioris m. Deep to the distal tendon of the levator, as mentioned. It inserts at the superior border of the tarsal plate. The levator itself doesn’t attach to the tarsal plate, Arerather, the fibers its ‘tendon’in Müller’s does. muscle What striated, is the or smooth?name of this Smoothtendinous structure? The levator aponeurosis Smooth muscle fibers…What does this indicate about the Levator aponeurosis innervation of Müller’s muscle? It indicatesWhile it itsis innervationthe primary is upper-lidvia the autonomic retractor, nervous the system (specificallylevator is in not this the case, only by one.the sympathetic What other branch) muscle Müeller m. also retracts the upper lid? Müller’s muscle Superior tarsal plate 71 Involutional Entropion vs Q/A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Where does Müller’s muscle originate? Where does it insert? Levator palpebrae superioris m. Deep to the distal tendon of the levator, as mentioned. It inserts at the superior border of the tarsal plate. The levator itself doesn’t attach to the tarsal plate, Arerather, the fibers its ‘tendon’in Müller’s does. muscle What striated, is the or smooth?name of this Smoothtendinous structure? The levator aponeurosis Smooth muscle fibers…What does this indicate about the innervation of Müller’s muscle? Levator aponeurosis While it is the primary upper-lid retractor, the It indicates its innervation is via the autonomicthree nervous words system (specificallylevator is in not this the case, only by one.the sympathetic What other branch) muscle Müeller m. also retracts the upper lid? Müller’s muscle Superior tarsal plate 72 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Where does Müller’s muscle originate? Where does it insert? Levator palpebrae superioris m. Deep to the distal tendon of the levator, as mentioned. It inserts at the superior border of the tarsal plate. The levator itself doesn’t attach to the tarsal plate, Arerather, the fibers its ‘tendon’in Müller’s does. muscle What striated, is the or smooth?name of this Smoothtendinous structure? The levator aponeurosis Smooth muscle fibers…What does this indicate about the Levator aponeurosis innervation of Müller’s muscle? It indicatesWhile it itsis innervationthe primary is upper-lidvia the autonomic retractor, nervous the system (specificallylevator is in not this the case, only by one.the sympathetic What other branch) muscle Müeller m. also retracts the upper lid? Müller’s muscle Superior tarsal plate 73 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Where does Müller’s muscle originate? Where does it insert? Levator palpebrae superioris m. Deep to the distal tendon of the levator, as mentioned. It inserts at the superior border of the tarsal plate. The levator itself doesn’t attach to the tarsal plate, Arerather, the fibers its ‘tendon’in Müller’s does. muscle What striated, is the or smooth?name of this Smoothtendinous structure? The levator aponeurosis Smooth muscle fibers…What does this indicate about the Levator aponeurosis innervation of Müller’s muscle? It indicatesWhile it itsis innervationthe primary is upper-lidvia the autonomic retractor, nervous the system (specificallylevator is in not this the case, only by one.the sympathetic What other branch) muscle Müeller m. also retracts the upper lid? Müller’s muscle Superior tarsal plate 74 Involutional Entropion vs QA Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Where does Müller’s muscle originate? Where does it insert? Levator palpebrae superioris m. Deep to the distal tendon of the levator, as mentioned. It inserts at the superior border of the tarsal plate. The levator itself doesn’t attach to the tarsal plate, Arerather, the fibers its ‘tendon’in Müller’s does. muscle What striated, is the or smooth?name of this Smoothtendinous structure? The levator aponeurosis Smooth muscle fibers…What does this indicate about the Levator aponeurosis innervation of Müller’s muscle? It indicatesWhile it itsis innervationthe primary is upper-lidvia the autonomic retractor, nervous the system (specificallylevator is in not this the case, only by one.the sympathetic What other branch) muscle Müeller m. also retracts the upper lid? Müller’s muscle Superior tarsal plate 75 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Hold the phone. Given that it originates at the orbital apex, how is it the levator elevates the upper lid?
Levator aponeurosis (Rhetorical question—advance to next slide) Müeller m.
Superior tarsal plate 76 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Hold the phone. Given that it originates at the orbital apex, how is it the levator elevates the upper lid? That is, why doesn’t contraction of the levator pull the upper lid margin back, ie, into the orbit?
Levator aponeurosis (OK, now answer) Müeller m.
Superior tarsal plate 77 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Hold the phone. Given that it originates at the orbital apex, how is it the levator elevates the upper lid? That is, why doesn’t contraction of the levator pull the upper lid margin back, ie, into the orbit? It’s because, on its way to the tarsal plate, the levator complex interacts with an orbital structure which acts as a Levator aponeurosis fulcrum to change the direction of the force-vector of the levator from anterior-posterior to superior-inferior. Müeller m.
Superior tarsal plate 78 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Hold the phone. Given that it originates at the orbital apex, how is it the levator elevates the upper lid? That is, why doesn’t contraction of the levator pull the upper lid margin ??? ??? back, ie, into the orbit? It’s because, on its way to the tarsal plate, the levator complex interacts with an orbital structure which acts as a Levator aponeurosis fulcrum to change the direction of the force-vector of the levator from anterior-posterior to superior-inferior.
Müeller m. What is the eponymous name of this structure?
Superior tarsal plate 79 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Hold the phone. Given that it originates at the orbital apex, how is it the levator elevates the upper lid? That is, why doesn’t contraction of the levator pull the upper lid margin Whitnall’s ligament back, ie, into the orbit? It’s because, on its way to the tarsal plate, the levator complex interacts with an orbital structure which acts as a Levator aponeurosis fulcrum to change the direction of the force-vector of the levator from anterior-posterior to superior-inferior.
Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 80 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Hold the phone. Given that it originates at the orbital apex, how is it the levator elevates the upper lid? That is, why doesn’t contraction of the levator pull the upper lid margin Whitnall’s ligament back, ie, into the orbit? At whatIt’s point because, in its forward on its way ‘journey’ to the doestarsal the plate, levator the levatorcomplex encountercomplex Whitnall’s interacts ligament? with an orbital structure which acts as a Levator aponeurosis At the pulleypoint where or fulcrum the complex to change splits the intodirection its anterior of the aponeurforce-vectorotic componentof the and levator its posterior from anteri Müeller-muscleor-posterior to component superior-inferior.
Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 81 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Hold the phone. Given that it originates at the orbital apex, how is it the levator elevates the upper lid? That is, why doesn’t contraction of the levator pull the upper lid margin Whitnall’s ligament back, ie, into the orbit? At whatIt’s point because, in its forward on its way ‘journey’ to the doestarsal the plate, levator the levatorcomplex encountercomplex Whitnall’s interacts ligament? with an orbital structure which acts as a Levator aponeurosis At the pulleypoint where or fulcrum the complex to change splits the intodirection its anterior of the aponeurforce-vectorotic componentof the and levator its posterior from anteri Müeller-muscleor-posterior to component superior-inferior.
Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 82 Involutional Entropion vs Involutional Ectropion
Whitnall’s ligament. Note the relationship to the levator muscle, as well as to the levator aponeurosis 83 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Hold the phone. Given that it originates at the orbital apex, how is it the levator elevates the upper lid? That is, why Located on doesn’tthe lateral contraction wall of the of orbitthe leva is ator protuberance pull the upper known lid margin as the Whitnall’s ligament lateral orbitalback tubercle, ie, into of Whitnallthe orbit?. Is it safe to assume that Whitnall’s ligament attachesIt’s because, to Whitnall’s(No on question its waytubercle? yet—keep to the tarsal going) plate, the levator You’d think complexso, but no. interacts The lateral with aspectan orbital of Whitnall’sstructure whichligame actsnt passes as a Levator aponeurosisthrough thepulley lacrimal or glandfulcrum to toinsert change on the the lateral direction orbital of the wal force-vectorl a mm or two aboveofWhitnall’s the levator tubercle. from anterior-posterior to superior-inferior.
Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 84 Involutional Entropion vs Involutional Ectropion
Whitnall’s tubercle 85 Involutional Entropion vs Q/A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Hold the phone. Given that it originates at the orbital apex, how is it the levator elevates the upper lid? That is, why Located on doesn’tthe lateral contraction wall of the of orbitthe leva is ator protuberance pull the upper known lid margin as the Whitnall’s ligament lateral orbitalback tubercle, ie, into of Whitnallthe orbit?. Is it safe to assume that Whitnall’s ligament attachesIt’s because, to Whitnall’s on its waytubercle? to the tarsal plate, the levator You’d think complexso, but no. interacts The lateral with aspectan orbital of Whitnall’sstructure whichligame actsnt passes as a Levator aponeurosisthrough thepulley lacrimal or glandfulcrum to toinsert change on the the lateral direction orbital of the wal force-vectorl a mm or two aboveofWhitnall’s the levator tubercle. from anterior-posterior to superior-inferior.
Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 86 Involutional Entropion vs Q/A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Hold the phone. Given that it originates at the orbital apex, how is it the levator elevates the upper lid? That is, why Located on doesn’tthe lateral contraction wall of the of orbitthe leva is ator protuberance pull the upper known lid margin as the Whitnall’s ligament lateral orbitalback tubercle, ie, into of Whitnallthe orbit?. Is it safe to assume that Whitnall’s ligament attachesIt’s because, to Whitnall’s on its waytubercle? to the tarsal plate, the levator You’d think complexso, but no. interacts The lateral with aspectan orbital of Whitnall’sstructure whichligame actsnt passes as a Levator aponeurosisthrough thepulley lacrimal or glandfulcrum to toinsert change on the the lateral direction orbital of the wal force-vectorl a mm or above? two abovebelow? ofWhitnall’s the levator tubercle. from anterior-posterior to superior-inferior. behind? Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 87 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m. Hold the phone. Given that it originates at the orbital apex, how is it the levator elevates the upper lid? That is, why Located on doesn’tthe lateral contraction wall of the of orbitthe leva is ator protuberance pull the upper known lid margin as the Whitnall’s ligament lateral orbitalback tubercle, ie, into of Whitnallthe orbit?. Is it safe to assume that Whitnall’s ligament attachesIt’s because, to Whitnall’s on its waytubercle? to the tarsal plate, the levator You’d think complexso, but no. interacts The lateral with aspectan orbital of Whitnall’sstructure whichligame actsnt passes as a Levator aponeurosisthrough thepulley lacrimal or glandfulcrum to toinsert change on the the lateral direction orbital of the wal force-vectorl a mm or two aboveofWhitnall’s the levator tubercle. from anterior-posterior to superior-inferior.
Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 88 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
OK then—ifUpper-lid not Whitnall’s ligament,Retraction what does attach to the lateral orbital tubercle of Whitnall? The attachmentsLevator arepalpebrae the ‘4 Ls superioris’: m. --The Lateral horn of the levator aponeurosis Hold the phone. Given that it originates at the orbital apex, --The Lateral canthal tendon how is it the levator elevates the upper lid? That is, why --The check ligament of the Lateral rectusLocated muscle on doesn’tthe lateral contraction wall of the of orbitthe leva is ator protuberance pull the upper known lid margin as the Whitnall’s ligament back, ie, into the orbit? --And one more L we will get to shortlylateral orbital tubercle of Whitnall. Is it safe to assume that Whitnall’s ligament attachesIt’s because, to Whitnall’s on its waytubercle? to the tarsal plate, the levator You’d think complexso, but no. interacts The lateral with aspectan orbital of Whitnall’sstructure whichligame actsnt passes as a Levator aponeurosisthrough thepulley lacrimal or glandfulcrum to toinsert change on the the lateral direction orbital of the wal force-vectorl a mm or two aboveofWhitnall’s the levator tubercle. from anterior-posterior to superior-inferior.
Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 89 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
OK then—ifUpper-lid not Whitnall’s ligament,Retraction what does attach to the lateral orbital tubercle of Whitnall? The attachments are the ‘4 Ls’: --The Lateral horn of the levator aponeurosis Hold the phone. Given that it originates at the orbital apex, --The Lateral canthal tendon how is it the levator elevates the upper lid? That is, why --The check ligament of the Lateral rectusLocated muscle on doesn’tthe lateral contraction wall of the of orbitthe leva is ator protuberance pull the upper known lid margin as the Whitnall’s ligament back, ie, into the orbit? --And one more L we will get to shortlylateral orbital tubercle of Whitnall. Is it safe to assume that Whitnall’s ligament attachesIt’s because, to Whitnall’s on its waytubercle? to the tarsal plate, the levator You’d think complexso, but no. interacts The lateral with aspectan orbital of Whitnall’sstructure whichligame actsnt passes as a Levator aponeurosisthrough thepulley lacrimal or glandfulcrum to toinsert change on the the lateral direction orbital of the wal force-vectorl a mm or two aboveofWhitnall’s the levator tubercle. from anterior-posterior to superior-inferior.
Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 90 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
OK then—ifUpper-lid not Whitnall’s ligament,Retraction what does attach to the lateral orbital tubercle of Whitnall? The attachmentsLevator arepalpebrae the ‘4 Ls superioris’: m. --The Lateral horn of the Levator aponeurosis Hold the phone. Given that it originates at the orbital apex, --The Lateral canthal tendon how is it the levator elevates the upper lid? That is, why --The check Ligament of the LateralLocated rectus muscle on doesn’tthe lateral contraction wall of the of orbitthe leva is ator protuberance pull the upper known lid margin as the Whitnall’s ligament back, ie, into the orbit? --And one more L we will get to shortly…lateral orbital tubercle of Whitnall. Is it safe to assume that Whitnall’s ligament attachesIt’s because, to Whitnall’s on its waytubercle? to the tarsal plate, the levator You’d think complexso, but no. interacts The lateral with aspectan orbital of Whitnall’sstructure whichligame actsnt passes as a Levator aponeurosisthrough thepulley lacrimal or glandfulcrum to toinsert change on the the lateral direction orbital of the wal force-vectorl a mm or two aboveofWhitnall’s the levator tubercle. from anterior-posterior to superior-inferior.
Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 91 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
OK then—ifUpper-lid not Whitnall’s ligament,Retraction what does attach to the lateral orbital tubercle of Whitnall? The attachments are the ‘4 Ls’: Levator palpebraeSpeaking of superioris the lacrimal m. gland…It is divided into palpebral and orbital lobes by a --The Lateral hornligamentous of the levator structure. aponeurosis Is that Holdstructure the phone. the lateral Given aspect that itof originates Whitnall’s at ligament? the orbital apex, --The Lateral canthalNo, tendonthe ligamentous structurehow that is divides it the levatorthe lac elevatesgland intothe lobes upper is thelid? That is, why --The check Ligamentlateral of hornthe L ateralof theLocated rectus levator muscle onaponeurosis doesn’tthe lateral contraction wall of the of orbitthe leva is ator protuberance pull the upper known lid margin as the Whitnall’s ligament back, ie, into the orbit? --And one more L we will get to shortly…lateral orbital tubercle of Whitnall. Is it safe to assume that Whitnall’s ligament attachesIt’s because, to Whitnall’s on its waytubercle? to the tarsal plate, the levator You’d think complexso, but no. interacts The lateral with aspectan orbital of Whitnall’sstructure whichligame actsnt passes as a Levator aponeurosisthrough thepulley lacrimal or fulcrum gland to to insert change on thethe directionlateral orbital of the wall force-vector a mm or two aboveofWhitnall’s the levator tubercle. from anterior-posterior to superior-inferior.
Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 92 Involutional Entropion vs Q/A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
OK then—ifUpper-lid not Whitnall’s ligament,Retraction what does attach to the lateral orbital tubercle of Whitnall? The attachments are the ‘4 Ls’: Levator palpebraeSpeaking of superioris the lacrimal m. gland…It is divided into palpebral and orbital lobes by a --The Lateral hornligamentous of the levator structure. aponeurosis Is that Holdstructure the phone. the lateral Given aspect that itof originates Whitnall’s at ligament? the orbital apex, --The Lateral canthalNo, tendonthe ligamentous structurehow that is divides it the levatorthe lac elevatesgland intothe lobes upper is thelid? That is, why doesn’t contraction of the levator pull the upper lid margin --The check Ligamentlateraltwo ofwords hornthe L ateralof theLocated rectus levator twomuscle onaponeurosis diff thewords lateral wall of the orbit is a protuberance known as the Whitnall’s ligament back, ie, into the orbit? --And one more L we will get to shortly…lateral orbital tubercle of Whitnall. Is it safe to assume that Whitnall’s ligament attachesIt’s because, to Whitnall’s on its waytubercle? to the tarsal plate, the levator You’d think complexso, but no. interacts The lateral with aspectan orbital of Whitnall’sstructure whichligame actsnt passes as a Levator aponeurosisthrough thepulley lacrimal or fulcrum gland to to insert change on thethe directionlateral orbital of the wall force-vector a mm or two aboveofWhitnall’s the levator tubercle. from anterior-posterior to superior-inferior.
Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 93 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
OK then—ifUpper-lid not Whitnall’s ligament,Retraction what does attach to the lateral orbital tubercle of Whitnall? The attachments are the ‘4 Ls’: Levator palpebraeSpeaking of superioris the lacrimal m. gland…It is divided into palpebral and orbital lobes by a --The Lateral hornligamentous of the levator structure. aponeurosis Is that Holdstructure the phone. the lateral Given aspect that itof originates Whitnall’s at ligament? the orbital apex, --The Lateral canthalNo, tendonthe ligamentous structurehow that is divides it the levatorthe lac elevatesgland intothe lobes upper is thelid? That is, why --The check Ligamentlateral of hornthe L ateralof theLocated rectus levator muscle onaponeurosis doesn’tthe lateral contraction wall of the of orbitthe leva is ator protuberance pull the upper known lid margin as the Whitnall’s ligament back, ie, into the orbit? --And one more L we will get to shortly…lateral orbital tubercle of Whitnall. Is it safe to assume that Whitnall’s ligament attachesIt’s because, to Whitnall’s on its waytubercle? to the tarsal plate, the levator You’d think complexso, but no. interacts The lateral with aspectan orbital of Whitnall’sstructure whichligame actsnt passes as a Levator aponeurosisthrough thepulley lacrimal or fulcrum gland to to insert change on thethe directionlateral orbital of the wall force-vector a mm or two aboveofWhitnall’s the levator tubercle. from anterior-posterior to superior-inferior.
Müeller m. What is the eponymous name of this structure? Whitnall’s ligament Superior tarsal plate 94 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Levator palpebrae superioris m.
Whitnall’s ligament
Now that we’ve reviewed upper-lid retraction, Levator aponeurosis let’s turn our attention to the less-familiar anatomy of lower-lid retraction Müeller m.
Superior tarsal plate Lower-lid Retraction 95 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction ? Levator palpebrae superioris m.
Whitnall’s ligament What lower-lid structure is analogous to the superior tarsal plate? Levator aponeurosis
Müeller m.
Superior tarsal plate Lower-lid Retraction 96 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m.
Whitnall’s ligament What lower-lid structure is analogous to the superior tarsal plate? Levator aponeurosis Hurr durr, the inferior tarsal plate
Müeller m.
Superior tarsal plate Lower-lid Retraction 97 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m.
Whitnall’sHow doesligament the inferior tarsal plate compare to the superior in terms of size? Like the superior, the inferior is about 30 mmWhat long, lower-lid and abou tstructure 1 mm thick. is analogous However, the inferior is only about 1/3 as tallto as the the superior superior (tarsal 4 vs 12 plate? mm) Levator aponeurosis Hurr durr, the inferior tarsal plate
Müeller m.
Superior tarsal plate Lower-lid Retraction 98 Involutional Entropion vs Q/A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m.
Whitnall’sHow doesligament the inferior tarsal plate compare to the superior in terms of size? Like the superior, the inferior is about 30# mmWhat long, lower-lid and abou tstructure 1# mm thick is analogous However, the inferior is only about 1/3 as tallto as the the superior superior (tarsal 4 vs 12 plate? mm) Levator aponeurosis Hurr durr, the inferior tarsal plate
Müeller m.
Superior tarsal plate Lower-lid Retraction 99 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m.
Whitnall’sHow doesligament the inferior tarsal plate compare to the superior in terms of size? Like the superior, the inferior is about 30 mmWhat long, lower-lid and abou tstructure 1 mm thick is analogous However, the inferior is only about 1/3 as tallto as the the superior superior (tarsal 4 vs 12 plate? mm) Levator aponeurosis Hurr durr, the inferior tarsal plate
Müeller m.
Superior tarsal plate Lower-lid Retraction 100 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m.
Whitnall’sHow doesligament the inferior tarsal plate compare to the superior in terms of size? Like the superior, the inferior is about 30 mmWhat long, lower-lid and abou tstructure 1 mm thick. is analogous However, the inferior is only about 1/3% as tallto as the the superior superior (tarsal 4 #vs vs #12 plate? mm) Levator aponeurosis Hurr durr, the inferior tarsal plate
Müeller m.
Superior tarsal plate Lower-lid Retraction 101 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m.
Whitnall’sHow doesligament the inferior tarsal plate compare to the superior in terms of size? Like the superior, the inferior is about 30 mmWhat long, lower-lid and abou tstructure 1 mm thick. is analogous However, the inferior is only about 1/3 as tallto as the the superior superior (tarsal 4 vs 12 plate? mm) Levator aponeurosis Hurr durr, the inferior tarsal plate
Müeller m.
Superior tarsal plate Lower-lid Retraction 102 Involutional Entropion vs Involutional Ectropion
Tarsal plates 103 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. What lower-lid structure is analogous to the levator palpebrae superioris? There is none. There is no skeletal (ie, striated) muscle Whitnall’s ligament involved in lower-lid retraction. Further, the lower-lid retraction complex doesn’t originate with a muscle.
Levator aponeurosis
??? Superior tarsal plate Lower-lid Retraction 104 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. What lower-lid structure is analogous to the levator palpebrae superioris? There is none. There is no skeletal (ie, striated) muscle Whitnall’s ligament involved in lower-lid retraction. Further, the lower-lid retraction complex doesn’t originate with a muscle.
Levator aponeurosis
??? Superior tarsal plate Lower-lid Retraction 105 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. What lower-lid structure is analogous to the levator palpebrae superioris? There is none. There is no skeletal (ie, striated) muscle Whitnall’s ligament involved in lower-lid retraction. Further, the lower-lid retraction complex doesn’t originate with a muscle.
Levator aponeurosis
??? Superior tarsal plate Lower-lid Retraction 106 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. What lower-lid structure is analogous to the levator palpebrae superioris? There is none. There is no skeletal (ie, striated) muscle Whitnall’s ligament involved in lower-lid retraction. Further, the lower-lid retraction complex doesn’t originate with a muscle. If not a muscle, from what does the lower-lid Levator aponeurosis retractor complex originate? From the capsulopalpebral head
??? Superior tarsal plate Lower-lid Retraction 107 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. What lower-lid structure is analogous to the levator palpebrae superioris? There is none. There is no skeletal (ie, striated) muscle Whitnall’s ligament involved in lower-lid retraction. Further, the lower-lid retraction complex doesn’t originate with a muscle. If not a muscle, from what does the lower-lid Levator aponeurosis retractor complex originate? From the capsulopalpebral head
Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 108 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m.
Is there a lower-lid equivalent of Müeller’s muscle? There is. The inferior tarsus muscle is a collection of Whitnall’s ligament smooth-muscle fibers. innervated by sympathetics. (It is not nearly as well developed as Müeller’s, however.)
Levator aponeurosis ??? Müeller muscle Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 109 Involutional Entropion vs Q/A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m.
Is there a lower-lid equivalent of Müeller’s muscle? There is. The inferiortwo words tarsus muscle is a collection of Whitnall’s ligament smooth-muscle fibers innervated by sympathetics. (It is not nearly as well developed as Müeller’s, however.)
Levator aponeurosis ??? Müeller muscle Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 110 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m.
Is there a lower-lid equivalent of Müeller’s muscle? There is. The inferior tarsus muscle is a collection of Whitnall’s ligament smooth-muscle fibers innervated by sympathetics. (It is not nearly as well developed as Müeller’s, however.)
Levator aponeurosis Inferior tarsal muscle Müeller muscle Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 111 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. ???
Whitnall’s ligament What is the lower-lid analogue for the levator aponeurosis? It is called the capsulopalpebral fascia (not to be confused with the capsulopalpebral head with which it is associated) Levator aponeurosis Inferior tarsal muscle Müeller m. Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 112 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. Capsulopalpebral fascia
Whitnall’s ligament What is the lower-lid analogue for the levator aponeurosis? It is called the capsulopalpebral fascia (not to be confused with the capsulopalpebral head with which it is associated) Levator aponeurosis Inferior tarsal muscle Müeller m. Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 113 Involutional Entropion vs Involutional Ectropion
Capsulopalpebral fascia 114 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH pick up Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. Capsulopalpebral fascia
And as was the case in the upper lid, is there Whitnall’s ligament an orbital structure that redirects the force- vector of the lower-lid retractors from A-P to ? superior-inferior, ie, is there a lower-lid Levator aponeurosis analogue to Whitnall’s ligament? Inferior tarsal muscle Müeller m. Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 115 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH pick up Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. Capsulopalpebral fascia
And as was the case in the upper lid, is there Whitnall’s ligament an orbital structure that redirects the force- Indeed there is! vector of the lower-lid retractors from A-P to ! superior-inferior, ie, is there a lower-lid Levator aponeurosis analogue to Whitnall’s ligament? Inferior tarsal muscle Müeller m. Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 116 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. Capsulopalpebral fascia
Whitnall’s ligament What is the name of this structure? ??? ???
Levator aponeurosis Inferior tarsal muscle Müeller m. Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 117 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. Capsulopalpebral fascia
Whitnall’s ligament What is the name of this structure? Lockwood’s ligament
Levator aponeurosis Inferior tarsal muscle Müeller m. Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 118 Involutional Entropion vs Involutional Ectropion
Lockwood’s ligament 119 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. Capsulopalpebral fascia
Whitnall’s ligament Lockwood’s ligament
Levator aponeurosisTo what does Lockwood’s ligament attach in the lateral orbit? (You think you don’t know, but you do.) Inferior tarsal muscle To Whitnall’s tubercle (it’s the fourth ‘L’ alluded to previously) Müeller m. Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 120 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
OK then—ifUpper-lid not Whitnall’s ligament,Retraction what does attach Inferior tarsal plate to the lateral orbital tubercle of Whitnall? The attachmentsLevator arepalpebrae the ‘4 Ls superioris’: m. --The Lateral horn of the Levator aponeurosis Capsulopalpebral fascia --The Lateral canthal tendon --The checkWhitnall’s Ligament of ligament the Lateral rectus muscle --Lockwood’s ligament Lockwood’s ligament
Levator aponeurosisTo what does Lockwood’s ligament attach in the lateral orbit? (You think you don’t know, but you do.) Inferior tarsal muscle To Whitnall’s tubercle (it’s the fourth ‘L’ alluded to previously) Müeller m. Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 121 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
Upper-lid Retraction Inferior tarsal plate Levator palpebrae superioris m. Capsulopalpebral fascia
Whitnall’s ligament Review slide—no question Lockwood’s ligament
Levator aponeurosis Inferior tarsal muscle Müeller m. Capsulopalpebral head Superior tarsal plate Lower-lid Retraction 122 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors
(OK, now we’re ready to answer this question) 123 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
(OK, now we’re ready to answer this question) 124 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
Other than entropion or ectropion, what signs might be present that would suggest the lower-lid retractors have disinserted? ------125 Involutional Entropion vs Q/A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
Other than entropion or ectropion, what signs might be present that would suggest the lower-lid retractors have disinserted? --The lower-lid margin might be riding high (aka reversetwo words ptosis ) -- -- 126 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
Other than entropion or ectropion, what signs might be present that would suggest the lower-lid retractors have disinserted? --The lower-lid margin might be riding high (aka reverse ptosis ) -- -- 127 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
Other than entropion or ectropion, what signs might be present that would suggest the lower-lid retractors have disinserted? --The lower-lid margin might be riding high (aka reverse ptosis ) --The failure of the lower lid to retract during downgazeone word -- 128 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
Other than entropion or ectropion, what signs might be present that would suggest the lower-lid retractors have disinserted? --The lower-lid margin might be riding high (aka reverse ptosis ) --The failure of the lower lid to retract during downgaze -- 129 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
Other than entropion or ectropion, what signs might be present that would suggest the lower-lid retractors have disinserted? --The lower-lid margin might be riding high (aka reverse ptosis ) --The failure of the lower lid to retract during downgaze --The presence of a whitetwo words line beneath the conj a mm or two below the inferior border of the tarsal plate 130 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
Other than entropion or ectropion, what signs might be present that would suggest the lower-lid retractors have disinserted? --The lower-lid margin might be riding high (aka reverse ptosis ) --The failure of the lower lid to retract during downgaze --The presence of a white line beneath the conj a mm or two below the inferior border of the tarsal plate 131 Involutional Entropion vs Involutional Ectropion
Patient with entropion of the right lower eyelid. Green arrow demonstrates the “white line.” 132 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
Other than entropion or ectropion, what signs might be present that would suggest the lower-lid retractors have disinserted? --The lower-lid margin might be riding high (aka reverse ptosis ) --The failure of the lower lid to retract during downgaze --The presence of a white line beneath the conj a mm or two below the inferior border of the tarsal plate; this line is in fact the
leading edge of thelotsa wordsdetached retractors 133 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
Other than entropion or ectropion, what signs might be present that would suggest the lower-lid retractors have disinserted? --The lower-lid margin might be riding high (aka reverse ptosis ) --The failure of the lower lid to retract during downgaze --The presence of a white line beneath the conj a mm or two below the inferior border of the tarsal plate; this line is in fact the leading edge of the detached retractors 134 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
Other than entropion or ectropion, what signs might be present that would suggest the lower-lid retractors have disinserted? --The lower-lid margin might be riding high (aka reverse ptosis ) --The failure of the lower lid to retract during downgaze I see--The how presencedisinsertion of of a the white retractors line wouldbeneath lead the to elevat conjion a mm of the or lower-lidtwo margin, but how might it contribute to rotation of the margin? In thisbelow regard, the it’sinferior important border to note of the that, tarsal like the plate; levator this aponeurosis line is in fact in the the upper lid, theleading capsulopalpebral edge of the fascia detached does not retractorsinsert solely onto the tarsal plate; rather, it sends tendrils to the skin and orbicularis overlying the plate. Thus, in addition to keeping the inferior tarsal plate from riding up, the retractor also keeps it from riding out, ie, away from the globe. You can imagine how, when coupled with horizontal lid laxity, allowing the inferior margin of the tarsal plate to drift away from the globe would let its upper margin rotate this way and that. 135 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
Other than entropion or ectropion, what signs might be present that would suggest the lower-lid retractors have disinserted? --The lower-lid margin might be riding high (aka reverse ptosis ) --The failure of the lower lid to retract during downgaze I see--The how presencedisinsertion of of a the white retractors line wouldbeneath lead the to elevat conjion a mm of the or lower-lidtwo margin, but how might it contribute to rotation of the margin? In thisbelow regard, the it’sinferior important border to note of the that, tarsal like the plate; levator this aponeurosis line is in fact in the the upper lid, theleading capsulopalpebral edge of the fascia detached does not retractorsinsert solely onto the tarsal plate; rather, it sends tendrils to the skin and orbicularis overlying the plate. Thus, in addition to keeping the inferior tarsal plate from riding up, the retractor also keeps it from riding out, ie, away from the globe. You can imagine how, when coupled with horizontal lid laxity, allowing the inferior margin of the tarsal plate to drift away from the globe would let its upper margin rotate this way and that. 136 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH
Other than entropion or ectropion, what signs might be present that would suggest the lower-lid retractors have disinserted? --The lower-lid margin might be riding high (aka reverse ptosis ) --The failure of the lower lid to retract during downgaze I see--The how presencedisinsertion of of a the white retractors line wouldbeneath lead the to elevat conjion a mm of the or lower-lidtwo margin, but how might it contribute to rotation of the margin? In thisbelow regard, the it’sinferior important border to note of the that, tarsal like the plate; levator this aponeurosis line is in fact in the the upper lid, theleading capsulopalpebral edge of the fascia detached does not retractorsinsert solely onto the tarsal plate; rather, it sends tendrils to the skin and orbicularis overlying the plate. Thus, in addition to keeping the inferior tarsal plate from riding up, the retractor also keeps it from riding out, ie, away from the globe. You can imagine how, when coupled with horizontal lid laxity, allowing the inferior margin of the tarsal plate to drift away from the globe would let its upper margin rotate in (or out). 137 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process 138 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH 139 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH How does enophthalmos contribute to lower-lid malpositioning? It’s pretty straightforward. If the globe is sitting deeper in the orbit, it follows that its apposition against the lid will be less robust, which will in turn increase ‘slack’ in the lid. And anything that contributes to lid laxity increases the likelihood that lid-margin malpositioning will occur. 140 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH How does enophthalmos contribute to lower-lid malpositioning? It’s pretty straightforward. If the globe is sitting deeper in the orbit, it follows that its apposition against the lid will be less robust, which will in turn increase ‘slack’ in the lid. And anything that contributes to lid laxity increases the likelihood that lid-margin malpositioning will occur. 141 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH How does enophthalmos contribute to lower-lid malpositioning? It’s pretty straightforward. If the globe is sitting deeper in the orbit, it follows that its apposition against the lid will be less robust, which will in turn increase ‘slack’ in the lid. And anything that contributes to lid laxity increases the likelihood that lid-margin malpositioning will occur. 142 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis 143 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis
Before we answer this question, let’s review the anatomy of the orbicularis muscle 144 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? 145 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture 146 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts— what are they? How are they defined? --? --? 147 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts— what are they? How are they defined? --Orbital --Palpebral 148 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts— what are they? There’sHow are a fundamental they defined? functional distinction between the orbital and --Orbital palpebral portions. What is it? --Palpebral The palpebral portion is responsible for normal blinking, whereas the orbital portion comes into play only during effortful/voluntary eye closure 149 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts— what are they? There’sHow are a fundamental they defined? functional distinction between the orbital and --Orbital palpebral portions. What is it? --Palpebral The palpebral portion is responsible for normal blinking, whereas the orbital portion comes into play only during effortful/voluntary eye closure 150 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts— what are they? How are they defined? --Orbital: ? --Palpebral: ? 151 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts— what are they? How are they defined? --Orbital: The portion overlying orbital bone --Palpebral: The portion overlying the lids 152 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts— what are they? --Orbital: The portion overlying orbital bone --Palpebral: The portion overlying the lids ----? ----? 153 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts— what are they? --Orbital: The portion overlying orbital bone --Palpebral: The portion overlying the lids ----Preseptal ----Pretarsal 154 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts— what are they? How are they defined? --Orbital: The portion overlying orbital bone --Palpebral: The portion overlying the lids ----Preseptal: ? ----Pretarsal: ? 155 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts— what are they? How are they defined? --Orbital: The portion overlying orbital bone --Palpebral: The portion overlying the lids ----Preseptal: The part overlying the orbital septum ----Pretarsal: The part overlying the tarsal plates 156 Involutional Entropion vs Involutional Ectropion
Orbicularis oculi 157 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
ThereThe ‘multiple is a special bands’ slip of are pretarsal organized orbicu larisinto thattwo isbasic located portions—what at the surface are they? ofHow the lidare margin. they defined? What is the The eponymous palpebral name? portion is further subdivided into two parts— The muscle of Riolan what are they? How are they defined? What--Orbital: is its appearancThe portione-based, overlying non-eponymous orbital bone name? The--Palpebral: gray line The portion overlying the lids ----Preseptal: The part overlying the orbital septum ----Pretarsal: The part overlying the tarsal plates 158 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
ThereThe ‘multiple is a special bands’ slip of are pretarsal organized orbicu larisinto thattwo isbasic located portions—what at the surface are they? ofHow the lidare margin. they defined? What is the The eponymous palpebral name? portion is further subdivided into two parts— The muscle of Riolan what are they? How are they defined? What--Orbital: is its appearancThe portione-based, overlying non-eponymous orbital bone name? The--Palpebral: gray line The portion overlying the lids ----Preseptal: The part overlying the orbital septum ----Pretarsal: The part overlying the tarsal plates 159 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
ThereThe ‘multiple is a special bands’ slip of are pretarsal organized orbicu larisinto thattwo isbasic located portions—what at the surface are they? ofHow the lidare margin. they defined? What is the The eponymous palpebral name? portion is further subdivided into two parts— The muscle of Riolan what are they? How are they defined? What--Orbital: is its appearancThe portione-based, overlying non-eponymous orbital bone name? The--Palpebral: gray line The portion overlying the lids ----Preseptal: The part overlying the orbital septum ----Pretarsal: The part overlying the tarsal plates 160 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis What is the basic arrangement of the fibers of the orbicularis? As multiple concentric bands encircling all or part of the orbital aperture
ThereThe ‘multiple is a special bands’ slip of are pretarsal organized orbicu larisinto thattwo isbasic located portions—what at the surface are they? ofHow the lidare margin. they defined? What is the The eponymous palpebral name? portion is further subdivided into two parts— The muscle of Riolan what are they? How are they defined? What--Orbital: is its appearancThe portione-based, overlying non-eponymous orbital bone name? The--Palpebral: gray line The portion overlying the lids ----Preseptal: The part overlying the orbital septum ----Pretarsal: The part overlying the tarsal plates 161 Involutional Entropion vs Involutional Ectropion
Muscle of Riolan (aka the gray line) 162 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis
(OK, now we’re ready to answer it) 163 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis ENTROPION ONLY
(OK, now we’re ready to answer it) 164 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis ENTROPION ONLY Let’s unpack this, because it’s really important. What does it mean to say the preseptal orbicularis ‘overrides’? Overrides what? 165 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis ENTROPION ONLY Let’s unpack this, because it’s really important. What does it mean to say the preseptal orbicularis ‘overrides’? Overrides what? It overrides the pretarsal orbicularis, ie, it slips up from its normal anatomic location below (inferior to) the pretarsal portion to lie atop or even above it 166 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis ENTROPION ONLY Let’s unpack this, because it’s really important. What does it mean to say the preseptal orbicularis ‘overrides’? Overrides what? It overrides the pretarsal orbicularis, ie, it slips up from its normal anatomic location below (inferior to) the pretarsal portion to lie atop or even above it
OK, but how does override lead to entropion? 167 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis ENTROPION ONLY Let’s unpack this, because it’s really important. What does it mean to say the preseptal orbicularis ‘overrides’? Overrides what? It overrides the pretarsal orbicularis, ie, it slips up from its normal anatomic location below (inferior to) the pretarsal portion to lie atop or even above it
OK, but how does override lead to entropion? Recall that these fibers are adherent to the preseptal skin overlying them. Thus, when these fibers ride up and over the tarsal plate, they bring with them tissue that belongs below the plate. 168 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity BOTH Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process BOTH Override of the preseptal orbicularis ENTROPION ONLY Let’s unpack this, because it’s really important. What does it mean to say the preseptal orbicularis ‘overrides’? Overrides what? It overrides the pretarsal orbicularis, ie, it slips up from its normal anatomic location below (inferior to) the pretarsal portion to lie atop or even above it
OK, but how does override lead to entropion? Recall that these fibers are adherent to the preseptal skin overlying them. Thus, when these fibers ride up and over the tarsal plate, they bring with them tissue that belongs below the plate. This leads to the inferior border of the tarsal plate rotating out, and causes the superior border to rotate in. 169 Involutional Entropion vs Involutional Ectropion
(A) Normal lower eyelid anatomy. The retractors pull the lower margin of the tarsus inferiorly and posteriorly, stabilizing the eyelid. 170 Involutional Entropion vs Involutional Ectropion
(A) Normal lower eyelid anatomy. The retractors (B) Involutional entropion. Note that the retractors pull the lower margin of the tarsus inferiorly and are detached from the tarsus. The preseptal posteriorly, stabilizing the eyelid. orbicularis is riding up and over the pretarsal portion, in the process inverting the lid margin. 171 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process
The takeaway point: Involutional entropion and ectropion of the lower lid have very similar pathogeneses. The determining factor re whether an individual will develop one vs the other is the status of the preseptal orbicularis. If it doesn’t override the lid margin, the lid will flop outward, and the pt will have ectropion. But if the preseptal orbicularis does override the lid margin, the margin will turn inward, resulting in entropion. 172 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process Override of the preseptal orbicularis?
The takeaway point: Involutional entropion and ectropion of the lower lid have very similar pathogeneses. The determining factor re whether an individual will develop one vs the other is the status of the preseptal orbicularis. If it doesn’t override the lid margin, the lid will flop outward, and the pt will have ectropion. But if the preseptal orbicularis does override the lid margin, the margin will turn inward, resulting in entropion. 173 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process Override of the preseptal orbicularis? NO ECTROPION
The takeaway point: Involutional entropion and ectropion of the lower lid have very similar pathogeneses. The determining factor re whether an individual will develop one vs the other is the status of the preseptal orbicularis. If it doesn’t override the lid margin, the lid will flop outward, and the pt will have ectropion. But if the preseptal orbicularis does override the lid margin, the margin will turn inward, resulting in entropion. 174 Involutional Entropion vs Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lid involutional entropion, lower-lid involutional ectropion, or both: Horizontal lid laxity Disinsertion of the eyelid retractors BOTH Enophthalmos due to loss of orbital fat as part of the normal aging process Override of the preseptal orbicularis? YES ENTROPION
The takeaway point: Involutional entropion and ectropion of the lower lid have very similar pathogeneses. The determining factor re whether an individual will develop one vs the other is the status of the preseptal orbicularis. If it doesn’t override the lid margin, the lid will flop outward, and the pt will have ectropion. But if the preseptal orbicularis does override the lid margin, the margin will turn inward, resulting in entropion. 175 Involutional Entropion vs Q Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-upper-lid involutional entropion, upper-lower-lid involutional ectropion, or both: Horizontal lid laxity?
Disinsertion of the eyelid retractors? Which of these play a role in the Enophthalmos due to loss of orbital fat pathogenesis of upper -lid as part of the normal aging process? involutional entropion/ectropion? Override of the preseptal orbicularis? 176 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-upper-lid involutional entropion, upper-lower-lid involutional ectropion, or both: Horizontal lid laxity?
Disinsertion of the eyelid retractors? Which of these play a role in the Enophthalmos due to loss of orbital fat pathogenesis of upper -lid as part of the normal aging process? involutional entropion/ectropion? Trick question. The upper lid is Override of the preseptal orbicularis? generally not subject to involutional changes of the sort that alter the configuration of the lid margin. 177 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-upper-lid involutional entropion, upper-lower-lid involutional ectropion, or both: Horizontal lid laxity?
Disinsertion of the eyelid retractors? Which of these play a role in the Enophthalmos due to loss of orbital fat pathogenesis of upper -lid as part of the normal aging process? involutional entropion/ectropion? Trick question. The upper lid is Override of the preseptal orbicularis? generally not subject to involutional changes of the sort that alter the configuration of the lid margin.
TL;DR People don’t get upper- lid involutional entropion or ectropion 178 Involutional Entropion vs A Involutional Ectropion
For each of the following, state whether it plays a role in the pathogenesis of lower-lidupper- involutional entropion, upper-lower-lid involutional ectropion, or both: Horizontal lid laxity?
Disinsertion of the eyelid retractors? Which of these play a role in the Enophthalmos due to loss of orbital fat pathogenesis of upper -lid as part of the normal aging process? involutional entropion/ectropion? Trick question. The upper lid is Override of the preseptal orbicularis? generally not subject to involutional changes of the sort that alter the configuration of the lid margin.
TL;DR People don’t get upper- lid involutional entropion or ectropion
But to be clear, entropion and ectropion 2ndry to other mechanisms can occur in the upper lid 179 Involutional Entropion vs Q Involutional Ectropion
An elderly patient presents with what you diagnose as involutional entropion. What should you do for the patient today?
1) 2) 180 Involutional Entropion vs A Involutional Ectropion
An elderly patient presents with what you diagnose as involutional entropion. What should you do for the patient today?
1) Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 181 Involutional Entropion vs Q Involutional Ectropion What are Quickert (aka Quickert-Rathbun) sutures? A suturing technique that everts an entropic lid
What suture material is used? Preferences vary, but 4-0 silk or chromic work well An elderly patient presents with what you Briefly, how are they placed? And how do they work? diagnoseThe pass starts just belowas involutionalthe lash line traveling down entropion. and posterior, passing What in front of and then below the tarsal plate. It comes out on the conj surface shortly before the inferior fornix. shouldWhen cinched, you the suture do torques for the theinward-curling patient lid away frtodayom the globe.? How many throws are placed? Usually three 1) Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 182 Involutional Entropion vs A Involutional Ectropion What are Quickert (aka Quickert-Rathbun) sutures? A suturing technique that everts an entropic lid
What suture material is used? Preferences vary, but 4-0 silk or chromic work well An elderly patient presents with what you Briefly, how are they placed? And how do they work? diagnoseThe pass starts just belowas involutionalthe lash line traveling down entropion. and posterior, passing What in front of and then below the tarsal plate. It comes out on the conj surface shortly before the inferior fornix. shouldWhen cinched, you the suture do torques for the theinward-curling patient lid away frtodayom the globe.? How many throws are placed? Usually three 1) Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 183 Involutional Entropion Involutionalvs entropion Involutionalvs Ectropion Q Involution ectropion What are Quickert (aka Quickert-Rathbun) sutures? A suturing technique that everts an entropic lid
What suture material is used? Preferences vary, but 4-0 silk or chromic work well An elderly patient presents with what you Briefly, how are they placed? And how do they work? diagnoseThe pass starts just belowas involutionalthe lash line traveling down entropion. and posterior, passing What in front of and then below the tarsal plate. It comes out on the conj surface shortly before the inferior fornix. shouldWhen cinched, you the suture do torques for the theinward-curling patient lid away frtodayom the globe.? How many throws are placed? Usually three 1) Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 184 Involutional Entropion vs A Involutional Ectropion What are Quickert (aka Quickert-Rathbun) sutures? A suturing technique that everts an entropic lid
What suture material is used? Preferences vary, but 4-0 silk or chromic work well An elderly patient presents with what you Briefly, how are they placed? And how do they work? diagnoseThe pass starts just belowas involutionalthe lash line traveling down entropion. and posterior, passing What in front of and then below the tarsal plate. It comes out on the conj surface shortly before the inferior fornix. shouldWhen cinched, you the suture do torques for the theinward-curling patient lid away frtodayom the globe.? How many throws are placed? Usually three 1) Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 185 Involutional Entropion vs Q Involutional Ectropion What are Quickert (aka Quickert-Rathbun) sutures? A suturing technique that everts an entropic lid
What suture material is used? Preferences vary, but 4-0 silk or chromic work well An elderly patient presents with what you Briefly, how are they placed? And how do they work? diagnoseThe pass starts just belowas involutionalthe lash line traveling down entropion. and posterior, passing What in front of and then below the tarsal plate. It comes out on the conj surface shortly before the inferior fornix. shouldWhen cinched, you the suture do torques for the theinward-curling patient lid away frtodayom the globe.? How many throws are placed? Usually three 1) Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 186 Involutional Entropion vs A Involutional Ectropion What are Quickert (aka Quickert-Rathbun) sutures? A suturing technique that everts an entropic lid
What suture material is used? Preferences vary, but 4-0 silk or chromic work well An elderly patient presents with what you Briefly, how are they placed? And how do they work? diagnoseThe pass starts just belowas involutionalthe lash line traveling down entropion. and posterior, passing What in front of and then below the tarsal plate. It comes out on the conj surface shortly before the inferior fornix. shouldWhen cinched, you the suture do torques for the theinward-curling patient lid away frtodayom the globe.? How many throws are placed? Usually three 1) Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 187 Involutional Entropion vs Q Involutional Ectropion What are Quickert (aka Quickert-Rathbun) sutures? A suturing technique that everts an entropic lid
What suture material is used? Preferences vary, but 4-0 silk or chromic work well An elderly patient presents with what you Briefly, how are they placed? And how do they work? diagnoseThe pass starts just belowas involutionalthe lash line traveling down entropion. and posterior, passing What in front of and then below the tarsal plate. It comes out on the conj surface shortly before the inferior fornix. shouldWhen cinched, you the suture do torques for the theinward-curling patient lid away frtodayom the globe.? How many throws are placed? Usually three 1) Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 188 Involutional Entropion vs A Involutional Ectropion What are Quickert (aka Quickert-Rathbun) sutures? A suturing technique that everts an entropic lid
What suture material is used? Preferences vary, but 4-0 silk or chromic work well An elderly patient presents with what you Briefly, how are they placed? And how do they work? diagnoseThe pass starts just belowas involutionalthe lash line traveling down entropion. and posterior, passing What in front of and then below the tarsal plate. It comes out on the conj surface shortly before the inferior fornix. shouldWhen cinched, you the suture do torques for the theinward-curling patient lid away frtodayom the globe.? How many throws are placed? Usually three 1) Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 189 Involutional Entropion vs Q Involutional Ectropion What are Quickert (aka Quickert-Rathbun) sutures? A suturing technique that everts an entropic lid
What suture material is used? Preferences vary, but 4-0 silk or chromic work well An elderly patient presents with what you Briefly, how are they placed? And how do they work? diagnoseThe pass starts just belowas involutionalthe lash line traveling down entropion. and posterior, passing What in front of and then below the tarsal plate. It comes out on the conj surface shortly before the inferior fornix. shouldWhen cinched, you the suture do torques for the theinward-curling patient lid away frtodayom the globe.? How many throws are placed? Usually three 1) Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 190 Involutional Entropion vs A Involutional Ectropion What are Quickert (aka Quickert-Rathbun) sutures? A suturing technique that everts an entropic lid
What suture material is used? Preferences vary, but 4-0 silk or chromic work well An elderly patient presents with what you Briefly, how are they placed? And how do they work? diagnoseThe pass starts just belowas involutionalthe lash line traveling down entropion. and posterior, passing What in front of and then below the tarsal plate. It comes out on the conj surface shortly before the inferior fornix. shouldWhen cinched, you the suture do torques for the theinward-curling patient lid away frtodayom the globe.? How many throws are placed? Usually three 1) Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 191 Involutional Entropion vs Involutional Ectropion
Quickert sutures 192 Involutional Entropion vs Q Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the same two therapeutic goals: 1) 2) 193 Involutional Entropion vs Q/A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the same two therapeutic goals: 1) Horizontalsurgical lid maneuver tightening to address laxity, and 2) 194 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the same two therapeutic goals: 1) Horizontal lid tightening to address laxity, and 2) 195 Involutional Entropion vs Q Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the same two therapeutic goals: 1) Horizontal lid tightening to address laxity, and 2) Permanent re-insertion of the lower-lid retractors
This is usually accomplished with a lateralthree tarsal words strip procedure 196 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the same two therapeutic goals: 1) Horizontal lid tightening to address laxity, and 2) Permanent re-insertion of the lower-lid retractors
This is usually accomplished with a lateral tarsal strip procedure 197 Involutional Entropion vs Q Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? sameA lateral canthotomy/inferiortwo therapeutic cantholysis goals: is performed, and the lateral aspect of the tarsus is exposed by removing from it the anterior and posterior lid lamellae, 1)as Horizontal well as the mucocutaneous lid tightening junction at to the addresslid margin. The laxity, lateral end and is trimmed, and the newly-exposed end is sutured to the periosteum of the internal aspect of 2)the Permanent lateral orbital wall. re-insertion of the lower-lid retractors
This is usually accomplished with a lateral tarsal strip procedure 198 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? sameA lateral canthotomy/inferiortwo therapeutic cantholysis goals: is performed, and the lateral aspect of the tarsus is exposed by removing from it the anterior and posterior lid lamellae, 1)as Horizontal well as the mucocutaneous lid tightening junction at to the addresslid margin. The laxity, lateral end and is trimmed, and the newly-exposed end is sutured to the periosteum of the internal aspect of 2)the Permanent lateral orbital wall. re-insertion of the lower-lid retractors
This is usually accomplished with a lateral tarsal strip procedure 199 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? sameA lateral canthotomy/inferiortwo therapeutic cantholysis goals: is performed, and the lateral aspect of the tarsus is exposed by removing from it the anterior and posterior lid lamellae, 1)as Horizontal well as the mucocutaneous lid tightening junction at to the addresslid margin. The laxity, lateral end and is trimmed, and the newly-exposed end is sutured to the periosteum of the internal aspect of 2)the Permanent lateral orbital wall. re-insertion of the lower-lid retractors
This is usually accomplished with a lateral tarsal strip procedure 200 Involutional Entropion vs Involutional Ectropion
Lateral tarsal strip procedure. A, Lateral stretching of the eyelid demonstrates the potential of lower lid tightening. (Note: The is pt has ectropion, not entropion.) 201 Involutional Entropion vs Involutional Ectropion
Lateral tarsal strip procedure. A, Lateral stretching of the eyelid demonstrates the potential of lower lid tightening. (Note: The is pt has ectropion, not entropion.) B, Lateral tarsal strip procedure: anchoring of tarsal strip to periosteum inside the lateral orbital rim. 202 Involutional Entropion vs Q Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? sameA lateral canthotomy/inferiortwo therapeutic cantholysis goals: is performed, and the lateral aspect of the tarsus is exposed by removing from it the anterior and posterior lid lamellae, 1)as Horizontal well as the mucocutaneous lid tightening junction at to the addresslid margin. The laxity, lateral end and is trimmed, and the newly-exposed end is sutured to the periosteum of the internal aspect of 2)the Permanent lateralThis orbital is a concept wall. re-insertion we haven’t addressed of previous the ly.lower-lid What’s with the retractors idea of ‘lid lamellae’? Newsflash: Eyelids are anatomically complex. The ‘lamella’ notion greatly simplifies their anatomy by conceptualizing the lids as being composed of only two parts—an anterior This is usuallylamella, accomplishedand a posterior one. with a lateral tarsal strip procedure
What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and conjunctiva 203 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? sameA lateral canthotomy/inferiortwo therapeutic cantholysis goals: is performed, and the lateral aspect of the tarsus is exposed by removing from it the anterior and posterior lid lamellae, 1)as Horizontal well as the mucocutaneous lid tightening junction at to the addresslid margin. The laxity, lateral end and is trimmed, and the newly-exposed end is sutured to the periosteum of the internal aspect of 2)the Permanent lateralThis orbital is a concept wall. re-insertion we haven’t addressed of previous the ly.lower-lid What’s with the retractors idea of ‘lid lamellae’? Newsflash: Eyelids are anatomically complex. The ‘lamella’ notion greatly simplifies their anatomy by conceptualizing the lids as being composed of only two parts—an anterior This is usuallylamella, accomplishedand a posterior one. with a lateral tarsal strip procedure
What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and conjunctiva 204 Involutional Entropion vs Q Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? sameA lateral canthotomy/inferiortwo therapeutic cantholysis goals: is performed, and the lateral aspect of the tarsus is exposed by removing from it the anterior and posterior lid lamellae, 1)as Horizontal well as the mucocutaneous lid tightening junction at to the addresslid margin. The laxity, lateral end and is trimmed, and the newly-exposed end is sutured to the periosteum of the internal aspect of 2)the Permanent lateralThis orbital is a concept wall. re-insertion we haven’t addressed of previous the ly.lower-lid What’s with the retractors idea of ‘lid lamellae’? Newsflash: Eyelids are anatomically complex. The ‘lamella’ notion greatly simplifies their anatomy by conceptualizing the lids as being composed of only two parts—an anterior This is usuallylamella, accomplishedand a posterior one. with a lateral tarsal strip procedure
What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and conjunctiva 205 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? sameA lateral canthotomy/inferiortwo therapeutic cantholysis goals: is performed, and the lateral aspect of the tarsus is exposed by removing from it the anterior and posterior lid lamellae, 1)as Horizontal well as the mucocutaneous lid tightening junction at to the addresslid margin. The laxity, lateral end and is trimmed, and the newly-exposed end is sutured to the periosteum of the internal aspect of 2)the Permanent lateralThis orbital is a concept wall. re-insertion we haven’t addressed of previous the ly.lower-lid What’s with the retractors idea of ‘lid lamellae’? Newsflash: Eyelids are anatomically complex. The ‘lamella’ notion greatly simplifies their anatomy by conceptualizing the lids as being composed of only two parts—an anterior This is usuallylamella, accomplishedand a posterior one. with a lateral tarsal strip procedure
What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and conjunctiva 206 Involutional Entropion vs Q Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? sameA lateral canthotomy/inferiortwo therapeutic cantholysis goals: is performed, and the lateral aspect of the tarsus is exposed by removing from it the anterior and posterior lid lamellae, 1)as Horizontal well as the mucocutaneous lid tightening junction at to the addresslid margin. The laxity, lateral end and is trimmed, and the newly-exposed end is sutured to the periosteum of the internal aspect of 2)the Permanent lateralThis orbital is a concept wall. re-insertion we haven’t addressed of previous the ly.lower-lid What’s with the retractors idea of ‘lid lamellae’? Newsflash: Eyelids are anatomically complex. The ‘lamella’ notion greatly simplifies their anatomy by conceptualizing the lids as being composed of only two parts—an anterior This is usuallylamella, accomplishedand a posterior one. with a lateral tarsal strip procedure
What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and conjunctiva 207 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? sameA lateral canthotomy/inferiortwo therapeutic cantholysis goals: is performed, and the lateral aspect of the tarsus is exposed by removing from it the anterior and posterior lid lamellae, 1)as Horizontal well as the mucocutaneous lid tightening junction at to the addresslid margin. The laxity, lateral end and is trimmed, and the newly-exposed end is sutured to the periosteum of the internal aspect of 2)the Permanent lateralThis orbital is a concept wall. re-insertion we haven’t addressed of previous the ly.lower-lid What’s with the retractors idea of ‘lid lamellae’? Newsflash: Eyelids are anatomically complex. The ‘lamella’ notion greatly simplifies their anatomy by conceptualizing the lids as being composed of only two parts—an anterior This is usuallylamella, accomplishedand a posterior one. with a lateral tarsal strip procedure
What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and conjunctiva 208 Involutional Entropion vs Involutional Ectropion
Eyelid lamellae 209 Involutional Entropion vs Q Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? sameA lateral canthotomy/inferiortwo therapeutic cantholysis goals: is performed, and the lateral aspect of the tarsus is exposed by removing from it the anterior and posterior lid lamellae, 1)as Horizontal well as the mucocutaneous lid tightening junction at to the addresslid margin. The laxity, lateral end and is trimmed, and the newly-exposed end is sutured to the periosteum of the internal aspect of 2)the Permanent lateralThis orbital is a concept wall. re-insertion we haven’t addressed of previous the ly.lower-lid What’s with the retractors idea of ‘lid lamellae’? Newsflash: Eyelids are anatomically complex. The ‘lamella’ notion greatly simplifies their anatomy by conceptualizing the lids as being composed of only two parts—an anterior This is usuallylamella, accomplishedand a posterior one. with a lateral tarsal strip procedure
What structures comprise each lamella? What comprises the dividing line Anterior: Skin and orbicularis muscle between the two lamellae? Posterior: Tarsal plate and conjunctiva The muscle of Riolan/gray line 210 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? sameA lateral canthotomy/inferiortwo therapeutic cantholysis goals: is performed, and the lateral aspect of the tarsus is exposed by removing from it the anterior and posterior lid lamellae, 1)as Horizontal well as the mucocutaneous lid tightening junction at to the addresslid margin. The laxity, lateral end and is trimmed, and the newly-exposed end is sutured to the periosteum of the internal aspect of 2)the Permanent lateralThis orbital is a concept wall. re-insertion we haven’t addressed of previous the ly.lower-lid What’s with the retractors idea of ‘lid lamellae’? Newsflash: Eyelids are anatomically complex. The ‘lamella’ notion greatly simplifies their anatomy by conceptualizing the lids as being composed of only two parts—an anterior This is usuallylamella, accomplishedand a posterior one. with a lateral tarsal strip procedure
What structures comprise each lamella? What comprises the dividing line Anterior: Skin and orbicularis muscle between the two lamellae? Posterior: Tarsal plate and conjunctiva The muscle of Riolan/gray line 211 Involutional Entropion vs Q Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? A lateral canthotomy/inferior cantholysis is performed, and the lateral aspect of sameDoes the eyelid two possess therapeutic a middle lamella? goals: Yes--boththe tarsus upper is exposed and lower bylids removing are conceptualized from it the as anteriorpossessing and a middle posterior lamella. lid lamellae, 1)However,as Horizontal well asthe themiddle mucocutaneous lamellae lid tightening are composed junction of at structuresto the addresslid margin. only found The laxity,beyond lateral the end non-and is trimmed, marginaland the edge newly-exposed of the tarsal plate end (ie, is sutursuperiored to thethe upper periosteum plate, and of inferiorthe internal to the lower).aspect of 2)Thus,the Permanent lateral at theThis location orbital is a concept ofwall. the re-insertion tarsal we haven’t plate (as addressed discussed of previous thehere), ly.therelower-lid What’s is no with middle the retractors idealamella. of ‘lid lamellae’? Newsflash: Eyelids are anatomically complex. The ‘lamella’ notion greatly simplifies their anatomy by conceptualizing the lids as being composed of only two parts—an anterior ThisMiddle is usuallylamella, lamella? accomplishedand a posterior one. with a lateral tarsal strip procedure
What structures comprise each lamella? What comprises the dividing line Anterior: Skin and orbicularis muscle between the two lamellae? Posterior: Tarsal plate and conjunctiva The muscle of Riolan/gray line 212 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? A lateral canthotomy/inferior cantholysis is performed, and the lateral aspect of sameDoes the eyelid two possess therapeutic a middle lamella? goals: Yes--boththe tarsus upper is exposed and lower bylids removing are conceptualized from it the as anteriorpossessing and a middle posterior lamella lid. lamellae, 1)However,as Horizontal well asthe themiddle mucocutaneous lamellae lid tightening are composed junction of at structuresto the addresslid margin. only found The laxity,beyond lateral the end non-and is trimmed, marginaland the edge newly-exposed of the tarsal plate end (ie, is sutursuperiored to thethe upper periosteum plate, and of inferiorthe internal to the lower).aspect of 2)Thus,the Permanent lateral at theThis location orbital is a concept ofwall. the re-insertion tarsal we haven’t plate (as addressed discussed of previous thehere), ly.therelower-lid What’s is no with middle the retractors idealamella. of ‘lid lamellae’? Newsflash: Eyelids are anatomically complex. The ‘lamella’ notion greatly simplifies their anatomy by conceptualizing the lids as being composed of only two parts—an anterior ThisMiddle is usuallylamella, lamella! accomplishedand a posterior one. with a lateral tarsal strip procedure
What structures comprise each lamella? What comprises the dividing line Anterior: Skin and orbicularis muscle between the two lamellae? Posterior: Tarsal plate and conjunctiva The muscle of Riolan/gray line 213 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? A lateral canthotomy/inferior cantholysis is performed, and the lateral aspect of sameDoes the eyelid two possess therapeutic a middle lamella? goals: Yes--boththe tarsus upper is exposed and lower bylids removing are conceptualized from it the as anteriorpossessing and a middle posterior lamella lid. lamellae, 1)However,as Horizontal well asthe themiddle mucocutaneous lamellae lid tightening are composed junction of at structuresto the addresslid margin. only found The laxity,beyond lateral the end non-and is trimmed, marginaland the edge newly-exposed of the tarsal plate end (ie, is sutursuperiored to thethe upper periosteum plate, and of inferiorthe internal to the lower).aspect of 2)Thus,the Permanent lateral at theThis location orbital is a concept ofwall. the re-insertion tarsal we haven’t plate (as addressed discussed of previous thehere), ly.therelower-lid What’s is no with middle the retractors idealamella. of ‘lid lamellae’? Newsflash: Eyelids are anatomically complex. The ‘lamella’ notion greatly simplifies their anatomy by conceptualizing the lids as being composed of only two parts—an anterior ThisMiddle is usuallylamella, lamella! accomplishedand a posterior one. with a lateral tarsal strip procedure
What structures comprise each lamella? What comprises the dividing line Anterior: Skin and orbicularis muscle between the two lamellae? Posterior: Tarsal plate and conjunctiva The muscle of Riolan/gray line 214 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the Briefly, how is the lateral tarsal strip procedure performed? A lateral canthotomy/inferior cantholysis is performed, and the lateral aspect of sameDoes the eyelid two possess therapeutic a middle lamella? goals: Yes--boththe tarsus upper is exposed and lower bylids removing are conceptualized from it the as anteriorpossessing and a middle posterior lamella lid. lamellae, 1)However,as Horizontal well asthe themiddle mucocutaneous lamellae lid tightening are composed junction of at structuresto the addresslid margin. only found The laxity,beyond lateral the end non-and is trimmed, marginaland the edge newly-exposed of the tarsal plate end (ie, is sutursuperiored to thethe upper periosteum plate, and of inferiorthe internal to the lower).aspect of 2)Thus,the Permanent lateralat theThis locationorbital is a concept wall. of there-insertion wetarsal haven’t plate addressed (as discussed of previous the here), ly.lower-lid What’sthere is with no middle the retractors idea lamella. of ‘lid lamellae’? Newsflash: Eyelids are anatomically complex. The ‘lamella’ notion greatly simplifies their anatomy by conceptualizing the lids as being composed of only two parts—an anterior ThisMiddle is usuallylamella, lamella! accomplishedand a posterior one. with a lateral tarsal strip procedure
What structures comprise each lamella? What comprises the dividing line Anterior: Skin and orbicularis muscle between the two lamellae? Posterior: Tarsal plate and conjunctiva The muscle of Riolan/gray line 215 Involutional Entropion vs Q Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the same two therapeutic goals: 1) Horizontal lid tightening to address laxity, and 2) Permanentsurgical maneuverre-insertion of the lower-lid retractors
This is usually accomplishedN with a lateral tarsal strip procedure e x t
Q 216 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the same two therapeutic goals: 1) Horizontal lid tightening to address laxity, and 2) Permanent re-insertion of the lower-lid retractors
This is usually accomplishedN with a lateral tarsal strip procedure e x t
Q 217 Involutional Entropion vs Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the same two therapeutic goals: 1) Horizontal lid tightening to address laxity, and 2) Permanent re-insertion of the lower-lid retractors
This is usually accomplished with a lateral tarsal strip procedure
This can be done via a skin or a conjunctival incision
(No question—advance when ready) 218 Involutional Entropion vs Q Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the same two therapeutic goals: 1) Horizontal lid tightening to address laxity, and 2) Permanent re-insertion of the lower-lid retractors
This is usually accomplished with a lateral tarsal strip procedure
This can be done via a skin or a conjunctival incision; both have advantages. --The chief advantage of the conj approach is…(?) 219 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the same two therapeutic goals: 1) Horizontal lid tightening to address laxity, and 2) Permanent re-insertion of the lower-lid retractors
This is usually accomplished with a lateral tarsal strip procedure
This can be done via a skin or a conjunctival incision; both have advantages. --The chief advantage of the conj approach is…the incision scar is hidden --The advantage of the skin approach is…the incision scar acts to prevent recurrent orbicularis override, thereby reducing the risk of surgical failure. 220 Involutional Entropion vs Q Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the same two therapeutic goals: 1) Horizontal lid tightening to address laxity, and 2) Permanent re-insertion of the lower-lid retractors
This is usually accomplished with a lateral tarsal strip procedure
This can be done via a skin or a conjunctival incision; both have advantages. --The chief advantage of the conj approach is…the incision scar is hidden --The advantage of the skin approach is…(?) 221 Involutional Entropion vs A Involutional Ectropion
Many surgical approaches to involutional entropion have been developed. However, the most effective approaches address the same two therapeutic goals: 1) Horizontal lid tightening to address laxity, and 2) Permanent re-insertion of the lower-lid retractors
This is usually accomplished with a lateral tarsal strip procedure
This can be done via a skin or a conjunctival incision; both have advantages. --The chief advantage of the conj approach is…the incision scar is hidden --The advantage of the skin approach is…the incision scar acts to prevent recurrent orbicularis override, thereby reducing the risk of surgical failure. 222 Involutional Entropion vs Q Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricialnot involutional 223 Involutional Entropion vs A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial 224 Involutional Entropion vs Q Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial
When you hear ‘upper-lid cicatricial entropion,’ a specific condition—one of the most common causes of blindness worldwide—should come instantly to mind. What is it? 225 Involutional Entropion vs A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial
When you hear ‘upper-lid cicatricial entropion,’ a specific condition—one of the most common causes of blindness worldwide—should come instantly to mind. What is it? Trachoma 226 Involutional Entropion vs Q Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa
Is trachoma primarily a follicular, or papillary conjunctivitis? Follicular
Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 227 Involutional Entropion vs Q/A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa
Is trachoma primarily a follicular, or papillary conjunctivitis? Follicular
Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 228 Involutional Entropion vs A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa
Is trachoma primarily a follicular, or papillary conjunctivitis? Follicular
Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 229 Involutional Entropion vs Q Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa
Is trachoma primarily a follicular, or papillary conjunctivitis? Follicular
Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 230 Involutional Entropion vs A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa
Is trachoma primarily a follicular, or papillary conjunctivitis? Follicular
Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 231 Involutional Entropion vs Q Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa
Is trachoma primarily a follicular, or papillary conjunctivitis? Follicular
Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 232 Involutional Entropion vs A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa
Is trachoma primarily a follicular, or papillary conjunctivitis? Follicular
Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 233 Involutional Entropion vs Q Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa
Is trachoma primarily a follicular, or papillary conjunctivitis? Follicular
Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 234 Involutional Entropion vs A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa
Is trachoma primarily a follicular, or papillary conjunctivitis? Follicular
Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 235 Involutional Entropion vs Q Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa
Is trachoma primarily a follicular, or papillary conjunctivitis? Follicular
Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 236 Involutional Entropion vs A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa
Is trachoma primarily a follicular, or papillary conjunctivitis? Follicular
Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 237 Involutional Entropion vs Q Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma WhereWhy in arethe theyworld blind, is trachoma ie, what prevalent?ocular structure is responsible? TheThe Middle cornea—it East, South is scarred, Asia, Africa and covered by a pannus
Is trachomaIn a nutshell, primarily what a sequence follicular, orof papillaryevents leads conjunctivitis? to corneal opacification? FollicularRepeated infections produce scarification of the superior palpebral conj, and the subsequent cicatricial entropion leads to severe trichiasis which Wheredecimates do the follicles the corneal tend surface to occur? On the superior palpebral conj, and the superior limbal region 238 Involutional Entropion vs A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma WhereWhy in arethe theyworld blind, is trachoma ie, what prevalent?ocular structure is responsible? TheThe Middle cornea—it East, South is scarred, Asia, Africa and covered by a pannus
Is trachomaIn a nutshell, primarily what a sequence follicular, orof papillaryevents leads conjunctivitis? to corneal opacification? FollicularRepeated infections produce scarification of the superior palpebral conj, and the subsequent cicatricial entropion leads to severe trichiasis which Wheredecimates do the follicles the corneal tend surface to occur? On the superior palpebral conj, and the superior limbal region 239 Involutional Entropion vs Involutional Ectropion
Trachoma: End stage 240 Involutional Entropion vs Q Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma WhereWhy in arethe theyworld blind, is trachoma ie, what prevalent?ocular structure is responsible? TheThe Middle cornea—it East, South is scarred, Asia, Africa and covered by a pannus
Is trachomaIn a nutshell, primarily what a sequence follicular, orof papillaryevents leads conjunctivitis? to corneal opacification? FollicularRepeated infections produce scarification of the superior palpebral conj, and the subsequent cicatricial entropion leads to severe trichiasis which Wheredecimates do the follicles the corneal tend surface to occur? On the superior palpebral conj, and the superior limbal region 241 Involutional Entropion vs A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma WhereWhy in arethe theyworld blind, is trachoma ie, what prevalent?ocular structure is responsible? TheThe Middle cornea—it East, South is scarred, Asia, Africa and covered by a pannus
Is trachomaIn a nutshell, primarily what a sequence follicular, orof papillaryevents leads conjunctivitis? to corneal opacification? FollicularRepeated infections produce scarification of the superior palpebral conj, and the subsequent cicatricial entropion leads to severe trichiasis which Wheredecimates do the follicles the corneal tend surface to occur? On the superior palpebral conj, and the superior limbal region 242 Involutional Entropion vs Q Involutional Ectropion
Trachoma: Scarring of tarsal conj (the depicted classic sign is called Arlt’stwo words line ) 243 Involutional Entropion vs A Involutional Ectropion
Trachoma: Scarring of tarsal conj (the depicted classic sign is called Arlt’s line ) 244 Involutional Entropion vs A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial What is the causative organism in trachoma? C trachomatis serotypes A,B,C When you hear ‘upper-lid cicatricial entropion, a specific condition—one of the most commonWhere causesdoes trachoma of blindne rankss as worldwide—should a cause of blindness worldwide?come instantly to mind. WhatIt isis theit? most common cause of infectious blindness Trachoma WhereWhy in arethe theyworld blind, is trachoma ie, what prevalent?ocular structure is responsible? TheThe Middle cornea—it East, South is scarred, Asia, Africa and covered by a pannus
Is trachomaIn a nutshell, primarily what a sequence follicular, orof papillaryevents leads conjunctivitis? to corneal opacification? FollicularRepeated infections produce scarification of the superior palpebral conj, and the subsequent cicatricial entropion leads to severe trichiasis which Wheredecimates do the follicles the corneal tend surface to occur? On the superior palpebral conj, and the superior limbal region 245 Involutional Entropion vs Involutional Ectropion
Trachoma: Cicatricial entropion 246 Involutional Entropion vs Q Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial How can you quickly differentiate between involutional and cicatricial entropion? 247 Involutional Entropion vs A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial How can you quickly differentiate between involutional and cicatricial entropion? Via attempted digital eversion (ie, ‘unrolling’) of the entropion 248 Involutional Entropion vs Q Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial How can you quickly differentiate between involutional and cicatricial entropion? Via attempted digital eversion (ie, ‘unrolling’) of the entropion How does this differentiate between the two? 249 Involutional Entropion vs A Involutional Ectropion
As an aside: While lower-lid entropion is usually involutional, upper-lid entropion is always cicatricial How can you quickly differentiate between involutional and cicatricial entropion? Via attempted digital eversion (ie, ‘unrolling’) of the entropion How does this differentiate between the two? If you can’t roll it out, it’s cicatricial. If you can roll it out, ask the patient to squeeze their eyelids shut. If it’s involutional, the lid will roll back up. 250 Involutional Entropion vs Q Involutional Ectropion
An elderly patient presents with what you diagnose as involutional ectropion. What should you do for the patient today?
1) Reverse Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 251 Involutional Entropion vs A Involutional Ectropion
An elderly patient presents with what you diagnose as involutional ectropion. What should you do for the patient today?
1) Reverse Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 252 Involutional Entropion vs Q Involutional Ectropion
How are reverse Quickert sutures like regular Quickert sutures, and how are they different? Reverse Quickert sutures are like regular Quickerts in that both Anwork elderly by temporarily… patientre-inserting presents the lid retractorswith what to the tarsalyou plate.
diagnoseThe two differ asin that… involutional ectropion. What 1) Regular Quickerts are used to manage entropion , and reverse shouldto manage you ectropiondo for ; andthe patient today? 2) regular Quickerts are usually thrown on the skin side of the lid, whereas reverse Quickerts are thrown on the conj side. 1) Reverse Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 253 Involutional Entropion vs A Involutional Ectropion
How are reverse Quickert sutures like regular Quickert sutures, and how are they different? Reverse Quickert sutures are like regular Quickerts in that both Anwork elderly by temporarily… patientre-inserting presents the lid retractorswith what to the tarsalyou plate.
diagnoseThe two differ asin that… involutional ectropion. What 1) Regular Quickerts are used to manage entropion , and reverse shouldto manage you ectropiondo for ; andthe patient today? 2) regular Quickerts are usually thrown on the skin side of the lid, whereas reverse Quickerts are thrown on the conj side. 1) Reverse Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 254 Involutional Entropion vs Q Involutional Ectropion
How are reverse Quickert sutures like regular Quickert sutures, and how are they different? Reverse Quickert sutures are like regular Quickerts in that both Anwork elderly by temporarily… patientre-inserting presents the lid retractorswith what to the tarsalyou plate.
diagnoseThe two differ asin that… involutional ectropion. What 1) Reverse Quickerts are used to manage ectropion, whereas shouldregular you Quickerts do forare used the to patientmanage entropion today?; and 2) regular Quickerts are usually thrown on the skin side of the lid, whereas reverse Quickerts are thrown on the conj side. 1) Reverse Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 255 Involutional Entropion vs A Involutional Ectropion
How are reverse Quickert sutures like regular Quickert sutures, and how are they different? Reverse Quickert sutures are like regular Quickerts in that both Anwork elderly by temporarily… patientre-inserting presents the lid retractorswith what to the tarsalyou plate.
diagnoseThe two differ asin that… involutional ectropion. What 1) Reverse Quickerts are used to manage ectropion, whereas shouldregular you Quickerts do forare used the to patientmanage entropion today?; and 2) regular Quickerts are usually thrown on the skin side of the lid, whereas reverse Quickerts are thrown on the conj side. 1) Reverse Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 256 Involutional Entropion vs Q Involutional Ectropion
How are reverse Quickert sutures like regular Quickert sutures, and how are they different? Reverse Quickert sutures are like regular Quickerts in that both Anwork elderly by temporarily… patientre-inserting presents the lid retractorswith what to the tarsalyou plate.
diagnoseThe two differ asin that… involutional ectropion. What 1) Reverse Quickerts are used to manage ectropion, whereas shouldregular you Quickerts do for are used the to patientmanage entropion today?; and conj vs 2) regular Quickerts are usually thrown on the skinskin side of the lid, conj vs whereas reverse Quickerts are thrown on the conjskin side. 1) Reverse Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 257 Involutional Entropion vs A Involutional Ectropion
How are reverse Quickert sutures like regular Quickert sutures, and how are they different? Reverse Quickert sutures are like regular Quickerts in that both Anwork elderly by temporarily… patientre-inserting presents the lid retractorswith what to the tarsalyou plate.
diagnoseThe two differ asin that… involutional ectropion. What 1) Reverse Quickerts are used to manage ectropion, whereas shouldregular you Quickerts do for are used the to patientmanage entropion today?; and 2) regular Quickerts are usually thrown on the skin side of the lid, whereas reverse Quickerts are thrown on the conj side. 1) Reverse Quickert sutures as a temporizing measure 2) Schedule ‘em for definitive surgery 258 Involutional Entropion vs Q Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medialsurgery (two spindle words) procedure 259 Involutional Entropion vs A Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medial spindle procedure 260 Involutional Entropion vs Q Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medial spindle procedure
Briefly, how is the medial spindle procedure performed? A small ‘diamond’ of conj and underlying tissue is excised about 4 mm below the puncta. The resulting gap is then closed vertically, ie, the uppermost point of the diamond is apposed to the point directly below it. This closure causes the ectropic lid margin superior to the surgical site to roll inward. 261 Involutional Entropion vs A Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medial spindle procedure
Briefly, how is the medial spindle procedure performed? A small ‘diamond’ of conj and underlying tissue is excised about 4 mm below the puncta. The resulting gap is then closed vertically, ie, the uppermost point of the diamond is apposed to the point directly below it. This closure causes the ectropic lid margin superior to the surgical site to roll inward. 262 Involutional Entropion vs A Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medial spindle procedure
Briefly, how is the medial spindle procedure performed? A small ‘diamond’ of conj and underlying tissue is excised about 4 mm below the puncta. The resulting gap is then closed vertically, ie, the uppermost point of the diamond is apposed to the point directly below it. This closure causes the ectropic lid margin superior to the surgical site to roll inward. 263 Involutional Entropion vs Involutional Ectropion
Medial spindle procedure: Outline of excision of conjunctiva and retractors 264 Involutional Entropion vs Q Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medial spindle procedure
More severe disease requires a lateralsurgery tarsal (three words) strip 265 Involutional Entropion vs A Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medial spindle procedure More severe disease requires a lateral tarsal strip 266 Involutional Entropion vs Q Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medial spindle procedure More severe disease requires a lateral tarsal strip You should consider re-insertionspecific surgicalof the maneuver lower-lid retractors(cont) 267 Involutional Entropion vs A Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medial spindle procedure More severe disease requires a lateral tarsal strip You should consider re-insertion of the lower-lid retractors 268 Involutional Entropion vs Q Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medial spindle procedure More severe disease requires a lateral tarsal strip You should consider re-insertion of the lower-lid retractors
Chronic ectropion often produces anteriorbad sequelae lamellar contraction(cont) , which may require a full-thickness skin graft (FTSG) 269 Involutional Entropion vs A Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medial spindle procedure More severe disease requires a lateral tarsal strip You should consider re-insertion of the lower-lid retractors Chronic ectropion often produces anterior lamellar contraction, which may require a full-thickness skin graft (FTSG) 270 Involutional Entropion vs Q Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medial spindle procedure More severe disease requires a lateral tarsal strip You should consider re-insertion of the lower-lid retractors Chronic ectropion often produces anterior lamellar contraction, which may require a full-thicknessspecific surgical maneuver skin graft(cont) (FTSG) to release contracture-induced skin tension 271 Involutional Entropion vs A Involutional Ectropion
Managing involutional ectropion: Mild medial punctal eversion can be successfully treated with a medial spindle procedure More severe disease requires a lateral tarsal strip You should consider re-insertion of the lower-lid retractors Chronic ectropion often produces anterior lamellar contraction, which may require a full-thickness skin graft (FTSG) to release contracture-induced skin tension