1 Q Congenital Ectropion
What does the term Entropion mean? Ectropion 2 A Congenital Ectropion
What does the term Entropion mean? Ectropion It means the eyelid margin is turning inward 3 Q Congenital Ectropion
What does the term What does the term Entropion mean? Ectropion mean? It means the eyelid margin is turning inward 4 A Congenital 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 Q Congenital 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 A Congenital 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 Q Congenital Ectropion
Of the six, which can result in entropion? Entropion Categories Ectropion ? Congenital
? Involutional
? Paralytic
? Cicatricial
? Mechanical
? Acute Spastic 8 A Congenital 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 Q Congenital 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 A Congenital 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 Congenital Ectropion
Entropion Categories Ectropion Let’s look atCongenital congenital ectropion Congenital in more detail… Congenital
InvolutionalInvolutional Involutional
Paralytic Paralytic
Cicatricial Cicatricial Cicatricial
Mechanical Mechanical
Acute Spastic Acute Spastic 12 Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosisone long word syndrome 13 A Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome 14 Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome “Almost always,” of course, means ‘not always.’ Other than blepharophimosis syndrome, with what other conditions is congenital ectropion associated?
--Downa common syndrome syndrome
--Icthyosisa rare skin condition 15 A Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome “Almost always,” of course, means ‘not always.’ Other than blepharophimosis syndrome, with what other conditions is congenital ectropion associated? --Down syndrome --Icthyosis 16 Congenital Ectropion
In Down syndrome In icthyosis
Congenital ectropion 17 Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome
What does the word blepharophimosis mean? It refers to an abnormal shortening of both the horizontal and vertical extents of the palpebral fissure 18 A Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome
What does the word blepharophimosis mean? It refers to an abnormal shortening of both the horizontal and vertical extents of the palpebral fissure 19 Congenital Ectropion
Blepharophimosis 20 Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome
(We’ll talk more about blepharophimosis syndrome shortly) 21 Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment 22 A Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment 23 Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial 24 A Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment
Severe, symptomatic: Treat like cicatricial (ectropion, that is) 25 Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment
Severe, symptomatic: Treat like cicatricial(ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --?Lengthen the vertical extent of the anterior lamella of the lid --?prove apposition of the lid to the globe via a horizontal tightening procedure 26 A/Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment
Severe, symptomatic: Treat like cicatricial(ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anteriortwo words lamella of the lid --? 27 A/Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment
Severe, symptomatic: Treat like cicatricial(ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --? 28 A/Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment
Severe, symptomatic: Treat like cicatricial(ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tighteningthree words procedure 29 A Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment
Severe, symptomatic: Treat like cicatricial(ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 30 Q Congenital Ectropion
Congenital ectropion… ‘Anterior lamella’?Almost How manyalways layers does presents an eyelid have? as a component of the Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as theblepharophimosis distance from the margin at which syndrome one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posteriorManagement: lamella. What structures Mild, comprise asymptomatic: each lamella? No treatment Anterior: Skin and orbicularis muscle Posterior: Tarsal Severe, plate and conjunctivasymptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 31 Q/A Congenital Ectropion
Congenital ectropion… ‘Anterior lamella’?Almost How manyalways layers does presents an eyelid have? as a component of the Well, the lids have a number of layers (the precise count depends on whether it’s an upperfour vs words lower lid , as well as theblepharophimosis distancefour from other words the margin at which syndrome one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posteriorManagement: lamella. What structures Mild, comprise asymptomatic: each lamella? No treatment Anterior: Skin and orbicularis muscle Posterior: Tarsal Severe, plate and conjunctivasymptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 32 Q/A Congenital Ectropion
Congenital ectropion… ‘Anterior lamella’?Almost How manyalways layers does presents an eyelid have? as a component of the Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as theblepharophimosis distance from the margin at which syndrome one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posteriorManagement: lamella. What structures Mild, comprise asymptomatic: each lamella? No treatment Anterior: Skin and orbicularis muscle Posterior: Tarsal Severe, plate and conjunctivasymptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 33 Q/A Congenital Ectropion
Congenital ectropion… ‘Anterior lamella’?Almost How manyalways layers does presents an eyelid have? as a component of the Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as theblepharophimosis distance from the margin at which syndrome one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posteriorone Management:word lamella. What structures Mild, comprise asymptomatic: each lamella? No treatment Anterior: Skin and orbicularis muscle Posterior: Tarsal Severe, plate and conjunctivasymptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 34 A Congenital Ectropion
Congenital ectropion… ‘Anterior lamella’?Almost How manyalways layers does presents an eyelid have? as a component of the Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as theblepharophimosis distance from the margin at which syndrome one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posteriorManagement: lamella. What structures Mild, comprise asymptomatic: each lamella? No treatment Anterior: Skin and orbicularis muscle Posterior: Tarsal Severe, plate and conjunctivasymptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 35 Q Congenital Ectropion
Congenital ectropion… ‘Anterior lamella’?Almost How manyalways layers does presents an eyelid have? as a component of the Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as theblepharophimosis distance from the margin at which syndrome one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posteriorManagement: lamella. What structures Mild, comprise asymptomatic: each lamella? No treatment Anterior: Skin and orbicularis muscle Posterior: Tarsal Severe, plate and conjunctivasymptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 36 A Congenital Ectropion
Congenital ectropion… ‘Anterior lamella’?Almost How manyalways layers does presents an eyelid have? as a component of the Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as theblepharophimosis distance from the margin at which syndrome one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posteriorManagement: lamella. What structures Mild, comprise asymptomatic: each lamella? No treatment Anterior: Skin and orbicularis muscle Posterior: Tarsal Severe, plate and conjunctiva symptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 37 A Congenital Ectropion
Congenital ectropion… ‘Anterior lamella’?Almost How manyalways layers does presents an eyelid have? as a component of the Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as theblepharophimosis distance from the margin at which syndrome one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posteriorManagement: lamella. What structures Mild, comprise asymptomatic: each lamella? No treatment Anterior: Skin and orbicularis muscle Posterior: Tarsal Severe, plate and conjunctiva symptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 38 A Congenital Ectropion
Congenital ectropion… ‘Anterior lamella’?Almost How manyalways layers does presents an eyelid have? as a component of the Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as theblepharophimosis distance from the margin at which syndrome one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posteriorManagement: lamella. What structures Mild, comprise asymptomatic: each lamella? No treatment Anterior: Skin and orbicularis muscle Posterior: Tarsal Severe, plate and conjunctiva symptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 39 Congenital Ectropion
Eyelid lamellae 40 A Congenital Ectropion
Congenital ectropion… ‘Anterior lamella’?Almost How manyalways layers does presents an eyelid have? as a component of the Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as theblepharophimosis distance from the margin at which syndrome one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posteriorManagement: lamella. What structures Mild, comprise asymptomatic: each lamella? No treatment Anterior: Skin and orbicularis muscle Eyelids are anatomically complex. The ‘lamella’ idea Posterior: Tarsal plate and conjunctiva greatly simplifies their anatomy by conceptualizing Severe, symptomatic:the lids Treat as being like com posedcicatricial of only two(ectropion, parts. that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 41 Q Congenital Ectropion What about beyond the tarsal plates (ie, above the plate in the upper lid, and below the plate in the lower)? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior
OKCongenital then, what structures compriseectropion each of these three… lamellae beyond the tarsal plates? --The anterior lamella doesn’t change; it’s still skin and orbicularis. ‘Anterior--The lamella’?newly-arisenAlmost How middle manyalways layerslamella does ispresents composed an eyelid have?of the as eyelid a retractorscomponent and orbital septumof the, Well,as thewell lids (in havethe lower a number lid) of of the layers eyelid (the fat precisepads. count depends on whether it’s an upper vs lower lid , as well--Obviously, as theblepharophimosis distance beyond thefrom location the margin of the at tarsal which syndrome plate, one doesthe tarsa the lcounting). plate itself However, is not part from of the a surgical perspective,posterior at lamella the level, so ofit (thethe posteriortarsal plates lamella) it’s useful consists to thinkonly ofof thethem conjunctiv as havinga. two--an anterior lamella, and a posteriorManagement: lamella. What structures Mild, comprise asymptomatic: each lamella ? No treatment Anterior: Skin and orbicularis muscle Posterior: Tarsal Severe, plate and conjunctivasymptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 42 A Congenital Ectropion What about beyond the tarsal plates (ie, above the plate in the upper lid, and below the plate in the lower)? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior
OKCongenital then, what structures compriseectropion each of these three… lamellae beyond the tarsal plates? --The anterior lamella doesn’t change; it’s still skin and orbicularis. ‘Anterior--The lamella’?newly-arisenAlmost How middle manyalways layerslamella does ispresents composed an eyelid have?of the as eyelid a retractorscomponent and orbital septumof the, Well,as thewell lids (in havethe lower a number lid) of of the layers eyelid (the fat precisepads. count depends on whether it’s an upper vs lower lid , as well--Obviously, as theblepharophimosis distance beyond thefrom location the margin of the at tarsal which syndrome plate, one doesthe tarsa the lcounting). plate itself However, is not part from of the a surgical perspectiveposterior, at lamella the level, so ofit (thethe posteriortarsal plates lamella) it’s useful consists to thinkonly ofof thethem conjunctiv as havinga. two--an anterior lamella, and a posteriorManagement: lamella. What structures Mild, comprise asymptomatic: each lamella ? No treatment Anterior: Skin and orbicularis muscle Middle lamella Posterior: TarsalSevere, plate and symptomatic:conjunctiva Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 43 Q Congenital Ectropion What about beyond the tarsal plates (ie, above the plate in the upper lid, and below the plate in the lower)? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior
OKCongenital then, what structures compriseectropion each of these three… lamellae beyond the tarsal plates? --The(Anterioranterior lamella lamella first) doesn’t change; it’s still skin and orbicularis. ‘Anterior--The lamella’?newly-arisenAlmost How middle manyalways layerslamella does ispresents composed an eyelid have?of the as eyelid a retractorscomponent and orbital septumof the, Well,as thewell lids (in havethe lower a number lid) of of the layers eyelid (the fat precisepads. count depends on whether it’s an upper vs lower lid , as well--Obviously, as theblepharophimosis distance beyond thefrom location the margin of the at tarsal which syndrome plate, one doesthe tarsal the counting). plate itself However, is not part from of the a surgical perspective,posterior at lamella the level, so of it the(the tarsal posterior plates lamella) it’s useful consists to think only of ofthem the asconjunctiv having a.two--an anterior lamella, and a posteriorManagement: lamella. beyond the tarsal plates What structures Mild, comprise asymptomatic: each lamella ? No treatment Anterior: ? Skin and orbicularis muscle^ Middle lamella: Posterior: TarsalSevere, plate and symptomatic:conjunctiva Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 44 Q Congenital Ectropion What about beyond the tarsal plates (ie, above the plate in the upper lid, and below the plate in the lower)? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior
OKCongenital then, what structures compriseectropion each of these three… lamellae beyond the tarsal plates? --The anterior lamella doesn’t change; it’s still skin and orbicularis. ‘Anterior--The lamella’?newly-arisenAlmost How middle manyalways layerslamella does ispresents composed an eyelid have?of the as eyelid a retractorscomponent and orbital septumof the, Well,as thewell lids (in havethe lower a number lid) of of the layers eyelid (the fat precisepads. count depends on whether it’s an upper vs lower lid , as well--Obviously, as theblepharophimosis distance beyond thefrom location the margin of the at tarsal which syndrome plate, one doesthe tarsal the counting). plate itself However, is not part from of the a surgical perspective,posterior at lamella the level, so of it the(the tarsal posterior plates lamella) it’s useful consists to think only of ofthem the asconjunctiv having a.two--an anterior lamella, and a posteriorManagement: lamella. beyond the tarsal plates What structures Mild, comprise asymptomatic: each lamella ? No treatment Anterior: Skin and orbicularis muscle^ Middle lamella: Posterior: TasalSevere, plate and conjunctiva?symptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 45 Q Congenital Ectropion What about beyond the tarsal plates (ie, above the plate in the upper lid, and below the plate in the lower)? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior
OKCongenital then, what structures compriseectropion each of these three… lamellae beyond the tarsal plates? --The anterior lamella doesn’t change; it’s still skin and orbicularis. ‘Anterior--The lamella’?newly-arisenAlmost How middle manyalways layerslamella does ispresents composed an eyelid have?of the as eyelid a retractorscomponent and orbital septumof the, Well,as thewell lids (in havethe lower a number lid) of of the layers eyelid (the fat precisepads. count depends on whether it’s an upper vs lower lid , as well--Obviously,(Posterior as theblepharophimosis distance next)beyond thefrom location the margin of the at tarsal which syndrome plate, one doesthe tarsal the counting). plate itself However, is not part from of the a surgical perspective,posterior at lamella the level, so of it the(the tarsal posterior plates lamella) it’s useful consists to think only of ofthem the asconjunctiv having a.two--an anterior lamella, and a posteriorManagement: lamella. beyond the tarsal plates What structures Mild, comprise asymptomatic: each lamella ? No treatment Anterior: Skin and orbicularis muscle^ Middle lamella: Posterior:?TarsalSevere, plate and symptomatic: conjunctiva? Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 46 Q Congenital Ectropion What about beyond the tarsal plates (ie, above the plate in the upper lid, and below the plate in the lower)? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior
OKCongenital then, what structures compriseectropion each of these three… lamellae beyond the tarsal plates? --The anterior lamella doesn’t change; it’s still skin and orbicularis. ‘Anterior--The lamella’?newly-arisenAlmost How middle manyalways layerslamella does ispresents composed an eyelid have?of the as eyelid a retractorscomponent and orbital septumof the, Well,as thewell lids (in havethe lower a number lid) of of the layers eyelid (the fat precisepads. count depends on whether it’s an upper vs lower lid , as well--Obviously, as theblepharophimosis distance beyond thefrom location the margin of the at tarsal which syndrome plate, one doesthe tarsa the lcounting). plate itself However, can’t be partfrom of a thesurgical perspective,posterior lamella,at the level so itof (the the posteriortarsal plates lamella it’s useful) consists to think only of ofthem the asconjunctiva. having two--an anterior lamella, and a posteriorManagement: lamella. beyond the tarsal plates What structures Mild, comprise asymptomatic: each lamella ? No treatment Anterior: Skin and orbicularis muscle^ Middle lamella: Posterior: ConjunctivaSevere, symptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 47 Q Congenital Ectropion What about beyond the tarsal plates (ie, above the plate in the upper lid, and below the plate in the lower)? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior
OKCongenital then, what structures compriseectropion each of these three… lamellae beyond the tarsal plates? --The anterior lamella doesn’t change; it’s still skin and orbicularis. ‘Anterior lamella’? How many layers does an eyelid have? --The(Now newly-arisenAlmost the middle) middle always lamella ispresents composed of the as eyelid a retractorscomponent and orbital septumof the, Well,as thewell lids (in havethe lower a number lid) of of the layers eyelid (the fat precisepads. count depends on whether it’s an upper vs lower lid , as well--Obviously, as theblepharophimosis distance beyond thefrom location the margin of the at tarsal which syndrome plate, one doesthe tarsa the lcounting). plate itself However, can’t be partfrom of a thesurgical perspective,posterior lamella,at the level so itof (the the posteriortarsal plates lamella it’s useful) consists to think only of ofthem the asconjunctiva. having two--an anterior lamella, and a posteriorManagement: lamella. beyond the tarsal plates What structures Mild, comprise asymptomatic: each lamella ? No treatment Anterior: Skin and orbicularis muscle^ Middle lamella: ? Posterior: ConjunctivaSevere, symptomatic: Treat like cicatricial (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 48 Q Congenital Ectropion What about beyond the tarsal plates (ie, above the plate in the upper lid, and below the plate in the lower)? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior
OKCongenital then, what structures compriseectropion each of these three… lamellae beyond the tarsal plates? --The anterior lamella doesn’t change; it’s still skin and orbicularis. ‘Anterior--The lamella’?newly-arisenAlmost How middle manyalways layerslamella does ispresents composed an eyelid have?of the as eyelid a retractorscomponent and orbital septumof the, Well,as thewell lids (in havethe lower a number lid) the of eyelidlayers fat (the pads precise. count depends on whether it’s an upper vs lower lid , as well--Obviously, as theblepharophimosis distance beyond thefrom location the margin of the at tarsal which syndrome plate, one doesthe tarsa the lcounting). plate itself However, can’t be partfrom of a thesurgical perspective,posterior lamella,at the level so itof (the the posteriortarsal plates lamella it’s useful) consists to think only of ofthem the asconjunctiva. having two--an anterior lamella, and a posteriorManagement: lamella. beyond the tarsal plates What structures Mild, comprise asymptomatic: each lamella ? No treatment Anterior: Skin and orbicularis muscle^ Middle lamella: Eyelid retractors, orbital septum, Posterior: Conjunctiva Severe, symptomatic:eyelid Treat fat padslike (lower cicatricial lid) (ectropion, that is)
Like surgical correction of cicatricial ectropion, correction of congenital ectropion requires accomplishing two things. What are they? --Lengthen the vertical extent of the anterior lamella of the lid --Improve apposition of the lid to the globe via a horizontal tightening procedure 49 Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus
specific form 2) Epicanthus inversusof epicanthus 3) Ptosis 50 A Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 51 Congenital Ectropion
Blepharophimosis, ptosis, telecanthus, epicanthus inversus (we’ll unpack these terms shortly)
Blepharophimosis syndrome 52 Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Blepharophimosis Severe, syndrome symptomatic: has two other Treat names. like What cicatricial are they? --Congenital eyelid syndrome --WhatBlepharophimosis-ptosis-epicant are the otherhus defining inversus syndrome features (BPES) of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 53 AQ Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Blepharophimosis Severe, syndrome symptomatic: has two other Treat names. like What cicatricial are they? --Congenitaltwo generic words eyelid syndrome --WhatBlepharophimosis-ptosis-epicant are the otherhus defining inversus syndrome features (BPES) of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 54 AQ Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Blepharophimosis Severe, syndrome symptomatic: has two other Treat names. like What cicatricial are they? --Congenital eyelid syndrome --WhatBlepharophimosis-ptosis-epicant are the otherhus defining inversus syndrome features (BPES) of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 55 A/Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Blepharophimosis Severe, syndrome symptomatic: has two other Treat names. like What cicatricial are they? --Congenital eyelid syndrome --Blepharophimosis-ptosis-epicWhat arefour words, the much more other descriptiveanthus defining inversus syndrome features (BPES)abb. of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 56 A Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Blepharophimosis Severe, syndrome symptomatic: has two other Treat names. like What cicatricial are they? --Congenital eyelid syndrome --Blepharophimosis-ptosis-epicWhat are the otheranthus defining inversus syndrome features (BPES) of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 57 Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: What is the difference between telecanthus and hypertelorism? Mild, asymptomatic: No treatment Telecanthus refers to an abnormally increased distance between the medial canthi , whereas hypertelorismSevere, symptomatic:refers to an abnormally Treat incr likeeased cicatricial distance between the medial orbital walls What are the other components of the Which manifests as an increased interpupillary distance? Hypertelorismblepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 58 A/Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: What is the difference between telecanthus and hypertelorism? Mild, asymptomatic: No treatment Telecanthus refers to an abnormally increased distance between the medialtwo words canthi , whereas hypertelorismSevere, symptomatic:refers to an abnormally Treat incr likeeased cicatricial distance between the medialthree orbital words walls What are the other components of the Which manifests as an increased interpupillary distance? Hypertelorismblepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 59 A Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: What is the difference between telecanthus and hypertelorism? Mild, asymptomatic: No treatment Telecanthus refers to an abnormally increased distance between the medial canthi , whereas hypertelorismSevere, symptomatic:refers to an abnormally Treat incr likeeased cicatricial distance between the medial orbital walls What are the other components of the Which manifests as an increased interpupillary distance? Hypertelorismblepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 60 Q Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: What is the difference between telecanthus and hypertelorism? Mild, asymptomatic: No treatment Telecanthus refers to an abnormally increased distance between the medial canthi , whereas hypertelorismSevere, symptomatic:refers to an abnormally Treat incr likeeased cicatricial distance between the medial orbital walls What are the other components of the Which manifests as an increased interpupillary distance? Hypertelorismblepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 61 A Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: What is the difference between telecanthus and hypertelorism? Mild, asymptomatic: No treatment Telecanthus refers to an abnormally increased distance between the medial canthi , whereas hypertelorismSevere, symptomatic:refers to an abnormally Treat incr likeeased cicatricial distance between the medial orbital walls What are the other components of the Which manifests as an increased interpupillary distance? Hypertelorismblepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 62 Congenital Ectropion 63 QA Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: What is the difference between telecanthus and hypertelorism? Mild, asymptomatic: No treatment Telecanthus refers to an abnormally increased distance between the medial canthi , whereas hypertelorismSevere, symptomatic:refers to an abnormally Treat incr likeeased cicatricial distance between the medial orbital walls As mentioned previously, congenital ectropion occurs almost exclusively in the contextWhat of blepharophimosis are the syndrome other. Is the components same true of telecanthus? of the No,Which telecanthus manifests is associated as an increasedwith many other interpupillary conditions distance? Hypertelorismblepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 64 QA Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: What is the difference between telecanthus and hypertelorism? Mild, asymptomatic: No treatment Telecanthus refers to an abnormally increased distance between the medial canthi , whereas hypertelorismSevere, symptomatic:refers to an abnormally Treat incr likeeased cicatricial distance between the medial orbital walls As mentioned previously, congenital ectropion occurs almost exclusively in the contextWhat of blepharophimosis are the syndrome other. Is the components same true of telecanthus? of the No,Which telecanthus manifests is associated as an increasedwith many other interpupillary conditions distance? Hypertelorismblepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 65 QA Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other components of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus Is the ptosis purely structural, ie, 2ndry to blepharophimosis, 3) Ptosis or is there a problem with the levator? In fact levator function is usually very poor 66 QA Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other components of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus Is the ptosis purely structural, ie, 2ndry to blepharophimosis, 3) Ptosis or is there a problem with the levator? In fact levator function is usually very poor 67 QA Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other components of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus Is the ptosis purely structural, ie, 2ndry to blepharophimosis, 3) Ptosis Andor is thereit goes a problemwithout withsaying, the levator? ptosis occurs all the time in contextsIn fact levator other function than the is usually blepharophimosis very poor syndrome 68 QA Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the What does the term epicanthus refer to in this context? An epicanthusblepharophimosisis a fold of skin extending syndrome? above and/or below the medial canthal region. How far the fold extends in each direction determines1) Telecanthus the type of epicanthus (epicanthus inversus is one sort). 2) Epicanthus inversus 3) Ptosis 69 QA Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the What does the term epicanthus refer to in this context? An epicanthusblepharophimosisis a fold of skin extending syndrome? above and/or below the medial canthal region. How far the fold extends in each direction determines1) Telecanthus the type of epicanthus (epicanthus inversus is one sort). 2) Epicanthus inversus 3) Ptosis 70 QA Congenital Ectropion
Congenital ectropion… Almost always presents as a component of the blepharophimosis syndrome Management of congenital ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the What does the term epicanthus refer to in this context? An epicanthusblepharophimosisis a fold of skin extending syndrome? above and/or below the medial canthal region. How far the fold extends in each direction determines1) Telecanthus the type of epicanthus (epicanthus inversus is one sort). 2) Epicanthus inversus 3) Ptosis 71 Q Congenital Ectropion How many types of epicanthus are there? What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis arsalis:: PrimarilyPrimarily upperupperN lidlid --EpicanthusAlmost iinversusnversus always:: PrimarilyPrimarily presents lowerlower eas a lidlid component of the --Epicanthusblepharophimosis palpebralis:: Upper and Upper lower syndrome and equallyx lower equally t --Epicanthus Management s upraciliaris:: From brow of congenitalFrom to lower brow lid toectropion: lower lid Mild, asymptomatic: No treatmentQ Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 72 Q Congenital Ectropion How many types of epicanthus are there? What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis arsalis:: PrimarilyPrimarily upperupper lidlid --Epicanthus Almost iinversusnversus always:: PrimarilyPrimarily presents lowerlower as a lidlid component of the --Epicanthusblepharophimosis palpebralis:: Upper and Upper lower syndrome and equally lower equally --Epicanthus Management s upraciliaris:: From brow of congenitalFrom to lower brow lid toectropion: lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 73 Q Congenital Ectropion How many types of epicanthus are there? What are the four types of epicanthus? What’s(Other than involved inversus, duh) for each? Congenital ectropion… --Epicanthus t?arsalisarsalis:: Primarily Primarily upper upper lid lid --Epicanthus Almost inversusinversus always:: PrimarilyPrimarily presents lowerlower as a lidlid component of the --Epicanthusblepharophimosis ?palpebralis:: Upper and Upper lower syndrome and equally lower equally --Epicanthus Management ?s:upraciliaris: From brow of congenital Fromto lower brow lid ectropion: to lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 74 Q Congenital Ectropion How many types of epicanthus are there? What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus t?arsalisarsalis:: Primarily Primarily upper upper lid lid --Epicanthus Almost inversusinversus always:: PrimarilyPrimarily presentsMnemonic lowerlower forthcoming… as a lidlid component of the --Epicanthusblepharophimosis ?palpebralis:: Upper and Upper lower syndrome and equally lower equally --Epicanthus Management ?s:upraciliaris: From brow of congenital Fromto lower brow lid ectropion: to lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 75 Q Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalisarsalis:: Primarily Primarily upper upper lid lid --Epicanthus Almost inversus always: Primarily presentsMnemonic lower forthcoming… as a lid componentTIPS of the --Epicanthusblepharophimosis p: alpebralis:Upper and Upper lower syndrome andequally lower equally --Epicanthus Management s: upraciliaris:From brow of congenital toFrom lower brow lid ectropion: to lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 76 Q Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalisarsalis:: Primarily Primarilystart here upper upper lid lid --Epicanthus Almost inversus always: Primarily presentsMnemonic lower forthcoming… as a lid componentTIPS of the --Epicanthusblepharophimosis p: alpebralis:Upper and Upper lower syndrome andequally lower equally --Epicanthus Management s: upraciliaris:From brow of congenital toFrom lower brow lid ectropion: to lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 77 A/Q Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarilystart here upper lid --Epicanthus Almost inversus always: Primarily presents lower as a lid component of the --Epicanthusblepharophimosis p: Upper and lower syndrome equally --Epicanthus Management s: From brow of congenital to lower lid ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 78 A/Q Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarily upper lid --Epicanthus Almost inversus always: Primarily presents lower as a lid component of the --Epicanthusblepharophimosis p: Upper and lower syndromenext equally --Epicanthus Management s From brow of congenital to lower lid ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 79 A/Q Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarily upper lid --Epicanthus Almost inversus always: Primarily presents lower as a lid component of the --Epicanthusblepharophimosis palpebralis: Upper syndromenext and lower equally --Epicanthus Management s: From brow of congenital to lower lid ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 80 Q/A Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarily upper lid --Epicanthus Almost inversus always: Primarily presents lower as a lid component of the --Epicanthusblepharophimosis p:alpebralis Upper and: Upper lower syndrome and equally lower equally --Epicanthus Management s: From brow of congenital to lowerlast lid ectropion: Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 81 Q/A Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarily upper lid --Epicanthus Almost inversus always: Primarily presents lower as a lid component of the --Epicanthusblepharophimosis p:alpebralis Upper and: Upper lower syndrome and equally lower equally --Epicanthus Management supraciliaris: From brow of :congenital Fromto lowerlast brow lid ectropion:to lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 82 Q Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarily upper lid --Epicanthus Almost inversus: always Primarilypresents lower as a lidcomponent of the --Epicanthusblepharophimosis palpebralis: Upper syndrome and lower equally --Epicanthus Management supraciliaris: of congenitalFrom brow ectropion: to lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 83 A Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarily upper lid --Epicanthus Almost inversus: always Primarilypresents lower as a lidcomponent of the --Epicanthusblepharophimosis palpebralis: Upper syndrome and lower equally --Epicanthus Management supraciliaris: of congenitalFrom brow ectropion: to lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 84 Congenital Ectropion
Epicanthus tarsalis 85 Q Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarily upper lid --Epicanthus Almost inversus: always Primarilypresentslower as a lidcomponent of the --Epicanthusblepharophimosis palpebralis: Upper syndrome and lower equally --Epicanthus Management supraciliaris: of congenitalFrom brow ectropion: to lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 86 A Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarily upper lid --Epicanthus Almost inversus: always Primarilypresentslower as a lidcomponent of the --Epicanthusblepharophimosis palpebralis: Upper syndrome and lower equally --Epicanthus Management supraciliaris: of congenitalFrom brow ectropion: to lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 87 Congenital Ectropion
Epicanthus inversus 88 Q Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarily upper lid --Epicanthus Almost inversus: always Primarilypresentslower as a lidcomponent of the --Epicanthusblepharophimosis palpebralis: Upper syndrome and lower equally --Epicanthus Management supraciliaris: of congenitalFrom brow ectropion: to lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 89 A Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarily upper lid --Epicanthus Almost inversus: always Primarilypresentslower as a lidcomponent of the --Epicanthusblepharophimosis palpebralis: Upper syndromeand lower equally --Epicanthus Management: supraciliaris: From brow to lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 90 Congenital Ectropion
Epicanthus palpebralis 91 Q Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarily upper lid --Epicanthus Almost inversus: always Primarilypresentslower as a lidcomponent of the --Epicanthusblepharophimosis palpebralis: Upper syndromeand lower equally --Epicanthus Management: supraciliaris: From brownot lid to lower lid Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 92 A Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: PrimarilyPrimarily upperupper lidlid top down; --Epicanthus Almost inversus always: Primarily Primarilypresents lowerlower as a lid lidcomponent ofon the ground; --Epicanthusblepharophimosis p:alpebralis Upper and: Upper lower syndrome andequally lower equally all around; --Epicanthus Management: s:upraciliaris From brow: toFrom lower brow lid to lower lid to the crown. Mild, asymptomatic: No treatment Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis 93 Congenital Ectropion
Epicanthus supraciliaris 94 Congenital Ectropion
Epicanthal folds overview 95 Congenital Ectropion
What are the four types of epicanthus? What’s involved for each? Congenital ectropion… --Epicanthus tarsalis: Primarily Primarily upperupper lidlid top down; --Epicanthus Almost inversus always: Primarily Primarilypresents lowerlower as a lid lidcomponent ofon the ground; --Epicanthusblepharophimosis p:alpebralis Upper and: Upper lower syndrome andequally lower equally all around; --Epicanthus Management: s:upraciliarisFor From more brow on: toFromepicanthal lower brow lid foldsto lower and/or lid to the crown. blepharophimosis syndrome, see Mild, asymptomatic: No treatment slide-set O1 Severe, symptomatic: Treat like cicatricial What are the other defining features of the blepharophimosis syndrome? 1) Telecanthus 2) Epicanthus inversus 3) Ptosis