Content area
Full Text
ABSTRACT
Nine consecutive patients who presented with a medial ectropion (12 eyelids) and epiphora were prospectively evaluated and surgically managed. Medial ectropion was successfully corrected in all 12 eyelids (mean follow-up 12.2 months). A lateral tarsal strip procedure (Anderson procedure) was used to correct the horizontal lid laxity. Resecting the retractors of the lower lid subjacent to the punctal area corrected the punctal eversion. Prior to medial ectropion repair, three of the 12 eyes demonstrated evidence of complete obstruction at or below the level of the lacrimal sac. These patients required concurrent dacryocystorhinostomy (DCR) in addition to repair of the medial ectropion. DCR with silicone intubation obviated the need for anastomosis of lacrimal sac and nasal mucosal flaps, and it corrected the punctal stenosis. Histopathologic examination of the sac specimens confirmed chronic inflammation. One of six patients without complete obstruction required DCR after medial ectropion repair and punctoplasty. Medial ectropion may predispose to lower lacrimal obstruction. In turn, the epiphora may lead to aggravation of the medial ectropion as a result of wiping of tears.
Patients with medial ectropion usually present with epiphora, presumably on the basis of punctal malposition and, in some cases, punctal stenosis. We have consulted on patients who were referred for evaluation of persistent epiphora following successful medial ectropion repair and punctoplasty. In such patients, we have found unsuspected lower lacrimal obstruction. Therefore, we studied prospectively, patients referred for surgery of medial ectropion in order to investigate the incidence of lower lacrimal obstruction and to determine the results of surgery. Of nine consecutive patients (12 eyes) referred to the Bethesda Eye Institute for evaluation and management of medial ectropion, four eyes were discovered to have obstruction also at or below the level of the lacrimal sac. It seems possible that medial ectropion may be casually related to lower lacrimal obstruction. We hypothesize that reduced tear flow through the lacrimal excretory system in medial ectropion may predispose to low-grade infection and obstruction of the lower lacrimal system. Wiping of tears may aggravate the medial ectropion.
MATERIALS AND METHODS
All patients underwent complete ophthalmological evaluation. Only patients with medial ectropion rather than full length ectropion were included in this study. None of the patients had a history of dacryocystitis. All patients...