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ORIGINAL ARTICLE
Year : 2018  |  Volume : 10  |  Issue : 2  |  Page : 39-43

Complicated lower lid ectropions presenting to tertiary care hospital in Sub-Himalayan Region of Himachal Pradesh and their management


1 Department of Ophthalmology, Dr. RP Government Medical College Kangra at Tanda, Sadarpur, Himachal Pradesh, India
2 Department of Pharmacology, Dr. RP Government Medical College Kangra at Tanda, Sadarpur, Himachal Pradesh, India

Correspondence Address:
Dr. Gaurav Sharma
Department of Ophthalmology, Dr. RP Government Medical College Kangra at Tanda, Sadarpur, Himachal Pradesh
India
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DOI: 10.4103/sjopthal.sjopthal_18_18

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Introduction: Ectropions of the lower lid area are of diverse etiology. They may be involutional, mechanical, paralytic, or cicatricial. The patients have lot of discomfort due to exposure and epiphora. Some of them also develop complications like infectious keratitis that are vision threatening as well. Cicatricial ectropions, severe ectropions with tissue laxity are sometimes difficult to manage. In this study, we intend to describe techniques we have used for the management of selected complicated cases of Ectropions. Aim and Objectives: The aim of the study is to describe the complicated cases of ectropions presenting to a tertiary care hospital in Sub-Himalayan region of Himachal Pradesh, India, and the various techniques used in their management. Materials and Methods: Cases of complicated ectropions fulfilling the inclusion and exclusion criterion which presented to the department of ophthalmology were included in the study. The patients were subjected to detailed history and clinical examination according to a predesigned pro forma. They were divided into four subtypes and managed surgically. Results: Horizontal lid shortening with or without blepharoplasty was performed in the cases of involutional ectropions and showed good outcome in all cases. There was no significant lid notching postoperatively. The cicatricial ectropion cases were managed surgically using Z plasty in all but one case of generalized cicatricial ectropion where skin grafting using postauricular graft was used. Postoperatively, the patients improved symptomatically, and cosmetic outcome was also acceptable. Conclusions: Horizontal shortening with or without blepharoplasty if performed meticulously is a good procedure providing excellent results; however, the site for pentagon excision and the amount of resection required needs to be decided, along with any medial or lateral canthal tendon stabilization. Cicatricial ectropions unless are generalized or very severe managed well with Z plasty, however, it is very important to understand the dynamics of the scar before deciding the site and dimensions of the Z plasty. Full-thickness skin graft is sometimes the only option for generalized cicatricial ectropions.


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