Ectropion VS Entropion

Ectropion （外翻）

* Down syndrome會有cicatricial ectropion （考試喜歡寫entropion讓你挑錯。另外要注意Down syndrome是esotropia，不是exotropia；horizontal nystagmus，不是vertical nystagmus；是myopia而非hyperopia）
* Blepharophimosis有lateral lower eyelid ectropion secondary to ant. lamellar deficiency. （考試喜歡寫entropion讓你挑錯）

* anophthalmic ectropion–loosening lower eyelid
=> prothesis太重，太大或frequency removal所致

* ectropion可造成exposure keratitis

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entropion的分類：
 congenital（horizontal laxity）
 involutional
 acute spastic cicatricial(orbicularis spasm造成)
 Cicatricial(Vertical tarsoconjunctival contracture)

* cicatricial entropion ( secondary to post. lamellar scarring)
* 結膜結痂(conjunctival scarring) → 屬cicatricial

* Involutional entropion的成因
1. Horizontal eyelid laxity
2. lid retractor鬆弛
3. 年紀造成enophthalmos

* trichiasis有inturning of lashes
* Trachoma → cicatricial entropion

* Steven-Johnson syndrome → ectropion及entropion都可能

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Lid correction for entropion（重要！常考！）
=> Weis, Quickert suture, no FTSG.
常用於cicatrical entropion及厲害的involutional entropion

Repair of retractor–Weis repair
 lower eyelid retractor advancement
 lateral canthal tightening
 taping of the eyelid
 mucous membrane grafting to the posterior eyelid

Temporizing measures – 用Quickact suture（high recurrent rate）
 Horizontal eyelid tightening –lateral tarsal strip
 整層切開，再作eyelid margin rotation

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治療方式比較：

* Lid correction for entropion： Weis, Quickert suture

* repair for cicatricial ectropion：skin grafting

* Repair of lower eyelid retractor can be used in entropion and ectropion.

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重點整理：

Down syndrome和blepharophimosis是ECtroion！

Trachoma和Trichiasis是ENtropion

Steven-Johnson syndrome兩種都可能。