Upper eyelid ectropion repair.

Huerva V, Castanera D. BMJ Case Rep 2017. doi:10.1136/bcr-2017-221982 Description A 75-year-old man presented with a constant, not repositioned left upper eyelid ectropion (figure 1). The patient had suffered several episodes of infectious keratitis due to eyeball exposure. The lower eyelid presented also an ectropion due to hyperlaxity. Severely injected and hypertrophied superior tarsal conjunctiva was observed. The cornea was tarnished with loss of brightness due to poor lubrication by exposition (figure 1). The patient had no history of previous surgery, traumatic event, obstructive sleep apnoea (OSA) syndrome or multiple endocrine neoplasia. He underwent an upper lid lateral full thickness semilunar wedge resection of 15 mm and levator muscle aponeurosis reattachment through the eyelid crease (figures 2 and 3). A lateral tarsal sling was performed in lower eyelid. Epithelial hyperplasia with parakeratosis was informed in the histological study (figure 4). Cosmetic and functional results were rapidly obtained. No recurrence was noted over an 8-month follow-up (figure 5). Upper eyelid ectropion is a rare condition. Few cases have been reported. Spontaneous upper eyelid eversion has been described associated to floppy eyelid syndrome. Many of these have a severe OSA and usually occurs during night sleep. 3 However, this patient has no OSA. Additionally, this case presents inferior lower eyelid ectropion due to the hyperlaxity. Surgical correction of lower eyelid ectropion is well established. On the contrary, the correction of superior eyelid ectropion constitutes a challenge. In the first place, the rarity of the process makes it difficult for the general ophthalmologist to solve this problem. Second, because of the great horizontal laxity. Unlike ectropion of the lower eyelid that can be improved with lateral tensioning, a shortening is necessary through a full thickness Upper eyelid ectropion repair