Eyelid Ptosis & Ectropion Repair - Eyelid Plastic Surgery Los Angeles
What does the term Entropion Ectropion
Transcript of What does the term Entropion Ectropion
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Entropion Ectropion
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What does the term mean?
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Entropion Ectropion
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What does the term mean?
It means the eyelid margin is turning inward
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What does the term mean?
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Entropion Ectropion
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What does the term mean?
It means the eyelid margin is turning inward
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What does the term mean?
It means the eyelid margin is turning outward
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Entropion Ectropion
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What does the term mean?
It means the eyelid margin is turning inward
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Entropion Ectropion
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Categories
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.)
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Entropion EctropionCategories
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Congenital
Involutional
Paralytic
Cicatricial
Mechanical
Acute Spastic
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.)
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Congenital
Involutional
Paralytic
Cicatricial
Mechanical
Acute Spastic
Entropion EctropionCategories
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Of the six, which can result in entropion?
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Congenital
Involutional
Cicatricial
Acute Spastic
Entropion Ectropion
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CategoriesOf the six, which can result in entropion?
Congenital
Involutional
Paralytic
Cicatricial
Mechanical
Acute Spastic
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Congenital
Involutional
Cicatricial
Acute Spastic
Entropion Ectropion
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CategoriesOf the six, which can result in ectropion?
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Congenital
Involutional
Paralytic
Cicatricial
Mechanical
Acute Spastic
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Congenital Congenital
Involutional Involutional
Paralytic
Cicatricial Cicatricial
Mechanical
Acute Spastic
Entropion Ectropion
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CategoriesOf the six, which can result in ectropion?
Congenital
Involutional
Paralytic
Cicatricial
Mechanical
Acute Spastic
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Congenital Congenital
Involutional Involutional
Paralytic
Cicatricial Cicatricial
Mechanical
Acute Spastic
Entropion Ectropion
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CategoriesCongenital
Involutional
Paralytic
Cicatricial
Mechanical
Acute Spastic
Let’s look at paralytic ectropion in more detail…
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Upon leaving the skull, CN7 immediately enters the substance of a large gland. Which one?The parotid
While in the parotid gland, CN7 splits into branches. How many branches does it (usually) have?Five
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Upon leaving the skull, CN7 immediately enters the substance of a large gland. Which one?The parotid
While in the parotid gland, CN7 splits into branches. How many branches does it (usually) have?Five
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Upon leaving the skull, CN7 immediately enters the substance of a large gland. Which one?The parotid
While in the parotid gland, CN7 splits into branches. How many branches does it (usually) have?Five
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Upon leaving the skull, CN7 immediately enters the substance of a large gland. Which one?The parotid
While in the parotid gland, CN7 splits into branches. How many branches does it (usually) have?Five
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Facial nerve branching within the parotid gland
Paralytic Ectropion
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Upon leaving the skull, CN7 immediately enters the substance of a large gland. Which one?The parotid
While in the parotid gland, CN7 splits into branches. How many branches does it (usually) have?Five
Because of their anatomic relationship, inflammation involving the parotid gland can produce CN7 palsy. Speaking of, there is a classic syndrome involving parotitis and CN7 palsy (along with uveitis and fever). What is the eponymous name of this syndrome?Heerfordt syndrome
What is the underlying cause of inflammation in Heefordt syndrome?Sarcoidosis
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Upon leaving the skull, CN7 immediately enters the substance of a large gland. Which one?The parotid
While in the parotid gland, CN7 splits into branches. How many branches does it (usually) have?Five
Because of their anatomic relationship, inflammation involving the parotid gland can produce CN7 palsy. Speaking of, there is a classic syndrome involving parotitis and CN7 palsy (along with uveitis and fever). What is the eponymous name of this syndrome?Heerfordt syndrome
What is the underlying cause of inflammation in Heefordt syndrome?Sarcoidosis
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Upon leaving the skull, CN7 immediately enters the substance of a large gland. Which one?The parotid
While in the parotid gland, CN7 splits into branches. How many branches does it (usually) have?Five
Because of their anatomic relationship, inflammation involving the parotid gland can produce CN7 palsy. Speaking of, there is a classic syndrome involving parotitis and CN7 palsy (along with uveitis and fever). What is the eponymous name of this syndrome?Heerfordt syndrome
What is the underlying cause of inflammation in Heerfordt syndrome?Sarcoidosis
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Upon leaving the skull, CN7 immediately enters the substance of a large gland. Which one?The parotid
While in the parotid gland, CN7 splits into branches. How many branches does it (usually) have?Five
Because of their anatomic relationship, inflammation involving the parotid gland can produce CN7 palsy. Speaking of, there is a classic syndrome involving parotitis and CN7 palsy (along with uveitis and fever). What is the eponymous name of this syndrome?Heerfordt syndrome
What is the underlying cause of inflammation in Heerfordt syndrome?Sarcoidosis
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Paralytic Ectropion
What is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Upon leaving the skull, CN7 immediately enters the substance of a large gland. Which one?The parotid
While in the parotid gland, CN7 splits into branches. How many branches does it (usually) have?Five
Because of their anatomic relationship, inflammation involving the parotid gland can produce CN7 palsy. Speaking of, there is a classic syndrome involving parotitis and CN7 palsy (along with uveitis and fever). What is the eponymous name of this syndrome?Heerfordt syndrome
What is the underlying cause of inflammation in Heerfordt syndrome?Sarcoidosis In case you’re wondering, this is not useless trivia!
You may well see Heerfordt syndrome on the hoof (I have), and it’s definitely in play on the OKAPs, WQEs and Boards.
In the back of your mind, file an image of someone with chipmunk-looking cheeks (that’s the parotitis), facial palsy and uveitis under the headings ‘Heerfordt’ and ‘sarcoidosis.’ Trust me on this one.
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Heerfordt syndrome
Paralytic Ectropion
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
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Paralytic Ectropion
What is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
Let’s take a moment to review the anatomy of the orbicularis muscle
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they? How are they defined?--?--?
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they? How are they defined?--Orbital--Palpebral
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they? How are they defined?--Orbital--Palpebral
There’s a fundamental functional distinction between the orbital and palpebral portions. What is it?The palpebral portion is responsible for normal blinking, whereas the orbital portion comes into play only during effortful/voluntary eye closure
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they? How are they defined?--Orbital--Palpebral
There’s a fundamental functional distinction between the orbital and palpebral portions. What is it?The palpebral portion is responsible for normal blinking, whereas the orbital portion comes into play only during effortful/voluntary eye closure
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they? How are they defined?--Orbital: ?--Palpebral: ?
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they? How are they defined?--Orbital: The portion overlying orbital bone--Palpebral: The portion overlying the lids
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they?--Orbital: The portion overlying orbital bone--Palpebral: The portion overlying the lids ----?----?
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they?--Orbital: The portion overlying orbital bone--Palpebral: The portion overlying the lids ----Preseptal----Pretarsal
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they? How are they defined?--Orbital: The portion overlying orbital bone--Palpebral: The portion overlying the lids ----Preseptal: ?----Pretarsal: ?
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they? How are they defined?--Orbital: The portion overlying orbital bone--Palpebral: The portion overlying the lids ----Preseptal: The part overlying the orbital septum----Pretarsal: The part overlying the tarsal plates
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Orbicularis oculi
Paralytic Ectropion
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they? How are they defined?--Orbital: The portion overlying orbital bone--Palpebral: The portion overlying the lids ----Preseptal: The part overlying the orbital septum----Pretarsal: The part overlying the tarsal plates
There is a special slip of pretarsal orbicularis that is located at the surface of the lid margin. What is the eponymous name?The muscle of Riolan
What is its appearance-based, non-eponymous name?The gray line
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they? How are they defined?--Orbital: The portion overlying orbital bone--Palpebral: The portion overlying the lids ----Preseptal: The part overlying the orbital septum----Pretarsal: The part overlying the tarsal plates
There is a special slip of pretarsal orbicularis that is located at the surface of the lid margin. What is the eponymous name?The muscle of Riolan
What is its appearance-based, non-eponymous name?The gray line
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they? How are they defined?--Orbital: The portion overlying orbital bone--Palpebral: The portion overlying the lids ----Preseptal: The part overlying the orbital septum----Pretarsal: The part overlying the tarsal plates
There is a special slip of pretarsal orbicularis that is located at the surface of the lid margin. What is the eponymous name?The muscle of Riolan
What is its appearance-based, non-eponymous name?The gray line
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
What is the basic arrangement of the fibers of the orbicularis?As multiple concentric bands encircling all or part of the orbital aperture
The ‘multiple bands’ are organized into two basic portions—what are they? How are they defined? The palpebral portion is further subdivided into two parts—what are they? How are they defined?--Orbital: The portion overlying orbital bone--Palpebral: The portion overlying the lids ----Preseptal: The part overlying the orbital septum----Pretarsal: The part overlying the tarsal plates
There is a special slip of pretarsal orbicularis that is located at the surface of the lid margin. What is the eponymous name?The muscle of Riolan
What is its appearance-based, non-eponymous name?The gray line
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Muscle of Riolan(aka the gray line)
Paralytic Ectropion
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Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
Of its five, which two branches of CN7 (usually) innervate the orbicularis muscle?The temporal and zygomatic
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Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
Of its five, which two branches of CN7 (usually) innervate the orbicularis muscle?The temporal and zygomatic
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46
Orbicularis muscle innervation
Paralytic Ectropion
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47
Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
Does the ectropion involve the lower lid, the upper, or both?
![Page 48: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/48.jpg)
48
Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
Does the ectropion involve the lower lid, the upper, or both?The lower only (ectropion is not how orbicularis paralysis manifests in the upper lid)
![Page 49: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/49.jpg)
49
Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
Does the ectropion involve the lower lid, the upper, or both?The lower only (ectropion is not how orbicularis paralysis manifests in the upper lid)
OK then, how does orbicularis paralysis manifest in the upper lid?As lagophthalmos
What is lagophthalmos?The inability to completely close the eyelids
![Page 50: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/50.jpg)
50
Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
Does the ectropion involve the lower lid, the upper, or both?The lower only (ectropion is not how orbicularis paralysis manifests in the upper lid)
OK then, how does orbicularis paralysis manifest in the upper lid?As lagophthalmos
What is lagophthalmos?The inability to completely close the eyelids
![Page 51: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/51.jpg)
51
Paralytic EctropionQWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
Does the ectropion involve the lower lid, the upper, or both?The lower only (ectropion is not how orbicularis paralysis manifests in the upper lid)
OK then, how does orbicularis paralysis manifest in the upper lid?As lagophthalmos
What is lagophthalmos?The inability to completely close the eyelids
![Page 52: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/52.jpg)
52
Paralytic EctropionAWhat is the typical setting/cause of paralytic ectropion?A facial nerve (CN7) palsy
Paralysis of what facial muscle leads to ectropion?The orbicularis oculi
Does the ectropion involve the lower lid, the upper, or both?The lower only (ectropion is not how orbicularis paralysis manifests in the upper lid)
OK then, how does orbicularis paralysis manifest in the upper lid?As lagophthalmos
What is lagophthalmos?The inability to completely close the eyelids
![Page 53: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/53.jpg)
53
Paralytic lagophthalmos
Paralytic Ectropion
![Page 54: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/54.jpg)
Q As for managing paralytic ectropion:
54
Paralytic Ectropion
The overarching treatment goal is…
![Page 55: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/55.jpg)
A As for managing paralytic ectropion:
55
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
![Page 56: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/56.jpg)
Q As for managing paralytic ectropion:
56
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Two basic levels ofparalysis severity? ?
![Page 57: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/57.jpg)
A As for managing paralytic ectropion:
57
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentTwo basic levels ofparalysis severity
![Page 58: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/58.jpg)
As for managing paralytic ectropion:
58
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanent
If the paralysis/ectropion is…
Two basic levels ofparalysis severity
![Page 59: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/59.jpg)
Q As for managing paralytic ectropion:
59
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanent???
???
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Two basic levels ofparalysis severity
![Page 60: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/60.jpg)
A As for managing paralytic ectropion:
60
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Two basic levels ofparalysis severity
![Page 61: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/61.jpg)
Two basic levels ofparalysis severity
Q As for managing paralytic ectropion:
61
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
?
?
Withrespect
to…
There are two common ways to categorize tarsorrhaphies. What are they?One is categorize them in terms of their permanency; the other, in terms of their extent
Withrespect
to…
![Page 62: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/62.jpg)
Two basic levels ofparalysis severity
A As for managing paralytic ectropion:
62
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
There are two common ways to categorize tarsorrhaphies. What are they?One is to categorize them in terms of their permanency; the other, in terms of their extent
Permanancy
Extent
Withrespect
to…
Withrespect
to…
![Page 63: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/63.jpg)
Two basic levels ofparalysis severity
Q As for managing paralytic ectropion:
63
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
? ?Withrespect
to…
Withrespect
to…
With respect to permanency: What are the two types of tarsorrhaphy?
![Page 64: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/64.jpg)
Two basic levels ofparalysis severity
A As for managing paralytic ectropion:
64
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
With respect to permanency: What are the two types of tarsorrhaphy? Temporary PermanentWith
respectto…
Withrespect
to…
![Page 65: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/65.jpg)
Two basic levels ofparalysis severity
Q As for managing paralytic ectropion:
65
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
? ?
Withrespect
to…
Withrespect
to…
Temporary Permanent
With respect to extent: What are the two types of tarsorrhaphy?
![Page 66: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/66.jpg)
Two basic levels ofparalysis severity
A As for managing paralytic ectropion:
66
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
With respect to extent: What are the two types of tarsorrhaphy?
![Page 67: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/67.jpg)
Two basic levels ofparalysis severity
Q As for managing paralytic ectropion:
67
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
In terms of technique, temporary and permanent tarsorrhaphies differ in a couple of key ways. What are they?They are 1) the type of suture used, and 2) how the lid-margin epithelium is handled.
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
![Page 68: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/68.jpg)
Two basic levels ofparalysis severity
A As for managing paralytic ectropion:
68
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
In terms of technique, temporary and permanent tarsorrhaphies differ in a couple of key ways. What are they?They are 1) the type of suture used, and 2) how the lid-margin epithelium is handled.
![Page 69: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/69.jpg)
Two basic levels ofparalysis severity
Q As for managing paralytic ectropion:
69
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
In terms of technique, temporary and permanent tarsorrhaphies differ in a couple of key ways. What are they?They are 1) the type of suture used, and 2) how the lid-margin epithelium is handled.
What sort of suture is used for:--temporary tars? Nonabsorbable--permanent tars? Absorbable
![Page 70: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/70.jpg)
Two basic levels ofparalysis severity
A As for managing paralytic ectropion:
70
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
In terms of technique, temporary and permanent tarsorrhaphies differ in a couple of key ways. What are they?They are 1) the type of suture used, and 2) how the lid-margin epithelium is handled.
What sort of suture is used for:--temporary tars? Nonabsorbable--permanent tars? Absorbable
![Page 71: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/71.jpg)
Two basic levels ofparalysis severity
Q As for managing paralytic ectropion:
71
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
How is the epithelium handled in:--temporary tars? It is left alone--permanent tars? It is denuded
In terms of technique, temporary and permanent tarsorrhaphies differ in a couple of key ways. What are they?They are 1) the type of suture used, and 2) how the lid-margin epithelium is handled.
What sort of suture is used for:--temporary tars? Nonabsorbable--permanent tars? Absorbable
![Page 72: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/72.jpg)
Two basic levels ofparalysis severity
A As for managing paralytic ectropion:
72
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
How is the epithelium handled in:--temporary tars? It is left alone--permanent tars? It is denuded
In terms of technique, temporary and permanent tarsorrhaphies differ in a couple of key ways. What are they?They are 1) the type of suture used, and 2) how the lid-margin epithelium is handled.
What sort of suture is used for:--temporary tars? Nonabsorbable--permanent tars? Absorbable
![Page 73: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/73.jpg)
Two basic levels ofparalysis severity
Q As for managing paralytic ectropion:
73
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
How is the epithelium handled in:--temporary tars? It is left alone--permanent tars? It is denuded
In terms of technique, temporary and permanent tarsorrhaphies differ in a couple of key ways. What are they?They are 1) the type of suture used, and 2) how the lid-margin epithelium is handled.
What sort of suture is used for:--temporary tars? Nonabsorbable--permanent tars? Absorbable
What’s the purpose of denuding the lid-margin epithelium?As they heal, raw upper and lower lid margins will fuse, thereby making the tars permanent (as an aside, this is why absorbable sutures can be used—once the margins fuse, suture tension is no longer needed to maintain closure)
![Page 74: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/74.jpg)
Two basic levels ofparalysis severity
A As for managing paralytic ectropion:
74
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
How is the epithelium handled in:--temporary tars? It is left alone--permanent tars? It is denuded
In terms of technique, temporary and permanent tarsorrhaphies differ in a couple of key ways. What are they?They are 1) the type of suture used, and 2) how the lid-margin epithelium is handled.
What sort of suture is used for:--temporary tars? Nonabsorbable--permanent tars? Absorbable
What’s the purpose of denuding the lid-margin epithelium?As they heal, the raw upper and lower lid margins will fuse, thereby making the tars permanent (as an aside, this is why absorbable sutures can be used—once the margins fuse, suture tension is no longer needed to maintain lid closure)
![Page 75: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/75.jpg)
Two basic levels ofparalysis severity
Q As for managing paralytic ectropion:
75
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
Are partial tarsorrhaphies placed medially, or temporally?Per the Orbit BCSC book, either is acceptable. (Although IMHO temporal placement is preferred as it is technically easier to perform, has better cosmesis, and does not risk damaging the lacrimal apparatus. Just my $0.02.)
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
![Page 76: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/76.jpg)
Two basic levels ofparalysis severity
A As for managing paralytic ectropion:
76
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
Are partial tarsorrhaphies placed medially, or temporally?Per the Orbit book, either is acceptable. (Although IMHO temporal placement is preferred as it is technically easier to perform, has better cosmesis, and does not risk compromising the lacrimal apparatus. Just my $0.02.)
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
![Page 77: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/77.jpg)
77
Partial tarsorrhaphy
Paralytic Ectropion
![Page 78: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/78.jpg)
Two basic levels ofparalysis severity
As for managing paralytic ectropion:
78
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
How is the epithelium handled in:--temporary tars? It is left alone--permanent tars? It is denuded
In terms of technique, temporary and permanent tarsorrhaphies differ in a couple of key ways. What are they?They are 1) the type of suture used, and 2) how the lid-margin epithelium is handled.
What sort of suture is used for:--temporary tars? Nonabsorbable--permanent tars? Absorbable
What’s the purpose of denuding the lid-margin epithelium?As they heal, the raw upper and lower lid margins will fuse, thereby making the tars permanent (as an aside, this is why absorbable sutures can be used—once the margins fuse, suture tension is no longer needed to maintain lid closure)
Note that the BCSC Orbit book is not a fan of the permanent tarsorrhaphy—says it “should be avoided” unless absolutely necessary
![Page 79: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/79.jpg)
Two basic levels ofparalysis severity
As for managing paralytic ectropion:
79
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Instead, it advocates for gold weight placement in conjunction with lid tightening
![Page 80: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/80.jpg)
Two basic levels ofparalysis severity
Q As for managing paralytic ectropion:
80
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
There is an alternative technique that can be used to create a complete temporary tarsorrhaphy without sutures. What is it?The levator muscle can be paralyzed with an injection of botulinum toxin
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
![Page 81: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/81.jpg)
Two basic levels ofparalysis severity
Q/A As for managing paralytic ectropion:
81
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
There is an alternative technique that can be used to create a complete temporary tarsorrhaphy without sutures. What is it?The levator muscle can be paralyzed with an injection of botulinum toxin
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
![Page 82: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/82.jpg)
Two basic levels ofparalysis severity
A As for managing paralytic ectropion:
82
Paralytic Ectropion
The overarching treatment goal is…protect the cornea from exposure damage
Mild/temporary Severe/permanentLubricationOintmentLid taping
TarsorrhaphyGold weight placementLid tightening
If the paralysis/ectropion is…
…these maneuverswill likely be neededto protect the cornea
Permanancy
Extent
There is an alternative technique that can be used to create a complete temporarytarsorrhaphy without sutures. What is it?The levator muscle can be paralyzed with an injection of botulinum toxin
CompletePartial
Temporary PermanentWithrespect
to…
Withrespect
to…
![Page 83: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/83.jpg)
83
Neurotoxin (botulinum) tarsorrhaphy
Paralytic Ectropion
A 10-year-old female with right meta-herpetic corneal ulcer (top left). Anterior transcutaneous chemodenervation of levator muscle was performed with Botox (top right). One week after chemodenervationdemonstrating complete ptosis (bottom left). Patient in upgaze demonstrating preserved superior rectus function (bottom right).
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Q
Also, when managing paralytic ectropion… Remember: 7 + 5 = [Note: Not 12]
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Paralytic Ectropion
?
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A
Also, when managing paralytic ectropion… Remember: 7 + 5 = Tarsorrhaphy
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Paralytic Ectropion
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Q
Also, when managing paralytic ectropion… Remember: 7 + 5 = Tarsorrhaphy
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Paralytic Ectropion
7 + 5 = tarsorrhaphy? What on earth is that supposed to mean?
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Q/A
Also, when managing paralytic ectropion… Remember: 7 + 5 = Tarsorrhaphy(CN) (CN)
87
Paralytic Ectropion
7 + 5 = tarsorrhaphy? What on earth is that supposed to mean?It means if a pt has both a CN7 palsy preventing lid closure anddecreased corneal sensation (ie, CN5 dysfunction), then s/he is at very high risk for exposure keratopathy , and prophylactic tarsorrhaphy (or similar procedure) should be strongly considered.
two words
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A
Also, when managing paralytic ectropion… Remember: 7 + 5 = Tarsorrhaphy(CN) (CN)
88
Paralytic Ectropion
7 + 5 = tarsorrhaphy? What on earth is that supposed to mean?It means if a pt has both a CN7 palsy preventing lid closure anddecreased corneal sensation (ie, CN5 dysfunction), then s/he is at very high risk for exposure keratopathy , and prophylactic tarsorrhaphy (or similar procedure) should be strongly considered.
![Page 89: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/89.jpg)
Q
Also, when managing paralytic ectropion… Remember: 7 + 5 = Tarsorrhaphy(CN) (CN)
89
Paralytic Ectropion
7 + 5 = tarsorrhaphy? What on earth is that supposed to mean?It means if a pt has both a CN7 palsy preventing lid closure anddecreased corneal sensation (ie, CN5 dysfunction), then s/he is at very high risk for exposure keratopathy , and prophylactic tarsorrhaphy (or similar procedure) should be strongly considered.What does this imply about the initial evaluation of a pt presenting with paralytic ectropion?
That it must include assessment of corneal sensation
![Page 90: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/90.jpg)
A
Also, when managing paralytic ectropion… Remember: 7 + 5 = Tarsorrhaphy(CN) (CN)
90
Paralytic Ectropion
7 + 5 = tarsorrhaphy? What on earth is that supposed to mean?It means if a pt has both a CN7 palsy preventing lid closure anddecreased corneal sensation (ie, CN5 dysfunction), then s/he is at very high risk for exposure keratopathy , and prophylactic tarsorrhaphy (or similar procedure) should be strongly considered.What does this imply about the initial evaluation of a pt presenting with paralytic ectropion?
That it must include assessment of corneal sensation
![Page 91: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/91.jpg)
Q
Also, when managing paralytic ectropion… Remember: 7 + 5 = Tarsorrhaphy(CN) (CN)
91
Paralytic Ectropion
7 + 5 = tarsorrhaphy? What on earth is that supposed to mean?It means if a pt has both a CN7 palsy preventing lid closure anddecreased corneal sensation (ie, CN5 dysfunction), then s/he is at very high risk for exposure keratopathy , and prophylactic tarsorrhaphy (or similar procedure) should be strongly considered.What does this imply about the initial evaluation of a pt presenting with paralytic ectropion?
That it must include assessment of corneal sensation
What two broad categories of conditions causing paralytic ectropion are most likely to also result in loss of corneal sensation?CVA, and intracranial surgery
![Page 92: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/92.jpg)
A
Also, when managing paralytic ectropion… Remember: 7 + 5 = Tarsorrhaphy(CN) (CN)
92
Paralytic Ectropion
7 + 5 = tarsorrhaphy? What on earth is that supposed to mean?It means if a pt has both a CN7 palsy preventing lid closure anddecreased corneal sensation (ie, CN5 dysfunction), then s/he is at very high risk for exposure keratopathy , and prophylactic tarsorrhaphy (or similar procedure) should be strongly considered.What does this imply about the initial evaluation of a pt presenting with paralytic ectropion?
That it must include assessment of corneal sensation
What two broad categories of conditions causing paralytic ectropion are most likely to also result in loss of corneal sensation?CVA, and intracranial surgery
![Page 93: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/93.jpg)
Q
Also, when managing paralytic ectropion… Remember: 7 + 5 = Tarsorrhaphy(CN) (CN)
93
Paralytic Ectropion
7 + 5 = tarsorrhaphy? What on earth is that supposed to mean?It means if a pt has both a CN7 palsy preventing lid closure anddecreased corneal sensation (ie, CN5 dysfunction), then s/he is at very high risk for exposure keratopathy , and prophylactic tarsorrhaphy (or similar procedure) should be strongly considered.What does this imply about the initial evaluation of a pt presenting with paralytic ectropion?
That it must include assessment of corneal sensation
What two broad categories of conditions causing paralytic ectropion are most likely to also result in loss of corneal sensation?CVA, and intracranial surgery
What is the most common cause of simultaneous loss of CNs 5 & 7?Acoustic neuroma resection surgery
![Page 94: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/94.jpg)
Q/A
Also, when managing paralytic ectropion… Remember: 7 + 5 = Tarsorrhaphy(CN) (CN)
94
Paralytic Ectropion
7 + 5 = tarsorrhaphy? What on earth is that supposed to mean?It means if a pt has both a CN7 palsy preventing lid closure anddecreased corneal sensation (ie, CN5 dysfunction), then s/he is at very high risk for exposure keratopathy , and prophylactic tarsorrhaphy (or similar procedure) should be strongly considered.What does this imply about the initial evaluation of a pt presenting with paralytic ectropion?
That it must include assessment of corneal sensation
What two broad categories of conditions causing paralytic ectropion are most likely to also result in loss of corneal sensation?CVA, and intracranial surgery
What is the most common cause of simultaneous loss of CNs 5 & 7?Acoustic neuroma resection surgerytumor type (two words)
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A
Also, when managing paralytic ectropion… Remember: 7 + 5 = Tarsorrhaphy(CN) (CN)
95
Paralytic Ectropion
7 + 5 = tarsorrhaphy? What on earth is that supposed to mean?It means if a pt has both a CN7 palsy preventing lid closure anddecreased corneal sensation (ie, CN5 dysfunction), then s/he is at very high risk for exposure keratopathy , and prophylactic tarsorrhaphy (or similar procedure) should be strongly considered.What does this imply about the initial evaluation of a pt presenting with paralytic ectropion?
That it must include assessment of corneal sensation
What two broad categories of conditions causing paralytic ectropion are most likely to also result in loss of corneal sensation?CVA, and intracranial surgery
What is the most common cause of simultaneous loss of CNs 5 & 7?Acoustic neuroma resection surgery
![Page 96: What does the term Entropion Ectropion](https://reader030.fdocuments.in/reader030/viewer/2022012420/6174930b3ad3160fd33627a0/html5/thumbnails/96.jpg)
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Paralytic lagophthalmos
Paralytic Ectropion
A. A 33-year-old woman with complete right facial paralysis following resection of a large acoustic neuroma resulting in the loss of the facial nerve at the skull base.B. Lagophthalmos with corneal exposure despite the presence of Bell's phenomenon.C,D. Shortly after the initial tumor surgery, a 1 g gold weight was placed in the upper eyelid, followed by cross facial nerve graft. Three weeks later, full closure is achieved.