Kolkata Call Girls Service ❤️🍑 9xx000xx09 👄🫦 Independent Escort Service Kolka...
Eyelid Surgery for Ophthalmic Clinical Course UPPGH
1. Principles of Ophthalmic Plastic Surgery:
Surgical Manageement of Entropion,
Ectropion and Ptosis
Alexander D. Tan, MD
UP-PGH
President, PSOPRS
2. Basics
• Know your Anatomy ; important
landmarks
• Know the underlying pathology
• Good equipment (light, suture,
instruments, cautery machine)
• Incisions in Langers Lines, decrease
wound tension
• Good preop patient preparation ;
good post-op care
• Biopsy what you remove
3. Basic Oculoplastic Procedures
• Repair of Eyelid Lacerations
• Canalicular Repair with Intubation
• Excision; Shaving; Cauterization
• Section Biopsy
• Tarsorrhaphy
• I and D; I and C
• Electroepilation
• Quickert Suture
• Canthotomy
4. Entropion
• Inward turning of the lid margin
• Types: congenital, spastic,
involutional, cicatricial
• Management is directed in
correcting the underlying
pathology involved
5. Important notes in ocular exam
• Check for possible cause of spastic
entropion, scarring of posterior lamellae
• Slit lamp biomicroscopy
• Lid laxity: distraction and snap back test
• Rounding of the lateral commisure
• Lack of movement of lower lid in downgaze
• Overriding can be induced by squeezing
the eyelids
6. Spastic Entropion
• Guarding caused by recent ocular
surgery or inflammation
• May have beginning involutional
changes
• Mechanism is overriding of the
preseptal over the pretarsal
orbicularis
• Mgt: decrease inflammation, Botox A
7. Congenital Entropion
• Since birth, absence of lid crease
• Disinsertion of the lid retractors
• Management: reinsertion of lid
retractors
• Epiblepharon: seen in asian eyelids
– Usually would resolve with age
Management: excision of skin and
orbicularis
11. Involutional Entropion
• Mechanisms: lid laxity, disinsertion
of the lower lid retractors, overriding
of pretarsal and preseptal orbicularis
• Surgical Correction:
Quickert Rathbun sutures
Lateral tarsal strip
Reinsertion of lower lid retractors
17. Cicatricial Entropion
• Caused by shortage of the posterior
lamellae
• Management:
Mild cases: Tarsotomy with Marginal
rotation
Severe cases: lid recession, with buccal
mucosal graft, posterior lamella graft
24. Ectropion
• Outward turning of the lashes
• Associated with lid laxity and
canthal dehiscence
• Types: congenital, involutional,
paralytic, mechanical and cicatricial
25. Congenital Ectropion
• Congenital Ectropion: usually associated with
BPES; due to lack of anterior lamellae
• Euryblepharon: antimongoloid slant because of
inferiorly displaced lateral canthal tendons;
widened fissures of lateral eyelid, with lid margins
not touching the globe.
26.
27.
28.
29.
30.
31.
32.
33. Ectropion surgery
• Check for punctal ectropion
• Check for laxity of the medial
canthal tendon
• Check for presence of cicatrical
changes in anterior lamellae
39. Blepharoptosis
• Drooping of the upper lid
• Types: congenital, neurogenic,
involutional or disinsertional,
mechanical
• Pseudoptosis: enophthalmos, lid
retraction or exophthalmos in other
eye, hypotropia, lid swelling,
guarding
40. Preoperative Evaluation
1
2
3
4
Height of lid crease
MRD
MRD
Palpebral
fissure
5. Levator function 10. Lagophthalmos
6. Lid lag 11. Brow position
7. Orbicularis function
8. Pupil size
9. Phenylephrine test/ Dry Eye
54. Disinsertional Ptosis
• Most common type
• Associated with past ocular surgery,
recurrent upper lid swelling, contact
lens use
• Higher lid crease, good levator
function, deepening of superior
sulcus
