The histopathology of involutional ectropion and entropion

Involutional Entropion and Ectropion of the Lower Eyelid: Prevalence and Associated Risk Factors in the Elderly Population

“…19 -23 Also, medial canthal tendon laxity and disinsertion of the lower retractors are factors. 19,20,23,24 This is why the lateral tarsal strip procedure has shown a higher success rate than other surgical procedures in both involutional entropion and ectropion. 19,21,22,25 This study analyzed the importance of the axial ocular globe projection for the development of involutional entropion and ectropion in a large elderly population.…”

Eyelid aging: pathophysiology and clinical management

“…Age-related decrease and atrophy of the orbital fat as well as the relaxation of the ligamentous support lead to an increasing eyelid-globe disparity that again compounds eyelid laxity (9,16) . Some studies reported the presence of abnormal elastic fibers in involutional ectropion and entropion; however, they did not measure them nor did they address the possible reasons for the abnormal fibers (21,22) . Damasceno et al revealed a decrease in elastic fibers in the pretarsal orbicularis oculi muscle, in the tarsal stroma, and in the eyelid skin in patients suffering from age-related involutional ectropion and entropion (27) .…”

“…Additionally, upregulation of MMP-7 and MMP-9 by mechanical stress has been demonstrated (30,35,37) . In involutional ectropion and entropion, there is a significant negative correlation between horizontal eyelid laxity and extracellular matrix components, including collagen and elastic fibers, so that both components are affected by degeneration (Figure 1) (21,22,(39)(40)(41) . Aging skin is characterized by increasing laxity and decreasing numbers of collagen and elastic fibers (39,(42)(43)(44) .…”

“…The lateral laxity of the canthal tendon is the most important reason for the appearance of involutional ectropion and entropion. Laxity of the medial canthal tendon as well as false insertion of the lower retractors are also conductive parameters (12,(21)(22)(23)(24)(25)(26) . Age-related decrease and atrophy of the orbital fat as well as the relaxation of the ligamentous support lead to an increasing eyelid-globe disparity that again compounds eyelid laxity (9,16) .…”

Entropion-Ectropion

“…The lower eyelid instability is typically caused by horizontal laxity and eyelid retractor detachment, disinsertion or attenuation at the inferior tarsal border, and laxity of cheek tissues. Implicated structures include the tarsus and its size, 1 lower eyelid retractors and their dehiscence, 4 orbital fat shrinkage and prolapse, 5 horizontal eyelid laxity, 6 over-riding of preseptal orbicularis, 7 actinic changes in skin, [8][9][10] axial globe projection, 3,11 and laxity of cheek tissues. 12 The midface structures provide a positive vector support to the lower eyelid, and laxity of these tissues could lead to a negative vector effect on lower eyelid leading to malposition.…”