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Abstract: Postblepharoplasty ectropion is a very complex problem to deal with because its relevance is far to be only a functional complaint. Therefore, the best surgical approach requires both aesthetic and functional consideration. Here, we introduce the absorbable suture anchor technique, which can meet both needs, and its surgical procedure is simple and effective and has excellent stability for long-term results. This series included only ectropion patients caused by lower eyelid blepharoplasty, with or without receiving revision surgery. Forty-seven cases (64 eyes) were treated by a single surgeon through this method. Forty-six patients (97.9%) displayed adequate correction of the eyelid ectropion and a marked degree of improvement both in aesthetic terms and with regard to the functional disorders reported. One patient (2.1%) presented complications but brought under control after drainage and dressing change. His previous symptoms were also largely relieved. Absorbable suture anchor technique is an effective, minimally invasive, and safe method to correct postblepharoplasty ectropion., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

BACKGROUND Lamellar ichthyosis is a rare type of hereditary ichthyosis disease that is responsible for generalized dry skin and severe scaling. Congenital ectropion and eclabium are often associated with this condition. The ectropion can cause many ophthalmologic complications, mostly due to corneal exposure caused by the lack of eyelid cleft closure. The corneal exposure can cause ulceration and even corneal perforation leading to phthisis bulbi. CASE REPORT We report the case of a North African newborn baby diagnosed with congenital lamellar ichthyosis responsible for severe skin scaling, eclabium, and bilateral ectropion of both the upper and lower eyelids. The therapeutic care of the baby was ensured by a collaboration between ophthalmologist and dermatologist. The newborn was treated by oral acitretin and skin emollients for his dermatological conditions and on the ophthalmological level he was put on lubricating and moisturizing eye drops and gel, associated with daily repeated eyelid massage. The evolution after 6 months of treatment showed excellent results on both the dermatological and the ophthalmological level. CONCLUSIONS At the stage of cicatricial ectropion in lamellar ichthyosis, the management is mainly based on a chirurgical approach. However, if the ectropion is managed early enough, the treatment could be medical, which is much easier, produces very good results, and prevents the progression toward eyelid fibrosis and its associated complications that can make the management of the ectropion much harder.

Aim: To report the cases of five children with unilateral advanced glaucoma in isolated congenital ectropion uveae (CEU) with ipsilateral ptosis and myopia. Methods: This is an ambispective observational case series. After diagnosing one patient with CEU and glaucoma, consecutive patients presenting with unilateral ptosis, congenital iris anomaly, and glaucoma between 2014 to 2020, and had completed a minimum one-year postoperative follow-up, were analyzed. Results: Of the 1421 newly registered pediatric glaucoma patients in the period under review, five children were diagnosed with CEU. All patients presented with gradual painless diminution of vision in the left eye in early adolescence. The left eye of all patients had peculiar clinical features: mild congenital ptosis, high iris insertion, crypt-less smooth iris surface, congenital ectropion uveae, pigments over anterior lens capsule, high myopia, advanced glaucomatous optic disc cupping, and very high intraocular pressure (IOP), which was > 45 mmHg in all cases. The right eye showed signs of angle dysgenesis with mild anterior iris insertion and numerous fine iris processes. Antiglaucoma medications and angle surgery failed to control the IOP, and all children required glaucoma filtration surgery, resulting in reasonable IOP control. Despite the older age, postoperative strict amblyopia treatment resulted in significant improvement in vision. Conclusions: Although ectropion uveae and ptosis have been present since birth, unilaterality, and the asymptomatic nature of the disease led to the late presentation with irreversible damage. Early surgical management and amblyopia therapy are the cornerstones of management. Abbreviations: CEU = Congenital ectropion uvea, CIES = Congenital Iris Ectropion Syndrome, ASD = Anterior segment dysgenesis syndrome, BCVA = Best-corrected visual acuity, IOP = Intraocular pressure., (© The Authors.Romanian Society of Ophthalmology.)

We report the case of congenital ectropion uveae in a 10-year-old boy with intractable unilateral glaucoma but no systemic association. Glaucoma in congenital ectropion uveae is often poorly responsive to medial therapy and requires surgical intervention. Satisfactory results are possible if diagnosis is established early and timely surgery performed, as was the case in our patient.

Background: Upper eyelid ectropion occurs as a post-blepharoplasty complication or involution change, and it causes dry eye symptoms that cannot be resolved with conservative management., Objectives: The aim of this study is to describe the authors' surgical technique of anatomical correction of upper eyelid ectropion, including tarsal scoring incision., Methods: The technique involves the following 4 steps: (1) adhesiolysis at the preaponeurotic layer; (2) undermining and redraping of the pretarsal flap in a pretarsal plane; (3) optional, partial thickness tarsal scoring incision over the central two-thirds; and (4) downward repositioning of the pretarsal flap and lower fixation to the tarsus. Outcomes were assessed based on the position of eyelid margin and the improvement of the dry eye symptoms., Results: A retrospective review of 54 cases of patients who underwent ectropion correction, including tarsal scoring incision, was performed. The eyelid margin was well positioned in 51 patients (94.4%). Of the 32 patients involved in the study assessed with the 7-point Patient Global Impression of Improvement, 29 (90.6%) reported the resolution of dry eye symptoms. Furthermore, in the 22 patients assessed with the Ocular Surface Disease Index, the mean score significantly decreased from 43.2 ± 24.1 before surgery to 29.8 ± 23.3 (P = 0.006) after surgery., Conclusions: The combination of partial-thickness tarsal plate scoring and lower flap redraping surgical techniques resolved the upper eyelid ectropion, reducing the dry eye symptoms., (© 2020 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.)

Ectropion is a rather frequent complication of ichthyosis with negative functional and esthetic impact. Lid surgery can provide significant improvement. We report on a series of four ichthyosis patients with ongoing bilateral eye problems despite intense medical treatment (mean age 27.8 ± 14.1 years). All patients suffered from lagophthalmos. Two of the patients had only lower lid ectropion. In two of the patients' ectropion was forming on the upper lid in addition to the lower lid when closing the eye. In three of four patients, ectropion was repaired by skin grafts from the supraclavicular region. In a child with lower and upper lid ectropion prepuce was used for repair surgery. At the end of the follow-up period of about 23.0 ± 12.7 months, none of the patients revealed lagophthalmos or corneal exposure. No intraoperative or postoperative complications have been observed in our patients. Ichthyosis patients with ectropion resistant to medical treatment, benefit from surgical treatment with full layer autografts. In boys, prepuce can be successfully used as autograft., (© 2020 Wiley Periodicals LLC.)

The majority of patients with Sézary syndrome (SS) present with classic symptoms of erythroderma, lymphadenopathy, and pruritus. However, there have been numerous reports of patients with SS who have non-classic signs. In this review, we report the less common clinical presentations of SS and discuss their relevant treatments. Our search included all literature on SS since 2008, the year the World Health Organization (WHO) incorporated the diagnostic criteria for SS into the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. We reviewed 896 articles and identified 505 patients with non-classic presentations of SS. Of these 505 patients, the most common non-classic signs of SS were keratoderma, onychodystrophy, alopecia, leonine facies, and ectropion. Given the aggressive and highly symptomatic nature of SS, it is imperative that clinicians recognize the less common signs of the disease to prevent delays in diagnosis and treatment. To our knowledge, this is the first review of the clinical variations of SS with a focus on non-classic signs and symptoms.

Aim: Lid eversion is an essential component of contact lens aftercare. Hence, this study determined the best method of lid eversion based on three criteria: comfort, speed of administration and the area of the palpebral conjunctiva exposed., Method: Twenty-five participants (aged 20-34) had 6 different techniques applied in random order by the same clinician on two separate occasions: three involving a cotton bud placed on the extended upper eyelid either centrally, at the top of the tarsal plate or off-centre; one using the wooden end of the bud placed at the top of the tarsal plate; one using the clinician's index finger to evert the lid; and one using a silicone rubber, finger-shaped substitute. The participants judged the degree of discomfort of each technique on a visual analogue scale. The time to complete the task was timed with a stop-watch and the area of exposed palpebral conjunctiva was captured with a digital slit lamp and assessed using image analysis., Results: There was no difference between the initial lid eversion or subsequent repeat in terms of comfort (F = 0.304, p = 0.586), time to complete (F = 3.075, p = 0.092) or area exposed (F = 2.311, p = 0.142). Lid eversion using fingers alone or the silicone substitute everter were similar in comfort (p = 0.312), being the most comfortable methods, with off-centre cotton bud eversion or the wooden end of the cotton bud the least comfortable techniques (F = 17.480, p < 0.001). The quickest method to perform was the wooden end of the cotton bud, followed by the silicone everter (F = 17.522, p < 0.001). The area of exposed palpebral conjunctiva was greatest using the silicone everter (F = 28.199, p < 0.001)., Conclusions: Lid eversion had repeatable results, with the silicone everter placed at the top of the tarsal plate the most comfortable for the patient, quick to perform and exposed a greater area of tarsal plate than other techniques and therefore is recommended to clinicians., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Significance: Ichthyosis is a group of heterogenous inherited skin disorders characterized by abnormal cornification and keratinization of the skin. Autosomal recessive congenital ichthyosis presents with severe lagophthalmos and cicatricial ectropion of both upper and lower lids. Chronic corneal exposure from lid abnormalities may lead to ulcerative keratitis or corneal perforation., Purpose: The case highlights a rarely seen condition that presents with potentially serious ocular complications and vision loss. Corneal complications may be avoided or managed with moisture goggles, corneal vaulting with scleral lenses, topical therapeutics, amniotic membrane, and surgical lid repair., Case Report: A 25-year-old woman presented with a painful right eye for 1 week. She had a medical history of autosomal recessive congenital ichthyosis. Her ocular adnexa revealed bilateral lagophthalmos and cicatricial ectropion of both upper and lower lids. The slit lamp of examination revealed an injected eye with corneal ulcer with hypopyon in the right eye and quiet eye with corneal scarring in the left eye. The patient was treated with topical moxifloxacin and polymyxin B sulfate/trimethoprim as well as in-office homatropine 5% in the right eye. The keratitis was treated to resolution, and the patient referred for consultation on lid repair., Conclusions: Chronic corneal exposure from autosomal recessive congenital ichthyosis may lead to severe dry eye, ulcerative keratitis, or perforation. Patients should be monitored carefully for corneal disease, educated on methods and devices to protect the corneal surface, and referred for surgical repair if indicated. Although rare, this condition presents unique findings that may be visually devastating. Awareness of the condition, as well as the various clinical presentations and appropriate management necessary, will prove beneficial to the patient.

Purpose: To investigate the effect of multiple lid eversions on lid wiper epitheliopathy (LWE), along with the effect of cumulative lid exposure time and the patterns of associated staining., Methods: The increase in area of lid wiper staining with lissamine green was compared by everting both the upper eyelids of each subject (i.e. contralateral design), with one eye being everted once for 45 s and the fellow eyelid everted three times, each time for 15 s. This pattern of contralateral eversion was repeated with a total of three eversions in one eye and nine eversions in the fellow eye, with each eye totalling 135 s cumulative exposure to eversion over about 9 min. The LWE area of staining was objectively quantified from slit lamp photography images captured at every lid eversion by 2 masked observers. Two-way repeated measures ANOVAs were used to determine the effect of number of lid eversions and cumulative exposure time on the amount of staining caused. Each image was also categorized into its primary LWE staining pattern, by a masked observer., Results: The multiple eversions condition caused significantly greater LWE than the single eversion condition (p < 0.001), while cumulative exposure time did not have a significant effect on LWE (p = 0.137). Classification of the primary staining patterns revealed that with more eyelid eversions there was a shift from mostly 'no staining' to minor patterns ('short horizontal bands' and 'vertical streaks') and then to more extensive patterns ('broad horizontal bands' and 'comb-shaped')., Conclusions: The number of eyelid eversions is a confounding factor that should be controlled when investigating LWE, in particular when considering the link with dry eye or contact lens discomfort. However the cumulative exposure time did not appear to influence the LWE magnitude., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the results of permanent medial tarsorrhaphy and to describe the surgical technique., Methods: Medial tarsorrhaphy was performed on 30 eyelids with symptomatic exposure keratopathy secondary to eyelid malposition. Observational, retrospective review of preoperative and postoperative examination findings was performed., Results: Average age of the cohort was 66 years (31-91). Medial tarsorrhaphy was performed to correct eyelid retraction (100%), exposure keratopathy (80%), lagophthalmos (57%), and ectropion (17%) in patients with cranial nerve VII palsy (47%), Graves eye disease (13%), eczema (7%), floppy eyelid syndrome (7%), after Mohs reconstruction (7%), orbital myositis (3%), and neurofibromatosis (3%). Seventy-three percent (73%) of patients had an average of 3 surgeries (N = 22, standard deviation = 1.12, range = 2-7) before undergoing medial tarsorrhaphy. Medial tarsorrhaphy was performed in combination with another procedure in 53% of cases. Palpebral fissure decreased postoperatively an average of 1.1 mm (N = 20; p = 0.005), inferior scleral show decreased 0.72 mm (N = 22; p = 0.03), lagophthalmos decreased 0.4 mm (N = 15; p = 0.27), and superficial punctate keratopathy improved by 61% (N = 27; p = 0.009). Ectropion completely resolved in 4 of 10 patients (40%). Seven patients (23%) required additional surgery following tarsorrhaphy an average of 8 months later (range = 2-16). In 1 patient (3%), a tarsorrhaphy opened prematurely, and 1 patient (3%) requested partial opening of the tarsorrhaphy. Average duration of follow up was 13 months (N = 30, standard deviation = 14.97, range = 0.2-45.7)., Conclusions: Medial tarsorrhaphy is a safe and effective primary or salvage technique to address complex causes of eyelid retraction, lagophthalmos, ectropion, and exposure keratopathy.

Importance: Cicatricial ectropion repair is effective and has a low complication rate., Background: To evaluate the effectiveness and long-term functional outcomes of surgical repair of lower lid cicatricial ectropion., Design: Prospective consecutive case series., Participants: Forty-four consecutive operations for cicatricial ectropion repair., Methods: Consecutive cases of cicatricial ectropion repair completed during 2007-2011 in Waikato Hospital and Hamilton Eye Clinic, New Zealand, were enrolled in the study following formal ethics approval. Ectropion repair was completed using inferior retractor repositioning, horizontal lid tightening and full-thickness skin grafting., Main Outcome Measures: Patient-reported symptoms and satisfaction, ectropion recurrence and punctal ectropion., Results: Forty-four eyes of 40 patients (30 males and 10 female) were included in the study. The average age at surgery was 75 years. Watering and poor appearance were the most common presenting symptoms. Postoperative follow-up was 1-6 years (mean = 4 years). There were no major perioperative complications, one patient developed trichiasis postoperatively. There were five reoperations (11%) during the study period. Two patients underwent medial spindle procedures for symptomatic medial ectropion and three patients required additional horizontal lid tightening. Seventy percent of patients reported satisfaction with their long-term results despite the partial recurrence of symptoms in 45%. Ectropion recurrence in <1 year occurred in three patients., Conclusion and Relevance: In this series, satisfactory appearance and symptom control were reported by 68% of patients at long-term follow-up. Preoperative marked ectropion with marked lid laxity is associated with early treatment failure and may be regarded as a relative contraindication to surgical correction with this technique. Punctal ectropion is an unreliable indicator of functional success., (© 2018 Royal Australian and New Zealand College of Ophthalmologists.)

This case reports the findings and management of a late preterm female infant born with congenital bilateral eyelid eversion with chemosis. The pathogenic process remains unknown but typically presents at birth, predominantly affecting the upper eyelid of both eyes. Black males, patients with trisomy 21, and collodion infants have a higher incidence of eyelid eversion. Treatment modalities range from conservative therapy including eye patching with antibiotic and lubricating ointment to invasive surgical eyelid suturing. In this case report, successful resolution of chemosis and eyelid inversion occurred with conservative management.

Purpose: This study aimed to evaluate the effect of orbital vector and other biometric parameters (i.e. axial globe length, axial globe projection) on the development of involutional entropion or ectropion., Methods: In this cross-sectional study, 167 eyes from 132 patients were included. Of these eyes, 128 had involutional entropion and 39 had involutional ectropion, all of lower lids. The axial globe projection was measured using Hertel exophthalmometry; axial globe length was assessed by A-mode ultrasound; and orbital vector was determined clinically. Patient-specific categorical variables and continuous variables were compared using the chi-square test and the two-sided t test, respectively. Correlations were derived using the Pearson correlation., Results: The percentage of females was 59% and 33.3% in the entropion group and in the ectropion group, respectively. A significant association was found between the gender and type of eyelid malposition (p = 0.015). Exophthalmometry reading was greater in the ectropion group than in the entropion group (17.7 ± 2.5 versus 10.8 ± 3.7 mm, respectively; p < 0.001). There was no significant correlation between axial globe length and exophthalmometry reading. Positive orbital vectors were observed in 87.5% of eyelids with involutional entropion. Negative orbital vectors were observed in 92.3% of eyelids with involutional ectropion (p < 0.001). Patients with negative orbital vectors showed greater axial globe projection than patients with positive orbital vectors (18.0 ± 2.1 versus 10.6 ± 3.5 mm, respectively; p < 0.001)., Conclusions: There is an association between orbital vector measurement and involutional entropion and ectropion. Measuring the orbital vector may help predict the development of these lid malpositions.

Ocular complications of graft-versus-host disease are well documented. While skin changes due to graft-versus-host disease have been mentioned in the literature, cicatricial ectropion has not been previous reported. The authors present a case of a 31-year-old male with cicatricial ectropion secondary to graft-versus-host disease requiring treatment with a full thickness skin graft.

Competing Interests: Conflict of Interest: None.

Purpose: Blepharocheilodontic (BCD) syndrome is a rare autosomal dominant condition characterized by eyelid malformations, cleft lip/palate, and ectodermal dysplasia. The molecular basis of BCD syndrome remains unknown., Methods: We recruited 11 patients from 8 families and performed exome sequencing for 5 families with de novo BCD syndrome cases and targeted Sanger sequencing in the 3 remaining families., Results: We identified five CDH1 heterozygous missense mutations and three CTNND1 heterozygous truncating mutations leading to loss-of-function or haploinsufficiency. Establishment of detailed genotype-phenotype correlations was not possible because of the size of the cohort; however, the phenotype seems to appear more severe in case of CDH1 mutations. Functional analysis of CDH1 mutations confirmed their deleterious impact and suggested accelerated E-cadherin degradation., Conclusion: Mutations in CDH1 encoding the E-cadherin were previously reported in hereditary diffuse gastric cancer as well as in nonsyndromic cleft lip/palate. Mutations in CTNND1 have never been reported before. The encoded protein, p120ctn, prevents E-cadherin endocytosis and stabilizes its localization at the cell surface. Conditional deletion of Cdh1 and Ctnnd1 in various animal models induces features reminiscent of BCD syndrome and underlines critical role of the E-cadherin-p120ctn interaction in eyelid, craniofacial, and tooth development. Our data assert BCD syndrome as a CDH1 pathway-related disorder due to mutations in CDH1 and CTNND1 and widen the phenotypic spectrum of E-cadherin anomalies.Genet Med advance online publication 09 March 2017.

Purpose: To examine the changes in microscopic anatomy of the lower eyelid tarsal ectropion repair with the Putterman ptosis clamp and better understand the anatomical changes associated with the eyelid malposition correction., Methods: Ten orbits from 5 fresh frozen cadaver heads, ranging in age from 53 to 77 years, were used for the dissection. For each head, a Putterman clamp tarsal ectropion repair was performed on one side, while the contralateral unoperated orbit served as a control. After performing the procedure, both orbits were exenterated and they, along with the resected specimens, were studied microscopically using Verhoeff-Masson trichrome and hematoxylin-eosin stains., Results: Conjunctiva, capsulopalpebral fascia, and smooth muscle were present on all tissue specimens incarcerated within the ptosis clamp. Tarsus was present in one specimen. There was a shortening of the posterior lamella of the eyelid with advancement of the capsulopalpebral fascia on all operated specimens when compared with controls., Conclusion: The Putterman clamp ectropion repair works by shortening the posterior lamella of the eyelid and advancing the lower eyelid retractors superiorly. This advancement tightens the lower eyelid retractors and thus stabilizes the eyelid in a more vertical position. In addition to a lateral tendon tuck as described in the original article to tighten horizontal eyelid laxity, this procedure addresses both vertical and horizontal laxity of tarsal ectropion.

A 56-year-old female presented with eyelid necrosis secondary to systemic levamisole-induced vasculitis. Skin biopsy revealed necrotic epidermis with small-vessel thrombosis, fibrinoid reaction, and neutrophilic infiltration of vessel walls in the dermis with +pANCA. She was treated with plasmapheresis and steroids. Six months later, she developed severe, symptomatic cicatrical ectropion with marked anterior lamellar shortage and middle lamellar contracture. Scar release in the middle lamellar plane with lateral tarsal strip procedures was performed, with full-thickness skin grafts from the upper eyelids. She remained fully epithelialized postoperatively with improvement in symptoms, although she incomplete graft take due to her eyelid necrosis and compromised dermal blood supply.

Background: Despite advances in the field of tissue expansion, the face is especially difficult to reconstruct using this technique due to its dynamic nature and high incidence of distortional scarring. This article aimed to review complications seen in pediatric facial tissue expansion, specifically ectropion, as well as its restorative treatment., Methods: A retrospective chart review of pediatric patients treated by tissue expansion for congenital facial lesions, trauma, or burns at Children's Hospital Los Angeles from January 2000 to present was performed. Patients were analyzed for preoperative diagnosis, reconstruction area, tissue expander location, number and fill volume of expanders, incidence of complications, including ectropion, and type of revision surgery., Results: A total of 88 patients with 150 expander reconstructions were examined. The total complication rate was 43.1% with an 11.3% rate of ectropion. Of the 10 cases of ectropion, 9 were treated with canthoplasty, whereas 1 was managed conservatively. In addition to canthoplasty, full-thickness skin graft was preformed in 1 patient, Z-plasty in 1, and lid switch in 2., Discussion: Tissue expansion is a safe and effective method of reconstruction for facial defects in the pediatric population despite complication rates being higher than other areas of the body. Specifically, ectropion can be a devastating complication, often requiring surgical correction. As such, careful planning should go into orientation and design of the reconstruction, and staged procedures should be strongly considered. Additionally, and possibly the most important, is setting patient and parental expectation about the possibility of ectropion and the necessity often for multiple corrective surgeries.

Purpose Tightening of the lower eyelid is often performed and many techniques are available. This paper describes the outcome of lower eyelid ectropion repair using the lateral tarsal strip procedure. Periosteal fixation of the tarsal strip can be performed with absorbable or non-absorbable sutures. This study compares the surgical results of periosteal fixation of the tarsal strip with a) absorbable and b) non-absorbable suture. Methods Of 206 patients who underwent surgery, data from 161 were available. During the 6 month follow-up period, suture material, recurrence rates and complications were assessed. The analysis was based on photo documentation, surgery reports and patient statements. In all cases surgery was performed by the same surgeon. Results After 6 months, patients showed similar recurrence rates, regardless of whether periosteal fixation of the tarsal strip had been performed with absorbable (61 patients) or non-absorbable (100 patients) material. Only a few complications occurred, including wound healing problems and one allergic reaction in the non-absorbable group. Conclusions In cases of lower eyelid ectropion, the surgical outcome after the tarsal strip procedure was similar for absorbable and non-absorbable sutures., (Georg Thieme Verlag KG Stuttgart · New York.)

Congenital aniridia is a kind of eye disease characterized by complete or partial hypoplasia of the iris and is associated with other ocular anomalies including corneal opacity, glaucoma, and foveal hypoplasia. Heterozygous mutation of paired box 6 (PAX6) gene was identified in most cases of aniridia, with iatrogenic mutations accounting for about two-third of the cases and chromosomal rearrangements accounting for the other one-third. We report rare cases of variant aniridia, congenital iris ectropion associated with foveal hypoplasia in both a woman and her son with a mutation of PAX6 gene. To our knowledge, deletion c. 936delC in exon 8 of PAX6 gene has not been reported until now.

Morgellons disease is characterized by complaints of uncomfortable skin sensations and fibers emanating from nonhealing skin lesions. Morgellons disease is well-known in the dermatology and psychiatry literature, where it is typically considered a subtype of delusional parasitosis, but it has not yet been described in the ophthalmology literature. A patient with self-reported Morgellons disease is presented, who was referred for evaluation of left lower eyelid ectropion. She reported that her skin was infested with fibers that were "trying to get down into the eyelid." On examination, she had ectropion of the left lower eyelid, broken cilia, and an ulcerated left upper eyelid lesion concerning for carcinoma. Biopsy of the lesion was consistent with excoriation. Treatment of her ectropion was deferred out of concern for wound dehiscence, given the patient's aggressive excoriation behavior. This case is presented to make the ophthalmologist aware of this disorder and to highlight the appropriate clinical management.

A newborn had a tight, dry skin with multiple fissures, an eclabium and ectropion. Breathing was compromised and regulation of body temperature was impaired. We described the patient as a 'collodion baby'. After genetic investigation the diagnosis congenital ichtyosis, recessive type 1 was made. At 12 months of age, the skin symptoms were significantly diminished.

Case Report: A 63-year-old gentleman, who was being treated with bisphosphonates for multiple myeloma, presented with a cicatricial ectropion of the lower eyelid, without exposure keratopathy. A CT scan demonstrated extensive destruction of bone with an infraorbital fracture surrounded by sclerotic bony changes. The patient was managed conservatively with discontinuation of bisphosphonate therapy and topical ocular lubricants. The patient's condition remained unchanged a year after this initial management.

A 41-year-old woman previously diagnosed with generalized eruptive keratoacanthomas of Grzybowski type presented with bilateral lower eyelid cicatrical ectropions. She had previously undergone multiple resections of syringomatous adenomas of both nipples, facial keratoacanthomas, and a lower left lip squamous cell carcinoma. Her facial and periocular skin was thickened with a cobblestone appearance. Cicatricial ectropions involved both upper and lower eyelids. Donor skin was harvested from the dorsum of the foot as this was the only disease-free area on her body, and she achieved a stable result with reduced tearing and improved appearance.

Aim of this review was to describe ectropion, entropion and trichiasis and their therapy. These eyelid pathologies are characterised by common symptoms (redness, excessive tearing and irritation of the eye) and by altered balance of the anterior and posterior lamellae of the eyelids. They involve more frequently the inferior eyelid and the therapy is mainly surgical. Parasurgical therapy may play a role as a temporary measure.

Orbital myxomas are extremely rare tumors. We describe a 75-year old male patient with lower eyelid ectropion and 8-mm of left non-axial proptosis. Orbital CT and MRI revealed a well-demarcated lesion in the lateral quadrant of the orbit. After complete surgical excision, histopathological examination led to the diagnosis of orbital myxoma. The patient was followed-up for 1 year without recurrence.

A healthy 5-month-old boy presented with a sporadic unilateral right-sided sectorial ectropion uveae, anterior insertion of the iris root, increased IOP, and glaucomatous disk changes. The absence of other additional ocular anomalies and the appearance of the angle led to a diagnosis of congenital iris ectropion syndrome. IOPs became refractory to maximal topical therapy, and trabeculotomy surgery was performed. The patient has since been stabilized on topical agents., (Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)

The ichthyoses encompass a variety of genetic disorders marked by abnormal epidermal differentiation. The neonatal period is critical for patients with ichthyosis because of the risk for significant associated morbidity and mortality, with the majority of complications arising as a result of impaired barrier function. This article reviews presentations of ichthyosis in the neonate, outlines risks and complications, and provides strategies for management., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Discoid lupus erythematosus is a common form of chronic cutaneous lupus erythematosus, an autoimmune inflammatory disease that affects most of the human organs, including the skin, kidneys, joints, heart and lungs. We describe a 45-year-old Caucasian woman with a 21-year history of eyelid redness and irritation. She had been treated with antibiotics, steroids and eyelid hygiene, a therapy that resulted to brief periods of relief of symptoms. In the last 12 months, her symptoms seemed to have exacerbated, despite the administration of a local therapy. Following biopsy, a diagnosis of discoid lupus erythematosus was confirmed and the patient was placed on a systemic therapy with hydroxychloroquine. The eyelid inflammation decreased but severe scarring of the marginal eyelids persisted, resulting in cicatricial ectropion., (© 2012 The Authors. Clinical and Experimental Optometry © 2012 Optometrists Association Australia.)