Cicatricial ectropion in progressive skin diseases

PURPOSE. To report the clinical course, patient care and treatment of cicatricial ectropion in patients with progressive skin diseases. METHOD. Review and photo series of three typical cases, which were followed for up to 10 years. RESULTS. In certain severe progressive skin diseases, tissue shrinkage may progress permanently. The soft lid tissue cannot withstand the forces of vertical lid traction. As a result, recurrent ectropion occurs. Patients with lamellar ichthyosis and with eruptive Grzybowski-type keratoacanthoma were followed for up to 10 years. Free skin grafts of severely involved donor skin were repeatedly transplanted to the lids. The lid margins were fixed by traction sutures in order to spread out the wound and to allow rapid vascular ingrowth and undisturbed healing. In this way, early wound contracture could be prevented. Nevertheless, follow-up revealed progressive shrinkage of the transplanted lid skin. Eversion of the lacrimal punctum was the first sign of progression. Epiphora was the leading complaint of the patients. Bacterial superinfection of the deepened lacrimal lake was more frequent in advanced ectropion. CONCLUSION. Patients should understand the natural history of their disease in order to accept multiple surgical procedures. Ectropion should be re-operated in time in order to reduce epiphora, to prevent corneal complications, and to avoid metaplasia and keratinization of the conjunctiva and thickening of the lid margin. The elasticity of the lid skin should be improved pharmacologically and by increasing the relative humidity of the home environment, especially in winter. Consistent vertical lid massage can delay recurrence.