Management of 'double eyelid ectropion' using 5% hypertonic saline in an Indian newborn

Objective: This report describes a clinically rare case of congenital ectropion involving both upper lids in a one-day-old Indian newborn. We emphasize the importance of non-invasive conservative management with 5% hypertonic saline. Method: Observational case report Result: A term newborn presented to us on day 1 with bilateral upper lid ectropion or 'double congenital ectropion' noted since birth following an uneventful vaginal delivery. Examination revealed severe chemosis and prolapse of upper palpebral conjunctiva bilaterally. The repeated attempts to manually revert the eyelids in position failed. Otherwise, the eyes were normal. We started to treat the baby with topical hypertonic saline (5% sodium chloride), topical antibiotic, and topical lubricant frequently. Eye pads soaked in 5% hypertonic saline were also used. Following five days of treatment, the chemosis and ectropion resolved completely without recurrence. Conclusion: We advocate non-invasive conservative management with 5% hypertonic saline soaked pads over the eyes along with topical antibiotic and lubricants. It should be the first line of treatment in all cases of congenital ectropion, before jumping to any aggressive invasive treatment like tarsorrhaphy, skin grafting etc., or unnecessary referral.