Issues

Ectropion

 

Ectropion is an eversion or rolling out of the eyelid margin, resulting in exposure of the palpebral conjunctiva.

Ophthalmic system (exposure and poor tear retention/distribution—may predispose patients to irritation, recurrent infections, and sight-threatening corneal disease).

 

SIGNALMENT

Dogs, seldom cats.

• Breeds with higher than average prevalence—sporting breeds (e.g., spaniels, hounds, and retrievers); giant breeds (e.g., Saint Bernards and mastiffs); any breed with loose facial skin (especially bloodhounds).
• Developmental—genetic predisposition in listed breeds; may occur in dogs < 1-year-old.
• Acquired—noted in other breeds; occurs late in life secondary to age-related loss of facial muscle tone and developing skin laxity.
• Intermittent—caused by fatigue; may be observed after strenuous exercise or when drowsy.

 

SIGNS

• Eversion of the lower eyelid with lack of contact of the lower lid to the globe and exposure of the palpebral conjunctiva and third eyelid—usually obvious.
• Facial staining caused by poor tear drainage—tears spill over onto the face instead of passing from the eye to the nose via the nasolacrimal ducts.
• History of mucoid to mucopurulent discharge owing to conjunctival exposure.
• Recurrent foreign body irritation due to debris localizing between lid and globe in an inferior cul-de-sac.
• History of bacterial conjunctivitis.

 

CAUSES & RISK FACTORS

• Usually secondary to breed-associated alterations in facial conformation and eyelid support.
• Marked weight loss or muscle mass loss about the head and orbits—may result in acquired disease.
• Tragic facial expression in hypothyroid dogs.
• Scarring of the eyelids secondary to injury or after overcorrection of entropion—may result in cicatricial disease.

 

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

• Usually clinically obvious.
• Look for any underlying disorder in non-predisposed breeds and patients with late-age onset.
• Loss of orbital or periorbital mass—may cause conditions in patients with masticatory myositis.
• Palpebral nerve paralysis—a condition associated with lack of muscle tone of the orbicularis oculi muscles.

 

CBC/BIOCHEMISTRY/URINALYSIS

N/A

 

OTHER LABORATORY TESTS

• Possible masticatory myositis—test for autoantibodies against type 2M muscle fibers.
• Palpebral nerve paralysis or tragic facial expression—consider testing for hypothyroidism.

 

IMAGING

N/A

 

DIAGNOSTIC PROCEDURES

• Palpebral nerve paralysis—full neurologic evaluation; potential for hypothyroidism.
• Secondary conjunctivitis—consider bacterial culture or cytologic examination to help select an appropriate topical antibiotic.
• Fluorescein or rose bengal staining of the cornea and conjunctiva—may document corneal ulcerations; may reveal the severity of the exposure problem.

 

TREATMENT

• Supportive care (topical lubricant or antibiotic-containing ointments) and good ocular and facial hygiene—are sufficient for most mild diseases.
• Surgical treatment—eyelid shortening or radical facelift; necessary for severely affected patients that have chronic ocular irritation.
• Intermittent, fatigue-induced condition—do not treat surgically.

 

MEDICATIONS

DRUG(S)

Topical broad-spectrum ophthalmic antibiotics—bacterial conjunctivitis or corneal ulceration. Neomycin/polymyxin B/bacitracin (or others based on bacterial culture and sensitivity) q6–8h.

Lubricant eye drops and ointments—reduce conjunctival and corneal desiccation secondary to exposure.

Hypothyroid and masticatory myositis-induced conditions—may respond well to appropriate medical treatment of the underlying disease.

 

CONTRAINDICATIONS/POSSIBLE INTERACTIONS

N/A

 

FOLLOW-UP

• May become more severe as the patient ages.
• Non-surgically treated patient—monitor for signs of infectious conjunctivitis, exposure keratopathy, corneal ulceration, and facial dermatitis.

 

MISCELLANEOUS

ASSOCIATED CONDITIONS

• Hypothyroidism
• Myopathy, focal
• Inflammatory—masticatory myositis and extraocular myositis

 

AGE-RELATED FACTORS

Old animals are more likely to have ectropion secondary to loss of facial muscle tone.

 

Visit your veterinarian as early recognition, diagnosis, and treatment are essential.

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