January-March 2018

Incidence of Lower Lid Ectropion Following Cataract Surgery in Government Hospital, Jamnagar

Devdatta J. Gohel1, Radhakrishan Khatri2*, Anwar Sipai3, Komal Vala4, Rutuja Unhale5

1Professor & Head of Department, 23rd year resident, 3Assistant Professor, 43rd year resident, 3rd year resident5 M. P. Shah medical college, Jamnagar


BACKGROUND: To study the incidence of lower lid ectropion after cataract surgery. OBJECTIVE: To compare the pre-operative lower lid parameters viz. punctalposition , snap back test ,medial canthal laxity , lateral canthal laxity on post operative day 1 , 7 and 15 and to analyze the factors associalted with ectropion in such cases. MATERIALS AND METHODS: 50 Patients who underwent cataract surgery in 2016 were randomly enrolled. Various parameters like punctal position, snap back test , medial and lateral canthal laxity were compared before and after cataract surgery on day 1, 7, 15. The same type of wire speculum was used while doing cataract surgery. Bridle suture was taken in each of the operations. SICS was done in every case under upper and lower lid peri-bulbar anaesthesia. RESULTS: A total of 50 patients were analyzed. Out of these 30 were females and 20 males. Of these, only 4 patients (8%) showed an associated grade 1 ectropion i.e.eversion of the medial lower lid margin along with punctal eversion. Snap back test took 2-3 seconds ie grade 1, medial canthal laxity was 2mm i.e. grade 1 and lateral canthal laxity was 2-4 mm ie grade 1. The status of the lower lid of the operated eye of these patients remained the sameon 3 subsequent follow up visits i.e. on day 1, day 7 and day 15. All of these 4 patients were between 75 to 80 years. Only 2 of the rest 46 patients(4.3%) whose lower lid condition was normal showed punctal eversion on the 1st post op day with normal snap back test , medial and lateral canthal laxity . Punctal eversion in theses 2 patients improved with subsequent follow ups. These 2 patients were over 75 years of age. CONCLUSIONS: Lower lid ectropion is not a common complication occurring after cataract operation as compared to post op ptosis which can occur as high as 4%. Age of the patient plays a more determining role in the incidence and progression of lower lid ectropion in these patients rather than any intra operative manouvers like using universal wire speculum, bridle suture or peri -bulbar blocks.

Keywords: Cataract, surgery, complication, ectropion, snap back test , medial canthal laxity, lateral canthal laxity

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