We present three rare cases of non-cicatrising upper lid ectropion, seen in two oculoplastic units.

Case 1

A 92 year old man with progressive dementia presented with a left upper lid ectropion, which could not be repositioned manually. The patient was of normal weight and had no history of obstructive sleep apnoea (OSA), joint laxity, or skin laxity. An injected, oedematous and hypertrophied upper lid tarsus was noted (fig 1A), but no obvious chronic staphylococcal changes. There was no evidence of anterior lamella cicatrisation (fig 1B and 1C). Moderate to severe horizontal laxity of the left upper eyelid and significant laxity of the left lateral canthal tendon (10 mm medial distraction) were noted. On the right side there was an aponeurotic ptosis, with a milder degree of horizontal laxity and lateral canthal tendon laxity (6 mm medial distraction). There was no evidence of enophthalmos. Conservative treatment with an eye shield, lubricants and topical steroids resulted in no improvement and the everted tarsus failed to remain in the correct position when manual repositioning was attempted. The patient underwent a left upper lid lateral full thickness pentagonal wedge resection of 15 mm, and levator aponeurosis reattachment, with no recurrence of …