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L.W. Deitz, D.C. Garibaldi, S.L. Merbs, M.P. Grant, N.T. Iliff; ASSOCIATION OF GENDER AND INVOLUTIONAL ECTROPION OF THE LOWER EYELID; A 10–YEAR PERSPECTIVE . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5606.
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Introduction: The epidemiology of involutional ectropion, a prevalent ophthalmic problem with considerable morbidity, has been poorly described. The Blue Mountains Eye Study reported significant correlations between ectropion and smoking, actinic skin changes, prior skin cancer resection, and age. In addition, men had a higher prevalence of ectropion than women (odds ratio = 2.1). However, this study did not subdivide ectropion by etiology. In our recent three–year retrospective review, cases of purely involutional ectropion were identified and a statistically significant association with male gender was demonstrated. The current study was designed to further investigate this gender association by examining a larger population over 10 years. Methods: We performed a retrospective review of all surgically repaired cases of involutional ectropion in the Oculoplastics Division of the Wilmer for the past 10 years. Involutional ectropion was defined as symptomatic eversion and/or laxity of the lower eyelid. Patients with prior lid surgery, trauma/scarring, enucleation, or paralytic ectropion or mechanical ectropion were excluded. The remaining patients with ectropion were analyzed. Results: Our review yielded 215 patients who had had surgery coded as ectropion repair over the 10–year period. Of these, 207 charts were available for review (96.3%). 177 (85.5%) were excluded according to the following criteria: prior trauma/scarring – 51 (34.4%); prior lid surgery – 30 (16.9%); post–enucleation – 30 (16.9%); paralytic ectropion – 24 (13.6%); mechanical – 9 (5.1%); miscellaneous– 23 (13.0%), leaving 30 patients with involutional ectropion (14.5%). Of these, 24 (80.0%) were male and 6 (20.0%) were female with a mean age of 76 years for men (range 54–90) and 75.3 years for women (range 55–96). This gender distribution was statistically significant (p<0.0002) compared to all new patients greater than 55 years old presenting over a similar period (3402 men – 40.2%, 5057 women – 59.8%). Comment: Untreated involutional ectropion may result in exposure keratopathy, punctal stenosis and epiphora, chronic conjunctival inflammation, and cosmetic deformity. Therefore, it is important to gain an understanding of the etiology and risk factors for development of this problem. This study supports our previous finding of a highly statistically significant association between involutional ectropion and male gender. Further work is needed to better understand the nature of the gender difference in the aging process of the lid and associated structures.
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