title: Anterior lamella actinic changes as a factor in involutional eyelid malposition.
abstract: OBJECTIVE
  We conducted a noncomparative, retrospective chart review of 45 patients and 51 eyelids with the diagnosis of involutional entropion or ectropion that underwent full-thickness lower eyelid shortening between June 2001 and February 2004, in whom the severity of actinic damage was analyzed in relation to the eyelid position. Patients with any different surgical approach or other primary causes of abnormal eyelid position, such as paralytic, congenital, or mechanical factors, were excluded.
  
  
  METHODS
  After excision, all eyelid specimens were examined by a single anatomic pathologist, who was masked to the type of eyelid malposition. The extent of dermal actinic change was evaluated under light microscopy, according to a previously validated grading system.
  
  
  RESULTS
  Fifty-one eyelids from 26 male and 19 female patients were analyzed. The mean age at the surgery was 76 +/- 10 years (range, 52 to 92 years), affecting one side in 39 cases and both sides in 6 cases. The most frequent eyelid malposition was ectropion, which affected two thirds of the cases (35 eyelids). Half of the patients presented with mild actinic skin changes; however, the severity of the histologic skin actinic changes was significantly worse in patients with ectropion in comparison to those with entropion (p < 0.0001).
  
  
  CONCLUSIONS
  Actinic damage affecting the anterior lamella of the lower eyelid contributes as an additional factor in final eyelid position in patients with involutional eyelid changes. More severe and extensive actinic changes were present in eyelids with ectropion.
authors.affiliation: Eyelid, Lacrimal, and Orbital Clinic, Department of Ophthalmology, Division of Surgery, Royal Brisbane and Women's Hospital, University of Queensland Medical School, Australia.
authors.forename: Jodie A
authors.initials: JA
authors.lastname: Marshall
authors.forename: Alejandra A
authors.initials: AA
authors.lastname: Valenzuela
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Strutton
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Sullivan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004483:Ectropion / Q000209:etiology* / Q000601:surgery; D004774:Entropion / Q000209:etiology* / Q000601:surgery; D005143:Eyelids / Q000473:pathology / Q000528:radiation effects*; D005260:Female; D006801:Humans; D007642:Keratosis / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000473:pathology / Q000528:radiation effects*; D013472:Sunlight / Q000009:adverse effects*