Lower eyelid ectropion is most frequently seen in older age, we describe a young patient known to be HIV positive on highly active antiretroviral therapy (HAART), who presented with ectropion unrelated to the previously described aetiologies.

Case report

40 year old HIV positive patient who presented to our clinic with a watery, uncomfortable left eye and a left lower eyelid ectropion. He was on HAART with Sustiva® and Kivexa®. After proving positive to herpes simplex virus type 2 on a conjunctival swab, he was put on Acyclovir 400mg BD by his physician 5 months prior to our visit, with no improvement in his lid pathology.

On examination, no evidence of a periorbital tumour or significant skin cicatrisation was evident and on CT scan his orbital structures were found to be normal.

A lateral tarsal strip with inverting sutures was performed and because of the unknown aetiology biopsy samples of both conjunctival and skin were taken for histopathological analysis. These were found to be normal.

Following surgery the ectropion completely resolved with a good functional and cosmetic outcome.

Eyelid malpositions in HIV+ patients have been reported to be mainly related with Karposi’s sarcoma lesions and muscle wastage and lipoatrophy as side effect of HAART therapy. Whilst the changes were subtle, and in the presence of normal tissues on CT and histological examination, it was considered that lid laxity was the cause of the lid malposition. Although we have not found any previous report of such association, we hypothesize the possible involvement of the disease process and treatment with antiretroviral therapy contributed to the change in our patient’s tissue strength. We consider that it is important to record such a case as it is an infrequent occurrence.