Ectropion of the eyelid is an outward bending or turning of the eyelid margin
Ectropion of the eyelid is an outward bending or turning of the eyelid margin

Ectropion of the eyelid is an outward bending or turning of the eyelid margin (especially the lower eyelid) that results in the displacement of tears It may deteriorate your normal eye functions and may make you uncomfortable.

You may have ectropion because of

  • An eye defect since birth
  • Involution (increased relaxation of the horizontal muscle of the lower eyelid)
  • Paralysis of the eye muscles
  • Cicatricial (shortening of the eye membrane containing the skin and eye muscles)
  • Mechanical causes such as
  1. Natural gravity.
  2. Effect of a tumor.
  3. Fluid accumulation in the eyes.
  4. Protrusion of eye fat.
  5. Poorly fitted spectacles.

You may experience 

  • Exposure of the cornea (the clear/transparent layer of the eye).
  • Irritation of the eye.
  • Epiphora (excessive watering of an eye due to exposure).
  • Inadequate lubrication.
  • Corneal abrasion (a disease of the clear layer of an eye).

You may have high chances of getting ectropion of the eyelid if you

  • Are aged.
  • Have a habit of eyelid rubbing.
  • Are constantly pulling eyelids excessively.
  • Using contact lenses.
  • Have an eyelid skin condition.
  • Have an injury to the eye.
  • Have an eye surgery.

Who can undergo this procedure?

Your eye specialist may suggest this surgery if you have

  • Foreign body sensation in the eye.
  • Hyperemia (excess blood in the eye vessels).
  • Epiphora (excessive watering of the eye).
  • Inflammation of the cornea (clear layer of the eye).
  • An open sore on the cornea (clear layer of the eye).

Your eye surgeon will examine you and address the shortening of the eye membrane (lamella) and other associated disorders before surgery. It is once again important to identify the cause of ectropion before surgical intervention. Defects such as relaxed eye muscle and outward bending (ectropion) of the tear duct opening (punctum) will require additional surgery. If you have an eye defect since birth, paralysis of the eye muscles, or other reasons of ectropion, then you may require different treatment.

When will your doctor not suggest this procedure?

Your doctor may not suggest this surgery if

  • Your condition can be corrected with other treatment options such as lubrication of the eye surface or horizontal tapping of the eyelid.
  • You are unable to tolerate the procedure.
  • You are suffering from severe uncontrolled eye inflammation or infection, and the progress is worse.
  • You may have a high chance of getting complications after surgery.

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What happens during an ectropion repair of the eyelid?

Before surgery, you will receive local anesthesia.

During surgery:

An eye specialist (ophthalmologist), an eye plastic surgeon, and a plastic surgeon will work together during this eye surgery. You may require multiple surgeries depending on the cause of your ectropion. The eye surgeon will customize your eye surgery after examining you.

Your surgeon will decide the type of surgery depending on the cause of your ectropion such as follows:

  • If your ectropion is due to eye muscle and ligament relaxation due to aging: Your surgeon may remove a small part from the outer corner of the lower eyelid. The eyelid is then stitched back together, and muscles will be tightened and repositioned again.
  • If your ectropion is due to scar tissue from an injury or a past surgery: Your eye surgeon will use a skin graft from the upper eyelid or behind your ear and support the eyelid.
  • If you have facial paralysis: You may need more surgeries to correct the eyelid.

After surgery:

  • You will be informed to wear an eye patch for 24 hours or more.
  • Your doctor will prescribe you an antibiotic and a steroidal ointment to apply on the eye several times a day for one week.
  • Your doctor will inform you to put cold compression regularly to reduce swelling and redness.
  • You may feel tightness in the eye after surgery for some days that heals over time.
  • Stitches will be removed a week after your surgery.

What are the complications of an ectropion repair of the eyelid?

Complications include:

  • Infection
  • Swelling
  • Bruising
  • Bleeding
  • Pain
  • Poor physical appearance of the eye
  • Drawing back of the lower eyelid
  • Dehiscence (opening) of wound sutures
  • Retrobulbar hematoma (accumulation of the blood behind your eyeball)
  • Corneal abrasion (scraping of the clear layer of an eye)
  • Canthal dystopia (displacement of the inner corner of the eye)

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Medically Reviewed on 10/6/2020
References
Medscape: https://emedicine.medscape.com/article/1844045-overview

American Academy of Ophthalmology: https://eyewiki.aao.org/Ectropion

https://www.healthdirect.gov.au/surgery/entropion-and-ectropion-repair

Bergstrom R, Czyz CN. Ectropion Lower Eyelid Reconstruction. [Updated 2020 Mar 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470449/

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