Ectropion

OUT TURNING EYELID (ECTROPION)

Ectropion is when the lower eyelid turns outwards so that the edge of the lid flops away from the eyeball. The lining of the lid may become red and swollen due to exposure to the air and there may be mucous discharge and crusting of the lids. The eye may water because the tear drainage tube in the lid is no longer in the right position to collect the tears.

What causes ectropion?

• The commonest cause of ectropion is aging change making the tissues around your eye become lax and the lid sag.

• Tightness of the lower lid skin from a variety of causes can pull the lid outwards.

• Ectropion may occur in a facial palsy, for example Bell’s palsy.

• A heavy lump or cyst in the lid can also cause ectropion.

Examination of the eyelids will enable the doctor to determine the cause and best treatment for your ectropion.

What is the treatment for ectropion?

Ectropion may get better as a Bell’s palsy improves or if any heavy lump or cyst is removed from the lid.

Treatment with ointment or drops may improve symptoms by reducing inflammation in the lining of the lower lid. The lid skin should be kept protected with Vaseline or moisturising cream.

If ectropion is troublesome an operation may be needed. Ectropion rarely threatens the vision so surgery is rarely an urgent matter. Most ectropion surgery is carried out under local anaesthetic as a day case.

What operations can be performed for ectropion?

Various surgical techniques are used to treat ectropion.  One of the most commonly used surgical techniques is Lateral tarsal strip. In this operation the eye lid is tightened at the outer corner by stitching the outer part of the lid to the tissue covering the bone of the eye socket.

A deep stitch is used in this operation, which is permanent. All the surface stitches are absorbable and will dissolve and can be removed by your eye specialist in 7-10 days after the operation. Occasionally the deep stitch will come loose and then the operation may need to be redone.

 It takes about 45 minutes to perform.

What happens after the operation?

You will have an eye patch over the side of your eye after the operation.  Leave any eye pad on for at least 4 hours - this will help to reduce bruising.

Do not worry if there is some blood on the eye pad when you remove it. Clean the eyelids gently with cooled, boiled water or (saline from the chemist) and cotton wool or tissues. It is normal for the eyelids to appear swollen and bruised for the first week or so.

If your eyelid feels sore when the anaesthetic wears off, take painkillers like Paracetamol or Ibuprofen. You may apply ice pack or frozen peas over the area of surgery to reduce pain and swelling.

The discomfort usually settles within one or two days. Use the ointment in the eye and on the stitches as instructed. If you have severe pain, not relieved by simple painkillers, please ring our eye clinic for advice or if afterhours or during public holidays you may contact Royal Victorian Eye and Ear Hospital on (03) 9929 8666.

The surgeon will normally use dissolving stitches in your eyelid, they often fall out on their own within 2 weeks, otherwise your surgeon will remove them for you after 14 days.

What are the risks of ectropion surgery?

• Discomfort and bruising in the lids

• Infection of the eyelids. This is not common but if it does occur the stitches may loosen so that a gap develops in the lid. The lid will often still heal well especially if antibiotic tablets are given but may take longer to settle down.

• Recurrence of the ectropion requiring further surgery

• Eyelid scarring

• Granuloma – this is a small lump that forms due to a reaction to the buried stitches. It may settle by itself or it may need to be surgically removed.