Ectropion Surgery in London

Ectropion is the term used to describe a condition where the lower eyelid turns out and droops away from the eye. It can also be described as the rolling out of the lower lid and eyelid margin. It is usually not serious but can be uncomfortable and affect a person's image and self confidence. Artificial tears may help with the symptoms, foreign body sensation and any mucous discharge.

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Symptoms of ectropion include the following:

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• Redness of the eyes and chronic conjunctivitis

• Watery eyes

• Irritation and grittiness

• Soreness of the eye

• Recurrent eye infections

• Sensitivity to light

• Corneal ulcer

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Ectropion and rolling out of the eyelids is caused by:

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Age - Involutional ectropion develops as the eyelid muscles and tendons become weaker and loosen with time.

Eyelid lump or cyst - An eyelid lump or cyst where the additional weight pulls the eyelid away from the eye causing an mechanical ectropion.

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Nerve paralysis - Facial paralysis of the nerves supply the eyelid as in a condition called Facial Nerve Palsy can result in weakness of the eyelid muscles and paralytic ectropion. 

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Skin shortening - Damage to the eyelid skin in burn injuries, long term sun damage, eyelid surgery and contact dermatitis can also result in ectropion due to shortening of the skin which is also known as cicatricial ectropion.

Congenital - Less common cases present at birth are known as congenital ectropion.

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Why is ectropion surgery done

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Ectropion surgery is done to correct the position of the eyelid allowing the eyelid to turn inward and resorting the natural look of the eyelid as well as preventing any damage to the eye as the result of the ectropion. If left untreated it can result in corneal exposure, which can lead to corneal ulceration and corneal infection. This could result in scar tissue and corneal damage affecting vision.​​

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Risks

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Possible risks of ectropion surgery include:

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• Infection

• Bleeding from the surgery

• Dryness and irritation of the eyes

• Difficulty closing the eyes

• Scarring (although this is usually put into the eyelid skin crease to hide it as much as possible)

• Skin discolouration

• Facial asymmetry

• A need for follow up surgery

• Temporary blurring of the vision

• Rarely, loss of vision

• Risks associated with surgery more general including anaesthetic reactions and blood clots

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To know which risks most apply to you talk to your doctor to understand more about ectropion surgery as well as the benefits and if they apply to you. This way you can decide with your doctor if ectropion surgery is a good option. There are different surgical procedures used ectropion depending on whether there is severe ectropion or not.

 

Severe cases may require skin graft but the majority are mild and the most common surgical intervention is a lateral canthotomy and lateral tarsal strip procedure with possible tightening of the orbicularis muscle. The surgical technique depends on the underlying cause and treating that whilst addressing any issues with the anterior lamella portion of the eyelid and the posterior lamella portion is needed.

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Non-surgical treatments for ectropion are often to provide temporary relief and include:

 

Using artificial tears to the eye to relieve the discomfort

Injection of filler to the eyelid to push the eyelid back into position​

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How you prepare

 

Before having ectropion surgery you will meet your Oculoplastic surgeon who specialises in ectropion surgery to discuss:

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• Your medical history including any previous surgery and current eye conditions.

• Your expectations with an honest discussion about what can be realistically achieved.

• A vision examination to check the eyes prior to surgery.

• A physical examination of  the eyelids to ensure that this is the correct procedure.

• Eyelid photography which can help with surgical planning and to provide evidence for any insurance claim.

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It is preferable to stop taking any blood thinner medication such as aspirin, ibuprofen, warfarin, apixiban and any other medication that can cause increased bleeding during ectropion surgery. Your doctor will discuss these with you to ensure that it is safe for you to do so prior to your ectropion surgery and will tell you how long before the operation.

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Stopping smoking several weeks before surgery can help improve the healing after ectropion surgery.

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You should arrange for someone to take you home after the procedure and stay with you for the first night following the operation and Mr Ahmad Aziz advises this. Surgery is usually done in Central London.

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What you can expect before the procedure

 

Ectropion surgery is usually done as a day case where you can go home the same day. Your surgeon will inject anaesthetic into your eyelids to numb the area and you can also have medication through a drip to help you relax.

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What you can expect during the procedure

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If the ectropion is age related your oculoplastic surgeon will remove a small section of the eyelid to make it tighter.   If the ectropion is more significant, then an incision is made on the inside of the eyelid to access the eyelid muscles which are then tightened to give a better turning in of the eyelid.  The incision is then closed with stitches.

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If your ectropion and rolling out of the eyelids is caused by scarring, injury or previous surgery a skin graft or flap is placed on the outer surface of the eyelid to help the eyelid turn inwards.  This can be done under a general anaesthetic with you asleep.

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What you can expect after the procedure

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After surgery you are monitored for complications. You are able to leave later that day to recuperate and begin the healing at home.

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After surgery you may temporarily experience:

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• Blurred vision from the lubricating ointment applied to your eyes at the time of ectropion surgery

• Watering of the eyes

• Sensitivity to light

• Double vision

• Puffy, numb eyelids from the anaesthetic and ectropion surgery

• Swelling and bruising similar to having black eyes which will settle within a week

• Pain or discomfort

Your doctor will likely suggest you take the following steps after surgery:

• Use ice packs on your eyes every hour the night you go home after the operation. The following day, use ice packs on your eyes four to five times throughout the day to help reduce the swelling

• Gently clean your eyelids and use prescribed medication.

• Avoid straining, heavy lifting and swimming for a week after ectropion surgery.

• Avoid strenuous activities, such as aerobics and jogging, for a week.

• Avoid smoking.

• Avoid rubbing your eyes.

• Not to use contact lenses for about four weeks after surgery.

• Wear darkly tinted sunglasses to protect the skin of your eyelids from sun and wind.

• Sleep with your head raised higher than your chest for 3 days after the surgery.

• After a few days, return to the surgeon to have stitches removed, if needed.

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Seek medical attention immediately if you experience any of the following:

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• Shortness of breath

• Chest pain

• An unusual heart rate

• Severe new eye pain

• Bleeding

• Vision problems​

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Results

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Many patients are satisfied with the results of ectropion surgery with he correction of the rolling out of the eyelids and benefit from a more natural appearance, better vision if the vision was affected. The results of the surgery can last a lifetime but for others the ectropion may recur with time. 

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The bruising and swelling noticeably settle within 2 weeks resorting a more natural look giving you confidence in going out publicly and subtle swelling that the patient may notice will generally resolve over a period of 2 months in the majority of cases. 

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Scars from the surgery can take months to fully fade but should be within the skin crease or under the lashes and well covered. You should protect your eyelids from too much sun exposure as you should do for the rest of your skin.

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