Eyelids Ectropian

What is Eyelid Ectropion?

Normally, the eyelid is protective of the eye from drying out and from damage due to foreign body. When a person develops an eyelid ectropion of the lower lid, the effects of the sun, gravity and age bring down the eyelid so that it separates the eyelid from the eyeball and the eyelid hangs away from the eyeball itself. The whole cheek can sag and pull down due to gravity. Eyelid ectropion, in its basic form, looks like a sagging lower eyelid that is pulled away from the lower eyelid.

An eyelid ectropion is the opposite of an eyelid entropion, where the eyelid is turned inward and the eyelashes rub on the eye ball. Both of these conditions need treatment and many need eyelid surgery.

Another cause of an eyelid ectropion is when the punctum, or drainage hole of the tears pulls away from the proper position so that tears fail to drain the way they’re supposed to. Irritation, itching, discomfort and burning of the eyes can result and the rest of the lower eyelid follows the punctum so that ectropion occurs.

You can treat minor forms of eyelid ectropion with glasses to protect the eye from the effects of the wind and with artificial tear eye drops that can moisten and protect the eye from being scratched or from drying out. Surgery is done when the nonsurgical methods fail or if the ectropion is significant. People show up for eyelid ectropion surgery because of epiphora, irritation of the eyes or for cosmetic reasons.

There is usually a progression from laxity of the eyelid to punctal ectropion and then onto medial ectropion and finally generalized or complete ectropion. Tears can’t drain and puddle into the lower lid with a lack of tears on the upper part of the eye ball. In eyelid ectropion surgery, the muscles that hold up the eyelid are tightened and shortened, reconnecting them to the lateral and medial edges of the lid. The punctum is replaced into its proper position so that it can begin to drain tears again.

The procedure most likely to be done is called a lateral tarsal strip procedure. This is a technique that takes care of a long lateral lower lid. A medial conjunctival spindle procedure is also sometimes done if the condition is mild and most of the ectropion is on the medial aspect of the eyelid. Lower lid retractors need to be reinserted if there is tarsal ectropion. For a form of eyelid ectropion called cicatricial ectropion, a procedure involving augmentation of the anterior lamellae.

Doctors usually protect the cornea during the surgical procedure and the surgery can be done under local anesthesia using an infraorbital nerve block and a subconjunctival injection in patients who happen to be especially sensitive.

Most people have no complications following an eyelid ectropion surgery. The cornea can be damaged if the doctor isn’t careful or hasn’t protected the cornea during surgery. Rarely, an infection or conjunctivitis can occur following surgery, which is treated with antibiotic eye drops or, rarely, oral antibiotics. Recovery occurs over about 2-4 weeks.