Ectropion Repair Surgery

Ectropion, or out-turning, of the eyelid usually involves the lower eyelid. The lower eyelid pulls away from the eye and visibly appears to sag down.

Causes

Most of the time, ectropion occurs along with the general aging changes in the skin. The lower eyelid can become looser, and eventually pull away from the eye by gravity. Bell's Palsy, or a temporary paralysis of the side of the face, can suddenly make these normal aging changes much worse, and the eye can become severely dry due to ectropion. Other conditions lead to scarring of the skin under the eyelid, which pulls the eyelid away from the eye.

Symptoms

Symptoms include irritation, swelling, and redness of the eyelid, tearing, and irritation and redness of the eye. The lower eyelid is usually pressed flush against the eye and keeps the eye bathed in lubricating tears. When the eyelid sags away, so do the tears, and the eye can become severely dry. Tearing occurs if the opening in the eyelid which drains tears away becomes separated from the eye. Thus, tears have no way to drain away except onto the face. Dryness of the cornea can lead to a scratchy sensation, redness of the eye, pain, and blurred vision. Sometimes the cornea can become infected.

With ectropion, the eyelids are turned out and so they don’t close or function properly. Normally when you blink, your eyelids move tears across the surface of your eye to the little openings - called puncta - at the inner part of your eyelids. These tears then drain through the puncta into the nose. With ectropion, your eyelids aren't flush against the surface of your eye, so they can't move tears to the puncta as effectively as they should. Tears pool in the corners of your eyes and instead of lubricating your eyes, they flow over your lid onto your cheek.

Also, because your eyelids are turned out, they don't properly protect your eyes. As a result, the inside of your eyelids and surface of your eyes are exposed to air and can become dry, irritated and inflamed. Rubbing your eyes in an attempt to relieve symptoms can lead to further irritation, mucous discharge and encrusted eyelids.

The eyelids are meant to protect the eyes and to preserve vision, and they are unable to do so if there is ectropion. The real concern for patients with ectropion is loss of transparency of the cornea and subsequent loss of vision if the eyelid malposition is not corrected in a timely fashion.

Treatment

While lubricating drops and ointments can provide temporary relief, eyelid surgery is usually necessary. The ectropion repair procedure is usually performed as an outpatient (there is usually no need for hospitalization). Local anesthesia, which numbs the eyelid, is combining with light sedation so there is little, if any, pain during or even after the procedure.

Final Reminders

To effectively treat ectropion requires a special understanding of the anatomy and pathophysiology of the eyelid. The excellent general plastic surgeon who does tummy tucks and breast augmentations almost NEVER has been trained in eyelid anatomy or pathophysiology and should NOT be the one you choose to treat your ectropion, which should be treated only by a fully fellowship trained oculo-facial surgeon. Fellowship in the American Society of Oculo-facial Plastic and Reconstructive Surgery (ASOPRS) indicates that the surgeon has greatest specialized training and expertise in this subspecialty.

If you have ectropion, please consult with Dr. Kass who is fully trained to treat this problem and has been in practice in Tampa Bay for over 20 years.

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Please contact the Center for Cosmetic Facial and Eye Plastic Surgery or call 727-522-3223 (FACE) for more information and a personal consultation.