Ectropion (out-turning eyelid)

An ectropion is an out-turning eyelid. This is a common problem that can result from the natural ageing process. The eyelid tissues gradually become lax and so the lower eyelid pulls away from the eyeball somewhat.

Ectropion can also occur if there is a shortage of lower eyelid skin (this is known as a cicatricial ectropion). Some skin conditions (such as eczema), chronic sun damage, injury or surgery to the lower eyelid may result in skin shortage and ectropion.

An ectropion can cause the following symptoms: 

• A watery eye (because the eyelid is unable to pump tears efficiently from the eye or because the tear drainage hole, the punctum, has become narrowed)
• A sore, gritty or red eye (the eyelid is unable to distribute a healthy tear film to protect the eye which can feel dry and gritty)
• A sore or red inner eyelid (the inside of the eyelid is exposed to the elements)
• Blurred vision - this can be due to an excessively dry or watery eye

Ectropion Surgery steps

• Ectropion surgery is usually performed under local anaesthesia with or without conscious intravenous sedation (“twilight anaesthesia”)
• The outer corner of the lower eyelid can be tightened to improve the position of the eyelid against the eyeball
• A lateral tarsal strip (LTS) is the commonest procedure used to tighten the eyelid. A small skin incision is made in the outer corner of the eyelids (the lateral canthus) to tighten the lower lid against the outer bony rim of the eye socket
• A lateral canthal resuspension (LCR) / canthopexy is an alternative method of tightening the lower eyelid. An upper eyelid skin crease incision is made to tighten the lower eyelid against the outer bony rim of the eye socket
• Often the inner corner of the out-turning lower eyelid needs to be repositioned so that the punctum (tear duct opening) can sit snugly against the eyeball. This is achieved by performing a medial spindle procedure which uses an absorbable suture to help tuck the inner corner of the eyelid in towards the eyeball. This is often combined with an eyelid tightening procedure
• To correct a cicatricial ectropion (with skin shortage) a skin graft usually needs to be taken from elsewhere (upper eyelid, in front or behind the ear or above the collar bone are common sites to take a skin graft from) and stitched into the lower eyelid. This is usually combined with an eyelid tightening procedure (LTS or LCR)
• Occasionally a skin graft can be avoided by moving a skin flap from the upper eyelid to the lower eyelid or lifting the mid-face structures (a SOOF lift or mid-face lift)
• A pad and bandage may be placed over the eye overnight. If a skin graft is required the dressings will remain in place for 5-7 days and removed at your first post-operative review

Risks and complications

In the hands of an experienced oculoplastic surgeon the risk of a serious complication is very low.

I will explain potential eyelid surgery complications in detail to you. You will be asked to sign a consent form to ensure that you fully understand the procedure you will undergo and any risks or potential complications which can include:

• Blurred or impaired vision, including loss of eyesight (extremely rare)
• Corneal abrasion - this is a scratch to the surface of the eyeball that causes persistent pain. This is rare but can occur with any surgery on or near the eye and is treated with antibiotic ointment. Sometimes a “bandage” contact lens needs to be used
• Bleeding (haematoma) - This can very rarely lead to a loss of vision, including blindness. A haematoma usually needs to be drained in the operating theatre
• Infection-this is rare but it is important to follow post-operative wound care instructions to help to prevent such a problem
• Numbness and other changes in skin sensation
• Undercorrection (so the eyelid still turns outwards)
• Overcorrection (so the eyelid now turns inwards)
• Tender orbital rim - the outer bony rim of the eye socket can be tender for a few weeks after an eyelid tightening procedure
• Misdirected eyelashes rubbing against the eyeball (trichiasis) - this can be a temporary problem if the eyelid has been out-turned for a long time (months / years). The lashes usually regrow in the correct direction after removal
• Skin graft problems - the graft can become thickened and requires regular massage as it heals. Sometimes a steroid injection is needed to help the thickening to improve. Rarely the graft can fail to take and wither away (graft necrosis). Scarring. Most eyelid wounds heal very well with scars that are barely perceptible after a few months. However occasionally wounds can become thickened and may require attention with additional treatment such as steroid injections or, rarely, surgical revision to improve the scar
• Sutures may spontaneously surface through the skin, become visible or produce irritation that require removal
• Asymmetry. Tightening of the lower eyelid on one side can give pulled up tight look to the operated eyelid but this usually settles over time. It is very unusual for further surgery to be required to address this
• Acute glaucoma - this is sudden raised pressure and pain within the eye,  haloes around lights with blurring of vision, headache and vomiting. This can occur very rarely following eyelid surgery. Any such symptoms following surgery should be reported to your surgeon who can diagnose and treat this, should this occur
• Possibility of revision surgery if the outcome is not as expected 

Be sure to ask questions:

It’s very important to ask any question you have about your proposed eyelid procedure. I’ll do my best to address any concern you may have.

When you go home

If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require admission to hospital and additional treatment.

Your consultation

The success and safety of your eyelid surgery procedure depends very much on your complete candidness during your cosmetic eyelid surgery consultation. You'll be asked a number of questions about your health, desires and lifestyle.

Please be prepared to discuss:

• Why you want the surgery, your expectations and desired outcome
• Medical conditions, drug allergies and previous medical treatments
• Use of current medications, vitamins, herbal supplements, alcohol & tobacco
• Previous surgeries

The following will also take place at your consultation

• Evaluation of your general health and any pre-existing health conditions or risk factors
• An assessment of your vision and a thorough eye examination including a slit-lamp examination of the eye.
• Photographs for your medical record
• A discussion about treatment options
• Recommendations for treatment most appropriate for you
• Discussion about likely outcomes of eyelid surgery and risks or potential complications
• The type of anaesthesia that will be used (This is usually “Twilight anaesthesia” using local anaesthesia with intravenous sedation administered by a consultant anaesthetist. However, a full general anaesthetic can be arranged if you prefer this option)

After the consultation I will send you a letter summarising your concerns and desires relating to your appearance along with my assessment and advice to you regarding treatment options.

You will also receive a quote for your proposed surgery and have the opportunity to attend for a further consultation prior to proceeding should you wish to ask any further questions.

Arrange a consultation