Ectropion is a condition where the eyelid, most commonly the lower eyelid, turns outward, away from the eyeball. This prevents proper lubrication and protection of the eye. It can lead to uncomfortable symptoms and, if left unaddressed, may result in significant eye problems.
Understanding Ectropion
Ectropion can arise from several causes, with age-related tissue laxity being the most frequent. As individuals age, eyelid tissues weaken and sag. Scarring from injuries, burns, or previous eyelid surgeries can also cause cicatricial ectropion, where contraction of the skin and muscle pulls the lid outward.
Facial nerve paralysis, such as from a stroke or Bell’s palsy, can weaken the muscles supporting the eyelid, resulting in paralytic ectropion. Tumors or other growths on the eyelid can mechanically pull the lid down, causing mechanical ectropion. Less commonly, ectropion can be present from birth due to a lack of sufficient skin on the lower eyelid, sometimes associated with genetic conditions like Down syndrome.
Individuals with ectropion often experience a variety of symptoms because the exposed cornea and conjunctiva (the lining of the eye) become irritated. Common complaints include excessive tearing, as tears cannot drain properly into the tear ducts, leading to pooling and overflow. The eye may also feel excessively dry, gritty, or sandy, accompanied by burning, itching, and redness. Light sensitivity and blurry vision can also occur.
If left untreated, ectropion can lead to several complications due to chronic exposure and irritation of the eye. The cornea is vulnerable to dryness, abrasions, and ulcers, which can impair vision. There is also an increased risk of conjunctivitis, an eye infection, which may present with pus or fluid around the eye. In severe cases, corneal damage can lead to permanent vision loss.
Common Repair Techniques
Surgical intervention is the primary method for correcting ectropion, with the specific technique chosen depending on the underlying cause. These procedures aim to reposition the eyelid against the eyeball, restoring its natural function and appearance. Most ectropion surgeries are performed as outpatient procedures, often under local anesthesia with or without sedation.
Horizontal Eyelid Tightening
This approach is common for age-related ectropion characterized by eyelid laxity, often performed via a lateral tarsal strip procedure. It addresses the loosening of the lateral canthal tendon, which supports the outer corner of the eyelid. The surgeon shortens and reattaches a strip of the eyelid’s posterior layer to the bone lining inside the outer orbital wall. This tightens the lower eyelid, pulling it back into proper alignment.
Skin Grafting
This technique is employed for cicatricial ectropion, caused by scarring or skin contraction. The scar tissue is released through an incision, and a piece of healthy skin from another part of the body, such as behind the ear, the upper eyelid, or the supraclavicular area, is harvested. This skin graft is then placed and sutured into the released area to provide additional tissue and relieve tension, allowing the eyelid to return to its normal position.
Medial Canthal Plication
This addresses ectropion affecting the inner corner of the eye, particularly when the tear duct opening (punctum) is everted. The technique involves tightening the medial canthal tendon, which supports the inner corner of the eyelid and plays a role in tear drainage. A suture sling may be used to reposition the medial eyelid and punctum. Some approaches involve removing a small piece of tissue near the punctum and suturing to invert the eyelid margin.
Other Techniques
For paralytic ectropion, which results from facial nerve weakness, horizontal eyelid tightening procedures like the lateral tarsal strip are commonly used. In some cases, a lower eyelid spacer graft, using materials such as ear cartilage or hard palate, may be added for support. Mechanical ectropion, caused by a mass or swelling, may require removal of the underlying cause. Sometimes a sub-orbicularis oculi fat (SOOF) lift or midface lift is performed with lid tightening for support.
Preparing for and Recovering from Repair
Preparation for ectropion repair begins with a pre-operative consultation. During this consultation, the surgeon will review the patient’s medical history, including any allergies and current medications. Patients must inform the surgeon about all medications, including supplements, as some, like blood thinners, may need to be adjusted to minimize bleeding risk.
Patients should avoid eating or drinking for at least six hours before surgery. On the day of the procedure, it is recommended to wear loose, comfortable clothing, preferably a top that buttons in the front. Patients should wash their face thoroughly and avoid wearing makeup, jewelry, contact lenses, or strong fragrances. If sedation is administered, an adult will need to drive the patient home and stay with them for at least 24 hours after the procedure.
Following ectropion repair, some discomfort, swelling, and bruising around the eye are expected. Patients should apply cold compresses for the first 48-72 hours to reduce swelling, then warm compresses once bruising subsides. Elevating the head with pillows while sleeping for the first few nights can also help minimize swelling.
Antibiotic ointment is prescribed for incision sites for one to two weeks to prevent infection. Dissolvable sutures are often used, though some may be removed by the surgeon after about two weeks. Patients should avoid rubbing their eyes, strenuous activities, heavy lifting, swimming, and wearing contact lenses or eye makeup for at least two weeks, or as advised by their surgeon. Initial improvements are often seen quickly, but full recovery can take several months.