What causes Ectropion?
Ectropion is usually due to relaxation of the tissues of the eyelid as a result of ageing changes. Therefore, it is most often seen in elderly people who develop stretching of the structures supporting the lower eyelid.
It can also arise as a result of undetected skin cancers pulling down the eyelid, trauma, contraction of scar tissue (from wounds, burns or surgery), and following eyelid or facial surgery.
Ectropion may develop following facial nerve palsy (Bells palsy), in which the muscles surrounding the eye (and other facial muscles on that side of the face) are paralysed. Finally, ectropion may be further aggravated due to constant wiping by the tearing patient, which tends to pull the eyelid further from the eye.
What are the symptoms of Ectropion?
Ectropion can cause chronic irritation to the eyelid and the eye. This can result in excessive tearing, crusting of the eyelid and mucous discharge, infection, irritation of the cornea, and impaired vision.
When the lower eyelid is turned outward and no longer touches the eye, it cannot properly spread the tear film across the eye, which leads to poor drainage of tears through the nasolacrimal (tear drainage) system.
The exposed inner lining of the eyelid becomes dry and inflamed. As a result, the eye may become damaged.
How is Ectropion treated?
To prevent dryness of the cornea because the tear film does not properly lubricate the eye, artificial tears and lubricating ointments may be used to keep the cornea moistened. A protective shield may be worn at night to keep moisture in the eye.
However, the majority of ectropion are treated surgically. The best method of ectropion repair often depends on the underlying cause. In the ‘involutional’ type of ectropion (associated with ageing), Dr Martin may elect to shorten and tighten the lower lid, thereby resolving the outwardly turned lid. This is typically completed with an incision of the skin at the lateral corner of the eye. He will then excise a small segment of the lateral aspect of the lower eyelid, and subsequently will reconnect the eyelid to the underlying tissues and the upper eyelid.
Ectropion which occurs as a result of scarring (cicatricial ectropion) is most likely to follow another surgical procedure of the face or eyelids, especially excision of skin lesions (such as skin cancers). This type of ectropion repair often requires skin grafting.
The donor site of the skin graft is often taken from the upper eyelid or from behind the ear. The skin from these sites will most closely match that of the lower eyelid skin.
What can I expect after surgery?
There is typically almost immediate resolution of the condition. Most patients have little, if any, discomfort. Dr Martin will prescribe antibiotic ointment and drops for your eyes (and/or graft site). There may be mild swelling and bruising following the procedure, however, this should resolve within 2-3 weeks.
Usually only a few sutures are placed in the skin at the lateral corner of the eye, and these are often removed 7-14 days post-operatively.
If a graft was required, both the donor site for the graft and the surgical site will usually heal within 2 weeks following surgery.