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Ectropion - Out rolling or saggy eye lid

What is ectropion?

Ectropion is the medical term used to describe outward turning and laxity of the eyelid. It occurs quite commonly in the lower eyelid, but can very rarely affect the upper lid.

The major causes of ectropion include:

  • Aging changes in the skin resulting in stretching and laxity

  • Sun damage causing tightening of the eyelid and cheek skin

  • Facial palsy, e.g . Bell’s palsy

  • Prior eyelid surgery which has distorted or scarred the eyelid

What are the symptoms of ectropion? 

Ectropion can lead to excessive watering of the eye, redness, mucous discharge, irritation of the eye or be cosmetically unsightly. Very occasionally severe ectropion can cause permanent damage to the surface of the eye if the eye lid does not close properly, which can affect the vision.

What is the treatment for ectropion?

Ectropion does not always need to be corrected and some people are happy not to have intervention. However, if the symptoms or appearance are to be corrected, ectropion will need to be repaired surgically. Normally this involves a small incision which is made at the outer corner of the lower lid and the loose structures stretched and shortened, then resutured to the tissue overlying the bone at the outer corner. If there is a lack of skin in the lid (which more commonly occurs in people who have had greater lifetime sun exposure) a skin graft may be required. The skin graft is usually taken from the area over the collar bone.

What happens on the day of surgery?

The surgery usually takes between 30 to 45 minutes and is usually performed under local anaesthesia (numbing injections around the eyelid) . Sometimes some sedation is also used to make you more sleepy and relaxed during the procedure. Very occasionally the procedure is done under general anaesthetic. It is usually a day case procedure which means you can go home after the operation providing you are safe to do so.

What should I do in preparation for surgery?

Blood thinning medications such as aspirin, clopidrogel (Plavix, Iscover) and warfarin can make bleeding more likely during and after surgery. If you are taking these drugs please tell me and we can discuss whether to continue them. If possible it is advisable to stop anti-inflammatory drugs like ibuprofen (Nurofen), fish oil, ginger, ginseng, St Johns Wort, Arnica and garlic containing supplements 2 weeks before surgery .

If you smoke I would recommended that if possible you stop smoking for at least 3 days prior and 1 week after surgery, because smoking impairs wound healing and increases the risk of infection.

Avoid heavy alcohol intake in the days before and after surgery. If you are having sedation or general anaesthetic, you are required to have nothing to eat or drink for at least six hours before surgery.

On the day of surgery please dress casually and wear a top which buttons at the front. Please wash your face on the morning of surgery and ideally men should shave. Do not wear any makeup, jewellery or contact lenses.

What happens after the operation?

A pad is sometimes put on the eyelid. We will advise you when to remove this. If both eyelids are padded, one or both will be removed before you go home. If a skin graft is performed the eye pad and dressing is usually left in place for 2 to 3 days. Swelling and bruising is usual after surgery but can vary considerably. Factors associated with greater swelling and bruising include increasing age, the use of aspirin, warfarin or other blood thinners and a history of previous surgery on the same lid.

The eyelid can be gently bathed with saline or cooled boiled water once or twice a day. Antibiotic ointment should then applied to the suture line and/or graft with a cotton-tipped bud. It can also be applied to the eyelid before showering or bathing to “waterproof” the suture line/graft. The wound area should be kept relatively dry for about three weeks, i.e. it should not be soaked or submerged in water but it is fine for it to get splashed with water for example whilst in the shower. If it does get wet, gently dab it dry, but do not rub the wounds when drying them.

Ice (crushed ice or frozen peas), cold packs, or cool gel face masks (available from most chemists) can be applied to the eyelid for 15 minutes at least 4 times daily for the first 5-7 days . This reduces lid swelling and bruising and can be continued for as long and as often as it seems to provide some benefit. About two-thirds of the bruising and swelling will have subsided by the first post-operative visit at one week. The remainder gradually subsides over the next several weeks and is usually invisible to others by six weeks. Your vision may be slightly blurred in the first couple of weeks while the lids are swollen: this will improve once the swelling settles.

You may have some pain or discomfort following your surgery, this is usually mild to moderate and normally relieved by simple painkillers such as paracetomol. Severe pain is very rare after eyelid surgery – you should notify me immediately if you experience more than mild to moderate pain. Some eyes may feel dry or gritty for the first few days to weeks after surgery. This can usually be relieved with the use of artificial tear drops that you can buy from the chemist.

You can use make-up the day after surgery, but avoid the areas with incisions or stitches. You can drive once you are happy with the vision and comfort in the eye(s), usually the next day. You should not drive if one eye is padded. 

It is sensible to avoid heavy physical activity (bending and lifting, digging, strenuous exercise) for the first week. Walking, reading, watching TV and light domestic duties can be performed when you feel able.

Do not use aspirin or blood-thinning medications for the first 5 days after surgery unless you are already on them or we have discussed this prior to surgery.

You will usually need about one week off work.

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