Ectropion Repair

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As we age, our faces change in a variety of different ways. One of these changes includes loosening of our skin and, in particular, our eyelids. The lower eyelid is normally held tightly against the eye by two tendons, one in each corner of the eye. As the skin loosens, so do these tendons, which can create laxity of the eyelid. In some cases, as the eyelid becomes looser, it can even turn away from the eye, which is called an ectropion. Patients can then have a variety of different symptoms that may necessitate this being fixed.

The Top patient shows a very loose lower eyelid. With very minimal downward pressure, the eyelid is able to be moved almost down to the cheek bone.

The bottom patient has a visibly turned-out lower eyelid. The inside corner of the eye is being pulled away from the eye even without any external pressure on the lid.

ectropion repair

What kind of symptoms does a lower eyelid ectropion produce?

The lower eyelid is responsible for a number of different functions, including protecting the surface of the eye, holding tears against the eye for lubrication, and drainage of tears away from the eye.  When the lower eyelid becomes loose, or in extreme cases, turns away from the eye, symptoms related to these functions can start to occur.

  • The eye can become irritated and red from exposure. Because the eyelid is loose or turned away from the eye, it cannot keep the eye closed appropriately, resulting in dryness and irritation, and in some cases, recurrent infections producing drainage and discharge.
  • Dry eye symptoms, like foreign body sensation and more matter in the eyes when waking up, become common because the eyelid does not help lubricate and spread the tears over the eye.

The inside corner of the lower eyelid contains one of the tear drains.  When the eyelid is loose or turned outward from the eye, the drain can no longer capture the tears normally.  This can result in a watery eye, and in some extreme cases, tears streaming down your face.

What causes an ectropion to occur?

There are a few different types of ectropion that happen for different reasons.

  • Age-related ectropion is the most common type and occurs because of normal aging. As we get older, the tendons that hold the eyelid tight loosen, causing the eyelid to sag.
  • Mechanical ectropion is a type that happens because a growth on the lower eyelid weighs the eyelid down, causing it to turn away from the eye.
  • Paralytic ectropion occurs because of a nerve issue that causes the muscles to sag. The most well-known form of this is Bell’s Palsy.
  • Scar-related ectropion occurs when a patient has had previous surgery or injury to the lower eyelid or cheek. The resulting scar contracts over time, pulling the eyelid away from the eye.
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How do you fix an ectropion?

Just as there are different causes of ectropion, there are different ways to fix ectropion.  In most cases, ectropion repair involves retightening the lower eyelid tendons so that the eyelid sits tight against the eye once again. In some cases, if the lower eyelid is also being pulled down by the cheek, additional stitches to support the cheek may also need to be used.  In cases of scar-related ectropion, skin grafts may also need to be used to provide the support necessary to tighten the eyelid.

Most ectropion repair can be performed in our office, though Dr. Dewan will discuss the most appropriate location for your surgery during your consultation.  Typically, the surgery is done with just local anesthesia which makes for a comfortable, quick recovery.

Does ectropion repair cause scarring?

The incision for ectropion repair typically falls into the natural lines of the outer corner of the eye called “crow’s feet” or smile lines. Because the incision follows these already present lines, the incision is typically very well hidden. The skin in this location is also quite thin, so it doesn’t typically scar in a thick or visible manner. If a skin graft is necessary, the most common location to get a graft is the upper eyelid. This incision is made in the natural eyelid crease, which heals very nicely and is very difficult to see after healing.

What is the recovery like?

As with most eyelid surgery, ectropion repair has a very comfortable recovery. Dr. Dewan typically only uses a single bandage in the outer corner of the eye to cover the stitches. The bandage can be removed the day after surgery, at which time a small amount of antibiotic ointment is used on the stitches a few times daily. Pain is minimal, and is best controlled with occasional Tylenol or ibuprofen. Some patients describe minor irritation of the surface of the eye for a few days after surgery, and we recommend using artificial tears, or a small amount of the antibiotic ointment, in the eye for this time. Most patients can resume their normal activities within a day or two and with only a few restrictions, including heavy lifting or cardiac exercise. The stitches typically dissolve within 10 days. Dr. Dewan sees post-operative patients 1 week following surgery to make sure you are healing well.

Will insurance pay for this?

Ectropion repair is generally considered a medical condition. Because the effects of ectropion include symptoms such as infections, eye irritation, and excessive tearing, insurance usually covers ectropion repair surgery. Prior to your surgery, our office will verify any prior-authorization requirements with your insurance. We will also generate an estimate for any out-of-pocket payments your insurance plan requires for surgery. These payments are collected 1 week prior to your surgery date.
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