Ectropion

Ectropion

Ectropion is the term used for an eyelid that turns outwards. This usually causes discomfort, watering and discharge because the surface of the eye is not properly protected. It can also be cosmetically undesirable.

The most common cause of entropion is age related change to the skin and muscles that dictate the normal position and tension of the lower lid.

If an ectropion is present lubricant drops and ointment should be used to protect the surface of the eye. The definitive approach to correcting an entropion is surgical repair.

Ectropion surgery is generally safe and is performed as a day case procedure. It has a high success rate and patient satisfaction.

Miles is a triple fellowship trained oculoplastic surgeon with specific expertise in eyelid plastic surgery. He performs lower eyelid malposition (entropion and ectropion) surgery on a weekly basis.

Entropion surgery

  • Procedure time 1-1.5hrs

  • Anaesthetic Local or General

  • Downtime 7-10 days

  • Driving 5 days

  • Exercise 7 days

  • Final result 2-3 months

  • Ectropion surgery usually involves tightening the lower eyelid and repairing the lower eyelid muscles to help roll the eyelid back in.

    Surgery is typically performed under local anaesthetic with or without sedation.

    There is usually a small skin incision at the outer corner of the eye which is hidden in a skin crease and almost undetectable. There may also be a second incision on inside of the lower eyelid.

    In the unusual scenario of ectropion caused by scarring or previous eyelid surgery a skin graft may be needed to roll the eyelid back in. This can be done under general anaesthetic. The graft typically heals very well with a good cosmetic result.

    Sutures are removed at 5-10days following surgery.

    There is a >95% success rate with entropion surgery and high rates of patient satisfaction.

  • The recovery period is typically two weeks. The final result of surgery is appreciated at around two to three months.

    Discomfort is minimal following the surgery, controlled with simple pain killers such as paracetamol.

    Temporary blurred vision due to the ointment applied to the eyes following surgery, reduced skin sensation, light sensitivity, and watering may occur and are typically short lived.

    Antibiotic ointment is prescribed to apply to the skin incisions twice a day for two weeks post-operatively.

    Sutures are often dissolvable but may be removed at 5-10 days following surgery. Scarring is minimal and usually undetectable.

    Swelling and bruising varies between patients but can take up to 4 weeks to resolve. Cold compresses and sleeping propped up in the days following surgery can speed up recovery.

  • Ectropion surgery is generally considered to be safe.

    As with any oculoplastic procedure, there are potential risks including infection, bleeding, scarring, asymmetry, over- or under-correction, and need for further surgery. These complications are unusual.

    Infection

    Post-operative infection is very rare and can be treated with antibiotics. Further surgery may be required and cosmesis can be affected. A severe infection is extremely unlikely.

    Bleeding

    A small amount of bloody discharge from the skin incision is expected post-operatively.

    Scarring

    Surgical incisions are meticulously planned to minimise scarring. Scarring following ectropion surgery is typically very subtle.

    Asymmetry

    When comparing the two sides of the face, we are all slightly asymmetrical. During the healing phase following surgery, especially if you have have surgery on one side, asymmetry may be noted and the eyelid(s) may feel tight. This is by design and they will relax to the correct position in the weeks following surgery. The vast majority of patients are very happy with final results.

    Allergy

    Allergic reactions are rare and precautions are taken for anyone with pre-existing allergies.

    Short and Long Term Outcomes

    Final results are seen at 2-3 months and should last for many years. It is unusual to need to repeat this procedure again in the future.

Miles is a consultant ophthalmologist and oculoplastic surgeon with a private practice at The London Clinic on Harley Street. He specialises in ophthalmic cosmetic, reconstructive, and lacrimal (tear drainage) surgery.

In addition to his private practice, Miles holds a substantive NHS consultant post at the Royal Free London and he established and runs the oculoplastic service at North Middlesex University Hospital. He also has expertise in cataract and pterygium surgery.

As an honorary clinical lecturer at UCL and assistant professor at St. George's University, Miles is actively involved in training the next generation of ophthalmologists.