Ectropion Eyelid Surgery

Key Information

PRICE

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TIME OF PROCEDURE

30 – 90 min

DOWNTIME

1 – 2 weeks

DISCOMFORT LEVEL

2 out of 5

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What is ectropion?

Ectropion is a condition in which the lower eyelid turns outward, exposing the inner part of the eyelid. This outward eversion can lead to irritation, excessive tearing, and a feeling of dryness. In severe cases, ectropion may cause repeated eye infections, corneal damage, or even ulceration, impacting overall eye health.

Ectropion commonly affects the lower eyelid, particularly in older adults, due to age-related laxity in the eyelid muscles and surrounding tissues. However, it can also be congenital (present at birth), though this is much less frequent.

Ectropion symptoms may vary from mild irritation and watery eyes to more pronounced signs such as constant tearing, redness, and sensitivity to light. Artificial tears and lubricating ointments may help temporarily alleviate symptoms, but ectropion surgery is recommended for long-term relief and eyelid malposition correction.

What are the types and causes of ectropion?

Ectropion can be divided into several types, each with distinct causes. Some forms are age-related, as the eyelid’s structural support weakens over time, while others result from factors like trauma, nerve damage, or inflammatory conditions.

Involutional ectropion: caused by age-related weakening of the eyelid’s structural support, leading to the outward turning of the lower eyelid. Typically developing around age 60 and beyond, this condition occurs as facial muscles, tendons, and ligaments lose strength and elasticity.

Cicatricial ectropion: caused by skin scarring, which pulls the eyelid outwards. Burns, trauma, previous eyelid surgery and skin conditions, including rosacea, can all have this effect.

Paralytic ectropion: caused by facial paralysis damage to the innervation of the muscles that supply the eyelid, usually seen following Bell’s palsy, facial nerve palsy.

Mechanical ectropion: caused by the weight of a mass pulling the lower eyelid down and outwards.

Congenital ectropion: caused when the lower lid margin has been turned outwards since birth and is the rarest type of ectropion.

Ectropion after blepharoplasty: this is a very complex problem to treat and can be due to all the above causes. Please see the revision blepharoplasty page for more details on how this can be approached.

Understanding the specific type of ectropion is essential for determining the appropriate ectropion treatment and ensuring effective relief from symptoms.

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What are the symptoms of ectropion?

Ectropion presents with various symptoms, primarily due to the outward turning of the lower eyelid, which exposes the sensitive inner part of the eyelid. This exposure often leads to discomfort, irritation, and an increased risk of eye infections. Key symptoms of ectropion include:

watery eyes (excessive tearing)
ocular irritation
mucoid discharge
redness
sensitivity to light and wind
dryness and gritty sensation

You should seek immediate medical advice if you see any of the following signs, as they may indicate the development of an eye infection or corneal ulcer:

the white of your eye has become very red.
your sensitivity to light and wind is quite strong.
any change in your vision.
copious discharge.
pain
if you see a white spot on the cornea

Note: ectropion may be diagnosed by an optician or GP who can refer you to an ophthalmologist for further assessment and treatment.

Tips to improve symptoms

While ectropion surgery is usually required for a complete solution, there are several ways to alleviate symptoms and improve comfort in the meantime:

Use eye lubricants

Applying artificial tears and lubricating ointments can help keep the eye surface moist, reducing dryness and irritation. These lubricants can also prevent damage to the cornea, improving overall comfort.

Apply emollient cream

If the lower eyelid skin becomes dry or cracked, using an emollient cream can help moisturise and soothe the area. This simple treatment can reduce irritation and support skin healing.

Gentle eyelid massage

Massaging the lower eyelid upwards may help counteract the downward contraction of the skin, providing temporary relief and improving tear distribution across the eye.

Protective measures

Wearing sunglasses outdoors can shield your eyes from light and wind, reducing irritation caused by environmental factors.

Cold compresses

Applying a cold compress to the eyelid can help reduce inflammation and soothe soreness, providing short-term comfort.

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How is ectropion diagnosed?

Ectropion can typically be identified during a routine eye examination by an optician or GP, who may refer you to an ophthalmologist for a more detailed assessment. The position of the eyelid, the degree of outward turning, and the condition of the eye’s surface are carefully examined to determine the severity of the ectropion and assess any associated issues like dryness, redness, or infection.

As part of the examination, your doctor may ask you to close your eyes to evaluate the tone and tightness of your eyelid muscles. It’s also essential to inform your doctor of any past surgeries, scars, or tumours, as this information aids in forming an accurate diagnosis and treatment plan.

At The Ezra Clinic, our highly experienced consultants will conduct a comprehensive examination to determine the most suitable treatment for your condition and symptoms. Untreated ectropion can lead to further complications, so seeking timely care is important to help maintain comfort and protect your eye health.

What are the risk factors for ectropion?

Several demographic factors and medical conditions can increase the likelihood of developing ectropion:

Age
Ectropion is more common among older adults. Over time, the eyelid muscles and surrounding tissue lose elasticity and strength, making the eyelids more susceptible to turning outward.

Previous surgery or trauma
A history of eyelid surgery or facial trauma can increase the risk of ectropion, as these may result in scar tissue or structural changes that impact eyelid alignment.

Facial paralysis
Conditions causing facial nerve palsy, such as Bell’s or other nerve injuries, increase the risk of paralytic ectropion by affecting the muscles that control eyelid movement.

Skin conditions
Chronic skin conditions, such as eczema or dermatitis around the eyelid, can lead to scarring and cicatricial ectropion due to skin contraction.

Congenital factors
Although rare, some individuals are born with structural differences that can predispose them to congenital ectropion, especially in cases linked to genetic syndromes.

What are the complications of ectropion?

If left untreated, ectropion can lead to several complications, as the exposed inner eyelid and eye surface are vulnerable to irritation and infection:

Chronic irritation
Constant exposure to the conjunctiva leads to ongoing irritation, often resulting in redness, burning, and discomfort that can interfere with daily life.

Excessive tearing and mucoid discharge
Tears may accumulate and overflow without proper drainage, causing constant tearing and sometimes a creamy discharge. This excess moisture can also create an environment conducive to infection.

Corneal damage
Prolonged exposure to the eye surface can lead to corneal dryness and, in severe cases, corneal ulcers or abrasions. These are serious complications that, if untreated, can threaten vision.

Infection risk
The exposed inner eyelid and the lack of effective tear drainage increase the risk of bacterial infections, leading to conjunctivitis and other inflammatory conditions.

Sensitivity to light
Dryness and irritation can make the eyes more sensitive to light and wind, further exacerbating discomfort and impacting the quality of life.

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How is ectropion surgery performed?

How is ectropion treated?

Ectropion surgery is the most effective treatment for correcting the outward turning of the eyelid, aiming to restore both its functional role and aesthetic appearance. The procedure is performed on an outpatient basis, often under local anaesthetic, to provide maximum comfort while allowing the patient to return home the same day. During the surgery, the ophthalmic surgeon focuses on tightening the eyelid muscles and reattaching or repositioning the eyelid, effectively allowing it to sit closer to the eye. The procedure’s duration, typically 30 to 90 minutes, depends on the ectropion type.

Note: You may spend around half a day in our clinic when allowing for preparation and aftercare.

Before the procedure

Depending on your planned anaesthesia, your doctor will advise you when to stop eating or drinking but the ectropion treatment usually only requires local anaesthesia with intravenous sedation, ensuring you are comfortable and sleepy throughout the procedure.

During the procedure

The surgery for age-related, or involutional, ectropion generally involves tightening the lower eyelid with stitches at the outer corner of the eye. However, depending on the type of ectropion, specific techniques may be necessary during the procedure to ensure optimal results.

For cicatricial ectropion, which is caused by scarring or skin contraction, surgery may require a skin graft or flap in addition to tightening the lower eyelid. The skin for grafting may be sourced from the upper eyelid, in front of or behind the ear, or from the upper arm. The choice of location depends on several factors unique to the patient, including skin availability, colour match, and texture.

Mechanical ectropion, often due to a lesion or mass on the eyelid, typically involves managing the lesion with a biopsy and, if necessary, additional surgery to restore the eyelid position.

In cases of paralytic ectropion associated with facial muscle weakness, a more comprehensive approach is taken to protect the eye surface and prevent visual impairment, often involving further supportive measures.

To minimise noticeable scarring, incisions are usually made along the natural creases of the eyelids. Stitches used in the procedure are typically removed within one to two weeks, allowing for a smoother recovery.

Aftercare

Following ectropion surgery, patients can expect some swelling, bruising, and mild discomfort around the surgical site, which generally subsides within a few days. The surgeon may prescribe antibiotic and steroid ointments to prevent infection, reduce inflammation, and aid healing. Artificial tears or lubricating eye drops may also be recommended to moisten the eye surface.

Patients are advised to avoid strenuous activities, heavy lifting, and bending over for at least one week post-surgery to minimise swelling and encourage healing. Cold compresses applied to the area can help alleviate discomfort and reduce swelling. It’s essential to keep the surgical area clean and avoid touching or rubbing the eye.

For most patients, the surgery will correct ectropion almost immediately.

Ectropion surgery before and after

FAQ

How to prevent ectropion?

While ectropion cannot always be prevented, particularly when it results from natural ageing or genetic factors, there are measures to reduce the risk:

Protect against sun damage
Sun exposure can contribute to skin changes and premature ageing. Wearing sunglasses and applying sunscreen around the eyes can help protect the delicate eyelid skin.

Avoid eye trauma
Protect your eyes from injury by wearing appropriate eye protection in situations that pose a risk, such as sports or certain work environments.

Manage skin conditions
If you have chronic skin conditions around the eyes, such as eczema, keeping these conditions well-managed can prevent skin irritation and scarring that may lead to ectropion.

What are the possible complications of ectropion surgery?

Ectropion surgery is generally safe and highly effective, though as with any surgical procedure, there are potential risks and complications, including:

Infection
Although rare, infection is a possible complication following surgery. Antibiotic ointments are often prescribed to help prevent this.

Bleeding and bruising
Some degree of bruising is normal post-surgery; however, excessive bleeding is uncommon and will be addressed by the surgeon if it occurs.

Scarring
Scarring at the surgical site is possible, though most scars are minimal and fade over time.

Overcorrection or under-correction
Following surgery, the eyelid may sometimes not sit perfectly against the eye. A follow-up or repeat surgery may be needed to adjust the eyelid position for optimal results.

Dryness or tearing
Changes to tear drainage may occur post-surgery, leading to increased tearing or dryness in some patients.

How common is ectropion?

Ectropion is relatively common, especially among older adults, due to the natural ageing process that causes eyelid muscles and tissues to loosen. It is also common in individuals who have had previous facial trauma or surgery, which can affect eyelid positioning.

Ectropion vs. entropion: What’s the difference?

Ectropion and entropion are both conditions involving the eyelid’s position relative to the eye:

Ectropion occurs when the eyelid turns outward, exposing the inner eyelid and causing irritation, excessive tearing, and dryness.
Entropion is the opposite condition, where the eyelid turns inward, causing the eyelashes to rub against the eye, which can lead to irritation, pain, and potential damage to the cornea.

Both conditions are more common in older adults and can be effectively treated with surgical intervention tailored to correct eyelid malposition.