for eyelid deformityEctropion / Entropion Surgery

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Last updated 10/7/2022

Is there a solution for eyelids that don’t close properly? 

In the normal eye, the upper and lower eyelid margins close like a window sash, forming a tight seal that protects your eyeball from external matter while preventing your tears from evaporating or spilling, which is important for keeping your eyes moist. Sometimes, as a result of aging, injury, a tumor, or surgery, the eyelid anatomy can get distorted, preventing the lid margins from coming together to form a seal. 

 

There are two conditions that can result from improper eyelid closure and each can cause distressing symptoms such as redness, an irritating feeling of something constantly in your eye, or excessive eye-watering. Known as Ectropion and Entropion, these eyelid malposition conditions are relatively rare, affecting 2% (entropion) to 3 % (ectropion) of the population.

What is the difference between Ectropion and Entropion?

Normal upper and lower eyelids close together tightly over the eyeball shielding it from external damage and stopping the evaporation of tears, which enable the eye to remain lubricated. Ectropion and entropion are two conditions that prevent the lids from shutting properly. The difference between these two conditions is described below.

 

What is Ectropion?

Ectropion is the condition in which the eyelid turns outward, causing the water line to be everted. This not only exposes the eyelid’s inner surface to irritating particles like dust or dirt but also makes the cornea vulnerable due to the rapid evaporation of lubricating tears. Over time, dry eyes can result in corneal abrasions and ulcers.

Symptoms of ectropion can include:

  • The formation of crusts along the eyelid margin
  • Mucus discharge from the eyes
  • Excess tearing or inadequate tear drainage
  • Corneal dryness, redness, and irritation
  • Vision changes
  • Sensitivity to light
  • Wind sensitivity
  • Eye Infections

 

What causes Ectropion?

 The most common cause of ectropion is an age-related weakening of the tissues and muscles responsible for eye closure. Ectropion more commonly involves the lower eyelid. It can affect one or both eyes, involve a segment of a lid or the entire eyelid margin can turn outward. 

 

A number of conditions can lead to ectropion:

  • Age-related laxity of the muscles and soft tissues surrounding the eyes
  • Injury to the eyelid
  • Scar tissue causing the delicate eyelid skin to retract
  • A tumor or skin condition of the eyelid
  • Previous surgery of the eyelids or face
  • Nerve injury or a facial paralysis
  • Congenital ectropion deformity (rare)

 

Is there a Treatment for Ectropion?

Luckily, there are a number of treatments available for ectropion and your doctor’s recommendations will be based on the degree and severity of your condition. Treatments can include artificial tears and lubricating ointments to temporarily relieve eye irritation or applying skin tape to temporarily support the eyelid in the correct position. 

 

Sometimes surgical treatment is required to repair stretched muscles or tendons, insert a skin graft or flap (rarely), or to address tearing problems. Ectropion surgery is typically performed as a same-day surgery procedure using local anesthesia and intravenous sedation.

 

What is Entropion?

Entropion is the condition characterized by an inward turning eyelid that causes constant rubbing of the eyelid rim and eyelashes against the cornea. The rubbing can be continuous or occur only during blinking or while squeezing the eye shut. Continual rubbing is dangerous because it can lead to corneal ulcers, scarring, and even vision loss. Not to mention that it’s very uncomfortable and, in extreme cases, downright painful

 

Symptoms of entropion can include: 

  • Eyelid crusting or mucous discharge
  • Excess tearing
  • Corneal redness
  • A foreign body sensation in the eye
  • Eye pain
  • Vision impairment
  • Light sensitivity
  • Sensitivity to wind

What causes entropion?

 Not surprisingly, the causes of entropion are similar to those for ectropion: 

  • Age-related laxity of the soft tissues and muscles of the eyelids
  • Scar tissue within the inner surface of the eyelid
  • Infection, tumor, or injury involving the eyelid

 

Is there a treatment for Entropion?

There are a number of tools your eye surgeon can use to help mitigate entropion symptoms and, if needed, to reposition the inverted eyelid. Irritation can be lessened with lubricating eye drops and ointments. Your doctor might prescribe medicated drops to manage swelling or infection. Surgical tape or stitches might be placed temporarily to realign the offending eyelid and spare the cornea from further injury. In certain instances, Botox might be injected to temporarily relax a tight eyelid muscle. 

Recovering from ectropion and entropion surgery

If surgery is required to correct an eyelid deformity, it is usually performed as a same-day surgery using local anesthesia and IV sedation. Post-op bruising typically subsides completely within two to three weeks. Swelling can take up to 4 weeks, although this time varies among patients. The final results are visible in 4 months.

 

You will leave the surgery suite with antibiotic ointment over your eyes and pressure dressings. Your surgeon will give you specific instructions as to maintain your head elevated while in bed, the application of cool packs, gentle eyelid cleaning using cotton swabs, and the application of antibiotic ointment. 

 

Your post-op care is key to obtaining the best outcomes. Therefore, you must commit to a somewhat labor-intensive post-op care regimen and adhere strictly to your surgeon’s instructions. If dissolving stitches are not used, stitches will usually be removed in the clinic at your two-week follow-up visit. Contact lenses are not permitted for several weeks following surgery.

 

Why Choose AGEI for your eyelid surgery?

Your eyes are one of the most delicate structures in your body. That’s why, when you’re looking for a Los Angeles area surgeon to correct the appearance or function of your eyelids and the structures surrounding your eyes, you want to seek out an oculoplastic surgeon.

 

As a trained ophthalmologist with a sub-specialty in oculoplastic surgery, Dr. Rafi Israel is able to thoroughly examine your eyes, understand any underlying eye disease, and identify potential problems that might impact the surgical plan -- things that even a board-certified facial plastic surgeon is not trained to do.

 

We have decades of experience in treating functional eye problems affecting patients’ vision and eye health. He has performed thousands of cosmetic procedures, including revisions of surgeries performed elsewhere with unsatisfactory outcomes. 

 

Among the conditions we treat are excess eyelid skin or fat, drooping eyelids, wrinkles around the eyes, eyelid reconstruction after tumor removal or eye injuries, excessive tearing, revising prior unsatisfactory eyelid surgeries, and abnormally turned in (entropion) or turned out (ectropion) lid margins. 

 

If you would like to schedule a consultation with us in our Beverly Hills office to discuss your concerns about the appearance or function of your eyelids and to learn what treatments might be right for you, please call 866-945-2745 or click here to request an appointment online.

 

At AGEI we take our patients’ safety seriously. That’s why our facility’s Covid-19 patient safety procedures exceed all CDC recommendations.

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