Ectropion Correction

This leaflet has been produced to provide information for patients requiring surgery to tighten a lax or drooping lower eyelid.

What is an ectropion?

What causes ectropion?

Most cases of ectropion are due to laxity of the eyelid as a result of ageing. Rarely the problem is present from birth (congenital). In some cases it results from scarring of the eyelid skin caused by certain skin conditions, infection, chemical burns, thermal burns, or other eyelid trauma, including previous surgery. Benign and malignant eyelid lesions may mechanically rotate the eyelid away from the eye.

How is this condition managed?

Lubricating ointment helps to relieve discomfort. Surgery is usually required for a definitive solution if the problem is severe and is causing significant symptoms. The aim of surgery is to restore the eyelid to its normal position and improve associated symptoms.

What does the surgery involve?

Ectropion surgery is usually performed under local anaesthesia as a day case, but a general anaesthetic is possible if you prefer. In most cases the eyelid is tightened and rotated into the normal anatomical position with some fine stitches. Occasionally, the skin of the eyelid may need to be enhanced with a skin graft. The local anaesthetic injection is a little uncomfortable, but the operation is not painful and generally lasts about 30-45 minutes. If a skin graft is required, surgical time increases to about 90 minutes.

Care after the operation

A pressure dressing is usually applied to the operated eye to reduce swelling and bruising. If both lower lids are operated on simultaneously, one eye may be covered but you will need to apply ice packs to the uncovered eye to stop it swelling. The dressing is usually removed at home on the first day after the operation but may have to remain undisturbed for a minimum of 48 hours if a skin graft is used.

Once the dressing is removed the wound can be carefully cleaned with some cooled boiled water and cotton wool balls or cotton gauze. You can shower normally but pat the wound carefully dry. Antibiotic drops, or ointment will be prescribed for the operated eye/eyes for 2 weeks and you will normally be reviewed in outpatients within 2-3 weeks after the surgery.

You can return to work, or normal activities, within a few days, but it is best to avoid swimming for 2 weeks. Whilst the eyelid is healing, the eye may feel a little gritty and tender at the outer corner. The stitches are usually self-dissolving but may be removed at your first outpatient visit after your operation.

What are the risks / side effects of ectropion surgery?

• Swelling and bruising of the eyelid is common, variable and usually resolves in 10-14 days.
• Excessive bleeding is usually due to blood-thinning tablets such as aspirin, clopidogrel or warfarin. These may have to be stopped before the operation but only if your surgeon advises and your GP approves.
• Bruising of eye may occur.
• Infection of the eyelid or eye socket may happen, but this is rare.
• The ectropion may recur, requiring further surgery.
• Allergic reaction to the local anaesthetic or antibiotic drops/ointment may happen but this is rare.
• The scar from the surgery usually blends in the natural skin crease and is barely visible in most cases, but may be noticeable. Some patients scar more readily than others.
• If a skin graft is used, the graft may not take, especially if there is infection. Skin grafts sometimes appear thicker, paler or more wrinkled than normal eyelid skin.
• Rarely a tender lump, called a granuloma, forms in relation to the eyelid wound. This usually disappears on its own but may need to be surgically removed if it persists.

Medication

Please bring a list of all of your medicines or a current repeat prescription from your GP.

You will be given some antibiotic ointment with advice on how to apply it to the operated eye(s) and wound(s) for 2 weeks after the operation. You may need to use paracetamol for a few days after the operation if the eye or wound is uncomfortable.

Contacts and further information

Please contact the theatre bookings team in the Eye Department on 01223 274863 if you have any queries regarding your appointment for surgery. For urgent post-operative concerns please contact the Emergency Eye Service on 01223 217778.