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Eyelid Turning Out (Ectropian)

What is an ectropion?
An ectropion is a degenerative condition that causes the eyelid to rotate out and away from the eyeball (Figure 7). It usually occurs over the age of 65. Think of an ectropion as the opposite of an entropion we discussed in chapter four.

What causes an ectropion?
Just like in an entropion, laxity and weakness in the lower eyelid predispose to the development of an ectropion. As gravity causes the midface to descend over time, eyelid weakness and poor support can result in the lower eyelid turning out. Again, there is no way to predict who will develop an ectropion (Figure 8).

Are there any other medical conditions that predispose one to the development of an ectropion?
Some skin conditions, such as rosacea, can cause certain types of ectropion. Also, inflammatory eyelid conditions, such as blepharitis, have been implicated.

What are the symptoms of a lower eyelid ectropion?
The most common symptoms of a lower eyelid ectropion are redness and irritation. The eye usually has a mucous discharge. The exposed part of the eyelid gets very red and dry. Crusting on this exposed part of the eyelid can develop and dry up. The biggest risk with an ectropion of the lower eyelid is drying of the eye and infection (Figure 9).

What is done to correct an ectropion?
Initially, one might try eye ointments to quiet down the inflammation and redness. A small number of ectropions may respond to this therapy only. However the majority of lower eyelid ectropions need to be repaired surgically.

Can you describe the surgical repair of an ectropion?
Surgery is performed in our outpatient surgical suite under local anesthesia with sedation. The procedure can take from 30 minutes to one hour, depending on the complexity of the correction. Most of the time the eyelid is corrected by a tightening procedure. Sometimes a skin graft is necessary. This is usually taken from the upper eyelid or from behind the ear. Patching is almost always required. Sometimes the eyelid is stitched closed for a few days. Fortunately there is minimal pain, even with the more involved cases. The surgical complications are the usual ones for eyelid surgery, including bleeding and infection. If a skin graft is placed, there is a small chance that it may not take. This does not

happen too often. Because the eyelids are very vascularized (have a lot of blood vessels), skin grafts have an excellent chance for survival.

Recovery can take place for one to six weeks depending on whether a skin graft was placed or not. None of these procedures usually interfere with getting back to your normal routine as soon as possible.

Do ectropions recur?
Unfortunately ectropions can recur. If due to chronic inflammatory skin conditions, the process will continue despite an excellent and successful surgical repair. All attempts are made to aggressively treat all chronic skin ailments. Sometimes this is done in conjunction with a dermatologist.

Eyelid malpositions can also occur in children. Ptosis, entropion, ectropion can be seen on a congenital (from birth) basis. Management needs to be individualized because of some special situations unique to children. For instance, ptosis in a child could result in a lazy eye (amblyopia) if the eyelid covers the visual axis during the first decade of life. Surgery for ptosis may need to be performed to prevent this. Other eyelid conditions in children are managed based on symptoms and with the goal of excellent visual development. Surgical repair will usually require general anesthesia.

Copyright © 2009 Atlantic Eye Physicians