Ectropion/Entropion
Ectropion is the medical term used to describe the lower eyelid turning outwards and drooping away from the eye. One or both eyes may be affected at the same time. Due to the turning out position of the lower lid the eyeball could become exposed. This can be extremely uncomfortable. The inner lining of the eyelid may become dry and sore. The eye will produce more tears to protect the surface so the eye may constantly water.
Sometimes the eye will not close properly due to the ectropion and the clear front window of the eye, called the cornea, may not be fully protected. In some cases, this can cause drop in vision.
What causes ectropion?
Older people are more commonly affected by ectropion because the muscles and attachments of the eyelids become weaker and more elastic with age. Damage to the skin near the eyelids can also cause ectropion through scarring and contracture. The strength and tone of the eyelids is maintained by the facial nerve, and impairment of this nerve (such as occurs in Bell’s palsy) may lead to laxity of the eyelid and secondary ectropion.
How can ectropion be treated?
The treatment of ectropion depends on the cause. If the skin of the lid has become tough from chronic eye drops usage, a change or cessation of the treatment might be sufficient. The most common treatment is a relatively minor operation to turn the lid inwards again to its normal position. The operation is carried out as a day case procedure with stitches to close the wound under local anaesthetic.
Complex cases, such as those where there have been previous injuries, surgery or facial nerve palsy, might require more extensive surgery and a sedative may be offered.
Common questions about Ectropion
The function of the lower eyelid is to protect the eye and to lead the tears into the inner corner of the eye, where they are drained away through the tear duct. Ectropion can result in exposure of the lower surface of the eye as well as watering of the eye. Rarely, if left untreated, ectropion can lead to corneal exposure and/or corneal infection, which can pose a risk to vision.
The operation involves tightening and repositioning of the lower eyelid, which will correct the lid position and, if required, the laxity. Deep stitches and ones to close the wound at the end of the operation are used. A pad will be placed over the eye at the end of the operation.
All surgery carries some risk. Bruising and swelling occurs around the operation site, but, is likely to go away in one to two weeks. Bleeding and infection, are possible with any operation, but are uncommon. Occasionally, the condition could recur over time, or the lid position could be over or under-corrected, which might require a further operation. There is a small scar at the surgical site. Dry, sore or irritated eye(s) can occur but are usually temporary. There can be asymmetry with the other side of the face or subtle changes to the appearance of the eye as a result of the intervention. Serious problems such as damage to nerves, the eye or surrounding structures are very uncommon.
The operation itself takes around 45 minutes per eyelid. You should expect to spend half a day in hospital, but will be free to go home an hour after the procedure if no sedative has been used.
Entropion is a condition in which the eyelid turns inward, resulting in the eyelashes directed towards the surface of the eye causing discomfort. If left untreated, it can cause excessive watering, crusting of the lid margin, discharge, irritation and infections. Serious inflammation of the surface of the eye could cause permanent damage and impair sight.
Both sets of eyelids can be affected, although the condition more commonly affects the lower lids.
Why do the eyelids turn inwards?
Entropion most commonly occurs due to changes in muscles and other tissues as a result of ageing. Occasionally, scarring of the inner lining of the eyelid due to infections, injury or inflammation can also cause the lid to turn in.
How will I know if I have an Entropion?
When the lid turns inward, the skin and lashes rub on the surface of the eye, and you may have a feeling of pain, that something is in the eye, notice excessive watering, crusting of the eyelid or discharge, sensitivity to light, changes to your vision or directly see that the lashes themselves are pointing in the wrong direction.
Common questions about Entropion
Entropion can be diagnosed by a routine eye examination. Special tests are not usually necessary.
If left untreated, entropion can lead to sensitivity to light and wind, scratches and infections of the surface of the eye which could be sight threatening. If entropion is present, it is important to have the condition treated before permanent damage occurs to the eye.
Temporary relief of entropion can be achieved by taping the eyelid or by having an injection to weaken the muscle that causes the lid to turn in. This may be undertaken before an operation is performed.
