Ectropion

Ectropion is an eyelid condition where the lower lid turns outwards. This can either be minimal with just the inner corner turning out by a millimetre or so or in severe condition where the entire eyelid turns out. The inside of the eyelid has a mucosal membrane which is apposed to the surface of the eye. When it is everted, it dries out and this can cause irritation and discharge. Additionally, the tears are not able to reach the tear duct (lacrimal punctum) at the nasal upper edge of the eyelid and where the lid turns out it forms a little pocket between the lower lid and the surface of the eye and tears gather here. Often when leaning forward it can lead to tears running down the cheek. Watery eyes are the most common complaint with ectropion, but it can also lead to dryness as the high portion of the eyelid is to spread the tears over the ocular surface. When it is not approximated to the surface of the eye, the cornea can dry out as it has lost its eyelid wiper function. Temporary lubricants can help but surgery is needed to correct this eyelid malposition.

Surgery is usually performed under local anaesthetic, but a general anaesthetic can be used should surgery cause anxiety or should it not be possible for the patient to keep entirely still. For a mild ectropion involving the punctum alone, punctoplasty with retropunctal cautery or medial spindle can take a matter of minutes however for a more significant ectropion eyelid tightening may be required as well. The surgery is generally safe, predictable and with low risk of complications. However, there is a small chance of recurrence of an ectropion after some time and a further procedure can be performed should this happen. If there is shortage of skin such as when ectropion happens as a result of previous surgery or trauma, a skin graft may be needed and surgery is more extensive.

The surgery would usually take place in the hospital as a day case procedure after which an eye pad would be put onto the eye. This can be removed the following day with clean hands and an antibiotic is usually applied for a week afterwards to the eyelid and eye. The stitches are usually absorbable and unless they are causing irritation they usually will not need to be removed.