Ectropion Repair

Ectropion is more common in older people because the muscles of the eyelid weaken with age (the eyelid itself and its attachments may stretch). Other causes of ectropion include damage to the skin near the eyelids which causes scarring and other tissue damage. Using eye drops for a long period of time can cause this, as can sun damage. Impairment to the facial nerve, as seen with Bell’s Palsy for example, can cause the eyelid to loosen and as a result turn outwards to form a secondary ectropion.

Your initial appointment will be with an ophthalmologist (a doctor specialising in eyes) in our outpatient clinic. The type of treatment offered to you will depend on what caused the condition.

If you have developed ectropion through long-term use of eye drops, changing or ceasing use of the eye drops could fix the damage to the eyelid.

For most patients, a minor operation to turn the eyelid inwards to its normal position is required. Ectropion caused by a previous injury, surgical procedure or facial nerve damage may require more extensive surgery, occasionally using a skin graft.

If you decide to have an operation following your consultation, you will need to have a pre-operative assessment.

There will always be a certain amount of bruising, swelling and mild bloodstaining of the tears after surgery. Other potential side-effects and risks from ectropion repair are uncommon but could include:

• Bleeding and infection.
• Recurrence of the condition over time.
• Changes to the lid position which might require a further operation.
• Minimal scarring.
• Damage to the eyeball, nerves in the eye and other surrounding structures (extremely rare).

You are allowed to eat and drink before your surgery and take your tablet medication as normal except for anticoagulants (aspirin, clopidogrel and warfarin).

Aspirin and anti-coagulants. If you take aspirin or drugs such as warfarin to thin your blood, you will be asked to seek advice from your GP about whether you could reduce or stop these medications prior to your surgery. This is because blood thinning medications can make bleeding more likely during and after surgery. Please do not stop your anticoagulant medication without consulting a doctor. The consultant will inform you when to restart your medication before you leave the Day Surgery Unit.

Getting to and from the hospital. We advise you not to drive to the hospital for your operation. After the surgery, a pad may be placed over the affected eye and ointment will be used which will affect your vision. Please try and arrange for a friend or family member to take you to and from the hospital.

Ectropion surgery is usually performed in our Day Surgery Unit under local anaesthetic. This means you will be awake during the operation, but you will be given an injection into the affected eyelid to numb the area and eye drops to make you feel more comfortable. Your surgery will be performed by a specialist eye surgeon who will tighten and reposition your lower eyelid, returning it to its normal position. Stitches will be used to close the wound and a pad may be placed over your eye at the end of the operation.

The operation takes around 45 minutes per eyelid and your total length of stay at our hospital will be a couple of hours.

Before leaving the hospital, you will be given an eye ointment to apply to the affected eye three times a day for seven to ten days. To apply the ointment, put approximately 1cm of the eye ointment on a clean fingertip and gently apply to stitches area, or place directly on the wound.  Please carry on using any other eye drops you were prescribed before the surgery unless your consultant advises you to stop.

The local anaesthetic will wear off after a couple of hours, but simple painkillers (paracetamol, ibuprofen) should be effective.

You can use a cold compress on the area for 10 mins every hour if needed; this will help reduce any swelling and bruising. A pair of non-rubber surgical gloves filled with cold water is an easy method or just a packet of frozen peas covered in something clean to avoid direct skin contact (to avoid frostbite).

We recommend you sleep with your head raised on a couple of pillows for two nights.

If you have any bleeding, please wash your hands thoroughly before applying gentle pressure for 10 minutes with a clean swab/makeup pad.

You will be advised on the day of your operation whether your stitches are dissolvable (resorbable, so will not need removing) or need to be removed in our outpatient clinic between one to two weeks after your operation. You will be given an appointment for this either on the day of surgery or the hospital will contact you.