Ectropion – Drooping eyelid
Ectropion is a condition characterized by the eversion of the eyelid. This means that its edge turns outward. The inner surface of the eyelid is then exposed and prone to irritation. Ectropion primarily affects older people and usually only affects the lower eyelid. Depending on its severity, all or part of the eyelid may be exposed. Artificial tears and lubricating ointments can help relieve the symptoms of ectropion. However, surgery is generally necessary to completely correct this condition. The surgeon resects the eyelid.
What is ectropion?
Ectropion is a drooping of the lower eyelid. The eyelid loses contact with the cornea.
The conjunctiva becomes visible and the eyelid may form a sort of pocket where secretions accumulate.
It can be degenerative (related to age and the loosening of the aponeuroses) or cicatricial (the scar pulls the eyelid downwards).
Symptoms
Normally, the eyelids meet edge to edge when blinking. In cases of ectropion, the lower eyelid droops and the tear drainage openings located on the inner part of the eyelid are everted. The symptoms of ectropion therefore result from this eyelid malposition:
Tearing – Tear drainage is not effective. They accumulate and run down the cheek like an overflowing pool.
Dryness – Because blinking is not working properly, tears are not distributed correctly across the surface of the eye. Paradoxically, you can therefore experience both watery eyes and a sensation of dryness.
Irritation – The drooping lower eyelid exposes the surface of the eye. This causes it to dry out and become irritated.
Photophobia – Eye irritation leads to dryness of the cornea. In case of injury, it becomes painful and the eye sensitive to light.
Diagnosis
The diagnosis of ectropion is clinical. The lower eyelid hangs or droops, revealing its pinkish inner part: the conjunctiva.
The ophthalmologist then investigates the cause and complications of the ectropion:
Corneal ulcer or irritation
Eyelid injury
Muscular paralysis,…
When to consult a doctor?
Consult an eyelid specialist without urgency if your eyes are constantly watering, irritated, or if your eyelid appears to be drooping or falling.
Emergency criteria
Seek emergency medical attention if you experience any of the following symptoms:
Rapidly progressive redness of the eye.
Intense pain or photophobia (sensitivity to light).
Decreased vision.
These symptoms are suggestive of a complication of ectropion, and in particular of a corneal ulcer which may impair your vision.
Causes
Ectropion can be caused by:
Muscle weakness – With age, muscles tend to weaken and tendons to stretch. These muscles and tendons keep your eyelid taut against your eye. When they weaken, your eyelid may begin to droop. This is called senile ectropion. It is the most common cause of ectropion.
Facial paralysis – Facial paralysis affecting the tone of the eyelid muscles can lead to ectropion. This is called paralytic ectropion.
Scars – Skin damaged by burns, trauma, or surgery can retract and affect how your eyelid closes. This is called cicatricial ectropion.
Tumors – Benign or cancerous growths on your eyelid can put pressure on it and cause it to turn outwards.
Malformation – Ectropion is rarely present at birth (congenital). When it is present, it is usually associated with genetic conditions such as Down syndrome (Trisomy 21).
Risk factors
The following factors increase your risk of developing ectropion:
Age – Due to aging and weakening of tissues. This is the most frequent cause of ectropion.
Previous eyelid surgeries – People who have had eyelid surgery are at risk of developing cicatricial ectropion.
Cancer, burns or previous trauma – These factors are also risk factors for cicatricial ectropion.
Complications
Ectropion leads to eye closure problems. The abnormal tear distribution causes corneal irritation and pain. Furthermore, tear drainage is impaired, resulting in chronic tearing.
In the most advanced stages, the cornea dries out and becomes abraded, leading to ulcers that can perforate. In severe cases, irreversible damage can occur.
Medical treatment – Relieving ectropion
Ectropion treatment is twofold. First, the symptoms must be relieved; this is the medical treatment. Then, the eyelid abnormality must be treated to prevent its recurrence. Eyelid repositioning is only possible surgically.
Here are some tips to relieve your symptoms and perhaps avoid surgery:
Use eye lubricants and healing agents – artificial tears and eye ointments will help protect your cornea and prevent vision-threatening scarring. Applying a healing ointment at night is essential for your cornea to heal.
Perform eyelid care – Wipe your eyes from the outside upwards and towards the nose to invert the eyelid and limit the tension forces causing it to droop.
Ectropion surgery
The ectropion operation consists of tightening the eyelid and bringing it back to the outer canthus on the side of your eye.
Before the intervention
The surgeon will inject a local anesthetic to desensitize your eyelid.
If necessary, the anesthesiologist will sedate you orally or intravenously to make you more comfortable.
The operation takes place on an outpatient basis.
The operation
In cases of ectropion caused by aging and the weakening of the muscles and ligaments around the eye, your surgeon will:
Remove a small portion of the lower eyelid at its outer edge.
Recreate a tendon on the edge of the eyelid.
Gather the tendon to the orbital bone on the side of your eye.
The eyelid will then rest correctly on the eye.
Case of cicatricial ectropion and facial paralysis
In cases of ectropion caused by a scar from a previous injury or surgery, the surgeon:
Takes a skin graft from the upper eyelid or behind the ear.
He repositions the flap at the level of the lower eyelid and sutures it.
In cases of facial paralysis or significant scarring, an associated cartilage graft can provide firmer support to the edge of the eyelid.
After the operation
It is advisable to:
Wear an eye patch for 24 hours.
Apply an antibiotic and anti-inflammatory ointment to your eye several times a day for 7 to 15 days.
Use compresses or a cold mask to reduce any bruising and swelling.
Post-operative care and convalescence
After the operation, you will most likely have:
Temporary edema.
Bruises on and around your eye.
Your eyelid will appear tight with an almond-shaped eye. It will gradually relax, restoring the eye to a normal appearance.
Stitches are usually removed 7 to 10 days after the operation.
The swelling and bruising will subside in about two weeks.
Complications of the operation
The potential complications of entropion surgery are the same as those of eyelid surgery:
Bleeding
Hematoma
Infection
Impact on the cornea.