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Eyelid Malpostion (Ectropion or Entropion “Turning out or turning in”)

ECTROPION / ENTROPION REPAIR

Ectropion (an outward turning of the eyelid) and Entropion (inward turning of the eyelid) are common disorders of the eyelid margin that can affect ocular function and comfort. Typically occurring on the lower eyelid, the skin of the inner lid is exposed, either in one section of eye or across the entire lid. This prevents tears from draining from the eye correctly, resulting in irritation. Common causes of ectropion include age-related weakening of the connective tissue around the eye, sun damage, tumors, burns and the removal of too much skin during a lower lid blepharoplasty. In some cases, ectropion occurs as a congenital birth defect or as a result of facial paralysis. Entropion usually arises as a result of aging since the muscles around the eyes may progressively weaken. A spasm or relaxation of the muscles near the eye can sometimes cause the lid to turn inward. Other causes can include injury, congenital defect, skin infections and various inflammatory conditions. You may also be at higher risk for entropion if you have undergone facial surgery or have facial scarring that affects the natural curve of the eyelid.

eyelidmalpostion

Normally, the upper and lower eyelids close tightly, protecting the eye from damage and preventing tear evaporation. If the edge of one eyelid turns inward (entropion), the eyelashes rub against the eye, which can lead to ulcer formation and scarring of the cornea. If the edge of one eyelid turns outward (ectropion), the two eyelids cannot meet properly, and tears are not spread over the eyeball. These conditions are more common among older people (generally the result of increased tissue relaxation with age); among people with eye changes caused by infection, surgery, or injury; and among people who have blepharospasm.

SYMPTOMS

Both entropion and ectropion can irritate the eyes, causing a feeling that something is in the eye (foreign body sensation), watering (tearing), and redness.

Artificial tears and eye lubricant ointments (for use overnight) can be used to keep the eye moist and soothe the irritation. Entropion and ectropion can be treated surgically—for instance, to preserve sight if damage to the eyes (such as corneal ulcer with entropion) is likely or has occurred, for comfort, or for cosmetic reasons.

Surgical repair may be recommended if the patient is at risk of ocular exposure, ulceration, dermatitis, or corneal scarring. Ectropion and entropion, as well as ptosis (drooping of the upper lid) and other eyelid disorders such as lid lesions/tumors are conveniently managed by Dr. Paul at Austin Oculofacial Plastics in any of his convenient Central Texas locations in South Austin, North Austin, Westlake, New Braunfels and Lakeway.

COMMON INDICATIONS FOR ECTROPION REPAIR

  • Documented ectropion with chronic eye irritation despite topical lubrication
  • Chronic keratoconjunctivitis
  • Tearing related to outflow (punctal ectropion or tear pump dysfunction)
  • Tearing related to reflex (chronic irritation)
  • Chronic dermatitis from tear irritation of periocular skin

Artificial tears can help provide temporary relief from dryness but for full correction of ectropion, a quick surgical procedure in which the lid is tightened may be necessary. The area is numbed with a local anesthetic and sometimes light sedation is provided as well. For ectropion due to muscle weakness, the surgery may involve the removal of a small section of eyelid to tighten the muscles in the area. When the ectropion is caused by scars or prior surgery, the procedure may need to rely on a skin graft to allow a successful repositioning of the eyelid.

COMMON INDICATIONS FOR ENTROPION REPAIR

  • Keratoconjunctivitis due to lashes touching the eyeball
  • Ocular irritation

Lubricating eye drops may be used to lessen certain symptoms such as dry eyes. Temporary relief can also sometimes be found by using Botox, skin tape to hold the eyelid in place or strategically placed stitches. But ultimately, entropion generally needs to be corrected through a brief surgical procedure in which the eyelids are repositioned. The area is numbed with a local anesthetic and sometimes light sedation is provided for this procedure as well. Entropion surgery may also involve the removal of a small section of eyelid to tighten the muscles in the area.

DIAGNOSIS

  • If you are experiencing any of these symptoms, give us a call at 512-642-5050 to schedule an visit with Dr. Paul. He will thoroughly examine your condition and base the diagnosis on the findings and let you know what the best options are for you.

TREATMENT

  • Artificial tears and eye ointments
  • Sometimes surgery