What Is An Ectropion?

Ectropion eyelid is a medical condition in which the eyelid, usually the lower one, turns outward away from the eyeball. This exposes the inner surface of the eyelid (the conjunctiva) and can lead to irritation, redness, and tearing.

Eyelid ectropion can cause discomfort and increase the risk of infections or corneal damage if left untreated. There are four main types of ectropion: involutional, cicatricial, mechanical, and paralytic.

Ectropion Causes & Types

Involutional ectropion: Involutional ectropion is the most common type and is mainly seen in the elderly population. This type of ectropion is primarily caused by age-related changes in the tissues surrounding the eyelid. As people age, the muscles, tendons, and ligaments supporting the eyelid may weaken or lose elasticity, leading to the eyelid turning outward.

Cicatricial ectropion: This form of ectropion is caused by scarring or contracture of the skin and other tissues surrounding the eyelid, which pulls the eyelid outward. The scarring can result from various causes, such as burns, trauma, surgery, or certain skin conditions like severe acne or rosacea.

Mechanical ectropion: In this type, the eyelid turns outward due to an external force or mass, such as a tumour or excessive swelling. The weight or pressure from the mass causes the eyelid to sag and turn away from the eye.

Paralytic ectropion: Paralytic ectropion occurs when the facial nerve (cranial nerve VII) is damaged or impaired, leading to paralysis or weakness of the muscles responsible for keeping the eyelid in its proper position. This can be caused by various factors, including facial nerve palsy, Bell's palsy, or other neurological disorders. The weakened muscles are unable to maintain the eyelid's normal position, causing eyelid droop and a turning outward.

Treatment for ectropion depends on the underlying cause and severity of the condition. Options can include lubricating eye drops, ointments, or artificial tears to relieve symptoms, as well as surgical intervention to tighten or reposition the affected eyelid.

Ectropion Symptoms

Eye ectropion can present with various symptoms, which may vary depending on the severity and type of the condition. Common symptoms of ectropion eye include:

Eyelid turning outward: The most noticeable symptom of ectropion is the outward turning of the lower eyelid (inverted eyelid), exposing the inner surface (conjunctiva) to the environment. Turning eyelids inside out is the most prominent symptom.

Eye Irritation and redness in bottom eyelid: The exposed conjunctiva may become irritated and inflamed due to contact with air, dust, or other environmental factors, leading to redness and discomfort.

Excessive tearing: Ectropion can interfere with the normal drainage of tears, causing them to pool and overflow, resulting in excessive tearing (epiphora).

Eye dryness and discomfort: In some cases, the exposed conjunctiva can become dry and uncomfortable, leading to a gritty or sandy sensation in the eye.

Eye crusting or mucus discharge: Ectropion can cause the accumulation of mucus or crust around the affected eye, particularly upon waking up in the morning.

Eye sensitivity to light: The exposed conjunctiva may become more sensitive to light, causing discomfort in bright environments.

Increased risk of eye infections: The exposed inner surface of the eyelid can be more susceptible to bacterial or viral infections, such as conjunctivitis or keratitis.

If you experience any of these ectropion symptoms or suspect that you may have ectropion, it is essential to consult an eye care professional, such as an ophthalmologist or optometrist, for a thorough evaluation and appropriate treatment.

Entropion Vs Ectropion

What is the difference between entropion and ectropion? Entropion and ectropion are two different eyelid conditions that affect the position and orientation of the eyelids.

Entropion occurs when the eyelid (usually the lower eyelid) turns inward toward the eye, causing the eyelashes and skin to rub against the cornea. This can lead to irritation, redness, tearing, and sometimes even corneal abrasions or infections.

Entropion can be caused by age-related changes to the eyelid or by scarring of the eyelid due to injury or previous surgery. Ectropion, (turning eyelids inside out) on the other hand, occurs when the eyelid (usually the lower eyelid) turns outward away from the eye, exposing the inner surface of the eyelid and the eye to the outside environment.

This can lead to dryness, tearing, redness, and a gritty sensation in the eye. Ectropion can also be caused by age-related changes to the eyelid or by nerve damage, injury, or previous surgery.

In summary, entropion (eye folding) involves an inward turning of the eyelid, while ectropion involves an outward turning of the eyelid. Both conditions can cause discomfort and affect vision and may require surgical correction.

How Common Is Ectropion

Ectropion is a relatively common condition, particularly among older adults. Its prevalence increases with age, as the tissues and muscles supporting the eyelids weaken over time.

Involutional ectropion, which is related to age-related changes, is the most common type. Exact prevalence numbers are difficult to determine, as the condition can range from mild to severe and may be underreported in some cases.

Ectropion is less common in younger individuals, and the other types (cicatricial, mechanical, and paralytic) are generally less frequent than involutional ectropion.

The prevalence of these types can be influenced by factors such as regional differences, access to healthcare, and the prevalence of underlying causes like trauma, surgery, or skin conditions.

Overall, while ectropion is not an extremely common condition in the general population, it is a relatively frequent concern among elderly individuals and those with specific risk factors.

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Ectropion Treatment

Treatment options for ectropion depend on the underlying cause, severity, and type of the condition. The primary goal of ectropion treatment is to alleviate symptoms, protect the eye from damage, and restore proper eyelid function. Here are some common treatment options for ectropion:

Lubricating eye drops, ointments, or artificial tears: These can provide temporary relief from symptoms like dryness, irritation, and discomfort. They help to keep the eye moist and protected while the underlying cause of ectropion is addressed.

Taping or patching the eyelid: In some cases, temporarily taping or patching the lower eyelid to the cheek can provide support and help alleviate symptoms. This technique is generally used as a short-term solution until a more permanent treatment can be performed.

Steroid or antibiotic eye drops or ointments: If inflammation or infection is present, a healthcare professional may prescribe topical steroids or antibiotics to reduce inflammation and treat the infection.

Surgical intervention: Ectropion surgery is often the most effective and definitive treatment for ectropion, particularly for cases that do not respond to conservative measures. The type of surgery performed depends on the underlying cause and severity of the condition. Some common surgical procedures include:

A) Eyelid tightening (lateral tarsal strip or canthoplasty): This procedure involves tightening the tendons and ligaments that support the eyelid, helping to reposition the eyelid and restore proper function.

B) Skin grafting or flap surgery: In cases of cicatricial ectropion caused by scarring or contracture, a skin graft or flap may be used to replace the scarred tissue, allowing the eyelid to return to its normal position.

C) Removal of a tumour or mass: If mechanical ectropion is caused by a tumour or other mass, removing the mass can help to relieve pressure on the eyelid and restore its proper position.

D) Facial nerve repair or rehabilitation: In cases of paralytic ectropion, treatment may involve repairing the damaged facial nerve or providing rehabilitation to strengthen the affected muscles.

The appropriate treatment option for an individual will depend on their specific situation and the underlying cause of their ectropion. It is essential to consult with an eye care professional, such as an ophthalmologist or optometrist, to determine the best course of treatment for each case.

Ectropion Surgery

Ectropion surgery is a group of surgical procedures aimed at correcting the outward turning of the eyelid, which typically affects the lower eyelid.

The goal of ectropion surgery is to restore the normal function and position of the eyelid, protect the eye from irritation, and alleviate symptoms such as dryness, discomfort, and excessive tearing.

The specific surgical technique used depends on the cause, severity, and type of ectropion. Some common ectropion surgery procedures include:

Eyelid tightening (lateral tarsal strip or canthoplasty): This procedure involves tightening the tendons and ligaments that support the eyelid by removing a small section of the outer corner of the eyelid (lateral canthal tendon) and reattaching it in a higher position. This helps to reposition the eyelid, restore proper function, and prevent it from turning outward. This surgery is often used to treat involutional ectropion.

Skin grafting or flap surgery: In cases of cicatricial ectropion caused by scarring or contracture, a skin graft or flap may be used to replace the scarred tissue. Skin grafts involve taking a small piece of healthy skin from another part of the body (usually behind the ear or from the upper eyelid) and attaching it to the affected area. Flap surgery involves creating a flap of nearby healthy tissue and repositioning it over the scarred area. Both techniques allow the eyelid to return to its normal position and function.

Removal of a tumour or mass: If mechanical ectropion is caused by a tumour or other mass, the surgeon will remove the mass to relieve pressure on the eyelid and restore its proper position.

Facial nerve repair or rehabilitation: In cases of paralytic ectropion, treatment may involve repairing the damaged facial nerve, if possible, or providing rehabilitation to strengthen the affected muscles.

Ectropion surgery is usually performed on an outpatient basis, with the patient under local anaesthesia and possibly sedation. The recovery time and postoperative care can vary depending on the specific procedure.

Most patients can expect some swelling, bruising, and discomfort for a few days to a few weeks following the surgery. It is important to follow your surgeon's postoperative care instructions to ensure a smooth recovery and optimal results.

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Ectropion & Corneal Ulceration

What Causes Ulcers On Eyes?

Ectropion can lead to corneal ulceration through repeated rubbing of the eyelashes and skin against the cornea, (ulcer in eye), which is the clear, protective layer covering the front of the eye. The constant rubbing and irritation can cause damage to the cornea, which can result in the formation of an ulcer.

Corneal ulceration is a serious condition that can lead to vision loss if left untreated, it is important to get treatment at the earliest stages of corneal ulcers for the best outcome. Corneal ulceration can allow bacteria or other microorganisms to enter the eye, causing an infection that can spread to other parts of the eye and even the surrounding tissues.

In severe cases, corneal ulcers can lead to scarring and permanent vision loss.

In addition to ectropion, other factors that can increase the risk of corneal ulceration include trauma to the eye, contact lens use, and certain underlying medical conditions that affect the immune system or tear production.

If you have symptoms of entropion, an eye ulcer or any other eye condition, it's important to seek prompt medical attention to prevent complications such as corneal ulceration.

Corneal Ulcer Treatments

The treatment for corneal ulceration depends on the severity and underlying cause of the condition. Mild cases may be treated with eye drops or ointments, while more severe cases may require surgical intervention.

Here are some common treatments for corneal ulceration:

Antibiotic eye drops or ointments: These are often the first line of treatment for corneal ulcers. They help to kill bacteria and prevent the infection from spreading.

Steroid eye drops: These may be used in combination with antibiotic drops to reduce inflammation and swelling in the eye.

Pain relief: Over-the-counter pain relievers such as acetaminophen or ibuprofen can help to relieve pain associated with corneal ulceration.

Bandage contact lenses: These are soft contact lenses that can protect the cornea and promote healing.

Surgical intervention: In some cases, surgical treatment may be necessary to remove damaged tissue or repair the cornea. This may include procedures such as corneal transplant or amniotic membrane transplantation.

Treatment of underlying conditions: If the corneal ulceration is caused by an underlying medical condition, such as entropion, dry eye syndrome or autoimmune disorders, treating the underlying condition may be necessary to prevent further damage to the cornea.

It's important to seek prompt medical attention if you suspect you have a corneal ulcer, as early treatment can help prevent complications and reduce the risk of vision loss.

How To Tell If Corneal Ulcer Is Healing

There are several signs that may indicate that a corneal ulcer is healing, including:

Reduced pain or discomfort: As the corneal ulcer heals, you may notice a reduction in pain or discomfort in the affected eye.

Improved vision: As the corneal ulcer heals, you may notice that your vision is improving, with less blurring or distortion.

Reduced redness: The redness and inflammation around the eye may begin to subside as the corneal ulcer heals.

Decreased sensitivity to light: If you experienced increased sensitivity to light with the corneal ulcer, this may gradually improve as the ulcer heals.

Smaller size or disappearance of the ulcer: As the ulcer heals, it may begin to shrink in size or disappear altogether.

It's important to note that the healing process for corneal ulcers can vary depending on the severity of the ulcer and the individual's overall health. Healing may take anywhere from a few days to several weeks, and it's important to follow your ophthalmologist's instructions regarding treatment and follow-up appointments.

If you experience any worsening symptoms or new symptoms during the healing process, it's important to contact your eye doctor immediately for further evaluation.

Bilateral Ectropion.

Bilateral ectropion refers to the condition where both lower eyelids turn outward away from the eyeball. Ectropion typically affects the lower eyelids, and it can occur on one side (unilateral) or both sides (bilateral). When ectropion is bilateral, it means that both lower eyelids have turned outward, exposing the inner surface (conjunctiva) and potentially leading to irritation, redness, and tearing.

The causes of bilateral ectropion can be like those of unilateral ectropion, including involutional changes due to ageing, scarring or contracture from trauma or skin conditions (cicatricial), external forces from tumours or masses (mechanical), or facial nerve damage (paralytic). The treatment options for bilateral ectropion are also like those for unilateral cases and may include conservative measures like lubricating eye drops or ointments, as well as surgical interventions to correct the eyelid position and restore proper function.

Ectropion Surgery Before and After.

Here is what you can expect with ectropion surgery before and after:

Before Ectropion Surgery.

Consultation: Before undergoing surgery, you'll have a consultation with an ophthalmologist or oculoplastic surgeon. They will evaluate your eye condition, discuss your medical history, and determine the cause of your ectropion. Based on their assessment, they will recommend an appropriate surgical technique to correct the condition.

Preoperative preparation: Prior to the surgery, your healthcare provider may give you specific instructions to follow, such as stopping certain medications, avoiding smoking, and arranging for transportation to and from the surgery centre.

Anaesthesia: Ectropion surgery is typically performed under local anaesthesia, often with sedation. This means that you'll be awake during the procedure, but the area around your eye will be numbed, and you may be given medication to help you relax.

After Ectropion Surgery.

Immediate post-operative care: After the surgery, you'll be monitored in a recovery area for a short time to ensure that you're recovering well from the anaesthesia and procedure. You may have an eye patch or bandage applied to protect the surgical site.

Discharge: Ectropion surgery is usually performed on an outpatient basis, so you can expect to return home the same day. You'll need someone to drive you home, as you may still be feeling the effects of the anaesthesia or sedation.

Post-operative instructions: Your surgeon will provide you with specific instructions on how to care for your eye after the surgery. This may include using prescribed eye drops or ointments, keeping the surgical area clean and dry, and avoiding activities that may strain your eye.

Recovery: Swelling, bruising, and discomfort are common after ectropion surgery and may last for a few days to a few weeks. You can expect to gradually return to your normal activities as your eye heals but be sure to follow your surgeon's recommendations for activity restrictions and follow-up appointments.

Follow-up appointments: You'll have follow-up appointments with your surgeon to monitor your healing progress and ensure that your eyelid is functioning properly. They may remove sutures, if necessary, and address any concerns you may have.

Results: As your eye heals, you should notice an improvement in the position and function of your eyelid. The exposed conjunctiva should be covered by the eyelid, reducing symptoms such as irritation, redness, and tearing. The outcome may take several weeks to months to become apparent, as the tissues continue to heal and adjust.

It's important to remember that individual experiences and recovery times may vary. Always follow your surgeon's instructions and recommendations to ensure the best possible outcome from your ectropion surgery.

Ectropion Surgery Cost UK.

The cost of ectropion repair and ectropion surgery UK with iSIGHT clinics is from £2475 (per eye)

The cost of ectropion eye surgery UK or ectropion treatment can vary depending on several factors, such as the severity of the condition or if the surgery is for bilateral ectropion surgery (both eyes), for this reason it is important to note that the costs associated with ectropion eye surgery need to be treated on a case-by-case basis.

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