Ectropion
Overview
Ectropion (ek-TROH-pee-on) is a condition in
which your eyelid turns outward. This leaves the inner eyelid surface exposed
and prone to irritation.
Ectropion is more common in older adults, and
it generally affects only the lower eyelid. In severe ectropion, the entire
length of the eyelid is turned out. In less severe ectropion, only one segment
of the eyelid sags away from the eye.
Artificial tears and lubricating ointments can
help relieve symptoms of ectropion. But usually surgery is needed to fully
correct the condition.
Symptoms
Normally when you blink, your eyelids
distribute tears evenly across your eyes, keeping the surfaces of the eyes
lubricated. These tears drain into small openings on the inner part of your
eyelids (puncta).
If you have ectropion, your lower lid pulls
away from your eye and tears don't drain properly into the puncta. The
resulting signs and symptoms can include:
·
Watery
eyes (excessive tearing). Without
proper drainage, your tears may pool and constantly flow over your eyelids.
·
Excessive
dryness. Ectropion can
cause your eyes to feel dry, gritty and sandy.
·
Irritation. Stagnant tears or dryness can irritate
your eyes, causing a burning sensation and redness in your eyelids and the
whites of your eyes.
·
Sensitivity
to light. Stagnant tears
or dry eyes can irritate the surface of the cornea, making you sensitive to
light.
When to see a doctor
See your doctor if your eyes are constantly watering
or irritated, or your eyelid seems to be sagging or drooping.
Seek immediate care if you have been diagnosed
with ectropion and you experience:
·
Rapidly increasing
redness in your eyes
·
Sensitivity to light
·
Decreasing vision
These are signs and symptoms of cornea
exposure or ulcers, which can harm your vision.
Causes
Ectropion can be caused by:
·
Muscle
weakness. As you age, the
muscles under your eyes tend to weaken, and tendons stretch out. These muscles
and tendons hold your eyelid taut against your eye. When they weaken, your
eyelid can begin to droop.
·
Facial
paralysis. Certain
conditions, such as Bell's palsy, and certain types of tumors can paralyze
facial nerves and muscles. Facial paralysis that affects eyelid muscles can
lead to ectropion.
·
Scars
or previous surgeries. Skin
that has been damaged by burns or trauma, such as a dog bite, can affect the
way that your eyelid rests against your eye. Previous eyelid surgery
(blepharoplasty) can cause ectropion, particularly if a considerable amount of
skin was removed from the eyelid at the time of surgery.
·
Eyelid
growths. Benign or
cancerous growths on your eyelid can cause the lid to turn outward.
·
Genetic
disorders. Rarely is
ectropion present at birth (congenital). When it is, it's usually associated
with genetic disorders, such as Down syndrome.
Risk factors
Factors that increase your risk of developing
ectropion include:
·
Age. The most common cause of ectropion is
weakening muscle tissue associated with aging.
·
Previous
eye surgeries. People who have
had eyelid surgery are at higher risk of developing ectropion later.
·
Previous
cancer, burns or trauma. If
you've had spots of skin cancer on your face, facial burns or trauma, you're at
higher risk of developing ectropion.
Complications
Ectropion leaves your cornea irritated and
exposed, making it more susceptible to drying. The result can be abrasions and
ulcers on the cornea, which can threaten your vision.
Diagnosis
Ectropion can usually be diagnosed with a
routine eye exam and physical. Your doctor may pull on your eyelids during the
exam or ask you to close your eyes forcefully. This helps him or her assess
each eyelid's muscle tone and tightness.
If your ectropion is caused by a scar, tumor,
previous surgery or radiation, your doctor will examine the surrounding tissue
as well.
Understanding how other conditions cause
ectropion is important in choosing the correct treatment or surgical technique.
Treatment
If your ectropion is mild, your doctor might
recommend artificial tears and ointments to ease the symptoms. Surgery is
generally required to fully correct ectropion.
Surgery
The type of surgery you have depends on the
condition of the tissue surrounding your eyelid and on the cause of your
ectropion:
·
Ectropion
caused by muscle and ligament relaxation due to aging. Your surgeon will likely remove a small
part of your lower eyelid at the outer edge. When the lid is stitched back
together, the tendons and muscles of the lid will be tightened, causing the lid
to rest properly on the eye. This procedure is generally relatively simple.
·
Ectropion
caused by scar tissue from injury or previous surgery. Your surgeon might need to use a skin
graft, taken from your upper eyelid or behind your ear, to help support the
lower lid. If you have facial paralysis or significant scarring, you might need
a second procedure to completely correct your ectropion.
Before surgery, you'll receive a local
anesthetic to numb your eyelid and the area around it. You may be lightly
sedated using oral or intravenous medication to make you more comfortable,
depending on the type of procedure you're having and whether it's done in an
outpatient surgical clinic.
After surgery you might need to:
·
Wear an eye patch for
24 hours
·
Use an antibiotic and
steroid ointment on your eye several times a day for one week
·
Use cold compresses
periodically to decrease bruising and swelling
After surgery you will likely experience:
·
Temporary swelling
·
Bruising on and around
your eye
Your eyelid might feel tight after surgery.
But as you heal, it will become more comfortable. Stitches are usually removed
about a week after surgery. You can expect the swelling and bruising to fade in
about two weeks.
Lifestyle and home remedies
These lifestyle tips may relieve your
discomfort from ectropion:
·
Use
eye lubricants. Artificial tears
and eye ointments can help keep your cornea lubricated and prevent
vision-threatening damage. Using an eye ointment and wearing a moisture shield
over your eye is particularly useful overnight.
·
Wipe
your eyes carefully. Constantly
wiping watery eyes can make your under-eye muscles and tendons stretch even
further, worsening your ectropion. Wipe from the outer eye up and in toward the
nose.
Preparing for your
appointment
If you have signs and symptoms of ectropion,
you're likely to start by seeing your primary care doctor. He or she may refer
you to a doctor who specializes in treating eye disorders (ophthalmologist).
Here's some information to help you get ready
for your appointment.
What you can do
Before your appointment take these steps:
·
List symptoms you've
been having and for how long.
·
Find a photo of
yourself before the appearance of your eyelid changed that you can bring to the
appointment.
·
List all medications,
vitamins and supplements you take, including the doses.
·
List key personal and
medical information, including other conditions, recent life changes and
stressors.
·
List questions to ask
your doctor.
·
Ask a relative or
friend to accompany you, to help you remember what the doctor says.
For ectropion, some basic questions to ask
your doctor include:
·
What's the most likely
cause of my symptoms?
·
What kinds of tests do
I need? Do they require any special preparation?
·
Is this condition
temporary or long lasting?
·
Can ectropion damage
my vision?
·
What treatments are
available, and which do you recommend?
·
What are the risks of
surgery?
·
What are the
alternatives to surgery?
·
I have these other
health conditions. How can I best manage them together?
·
Do you have any
brochures or other printed material that I can take with me? What websites do
you recommend?
What to expect from
your doctor
Your doctor is likely to ask you a number of
questions, such as:
·
When did you begin
experiencing symptoms?
·
Have your symptoms
been continuous or occasional?
·
Have you had any
previous surgery or procedures on your eye or eyelid?
·
Have you had any
radiation treatments of your head and neck?
·
Have you had any other
eye problems, such as an eye infection or an injury?
·
Are you taking any
blood thinners?
·
Are you taking
aspirin?
·
Are you using any
eyedrops?
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