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Ectropion Repair

(Lower Eyelid)

Click for Detailed Written Explanation About Ectropion Repair

ECTROPION / LATERAL CANTHOPLASTY / CONJUNCTIVOPLASTY of the upper or lower lid and possibly the use of lower lid implants such as Alloderm or a Dermis Fat Grafts.

WHAT CAN CAUSE THE NEED FOR LOWER EYELID SURGERY?

With age, the skin, muscles and tendons of the lower eyelid can sag and droop. In addition, the fat that surrounds and cushions the eyeball can bulge forward through the skin of the lower lids. As the tendons of the lower lid sag, the lower lid can evert and turn inside-out. This can lead to tearing, mucous discharge, crusting of the eyelashes and skin irritation. Excess skin and fat also create what many feel is an unattractive, aged appearance in the lower lids (“bags under the eyes”). Laxity of the upper lid can occur in a similar fashion but is most often related to obstructive sleep apnea.

WHAT IS A ECTROPION REPAIR?

Repair of a lower lid ectropion is typically done as an outpatient procedure. The patient usually gets a “local” injection of lidocaine (novocaine) and intravenous sedation although deeper anesthesia can be given if needed. The tendons of the eyelid in the corners of the eye are usually tightened with sutures through small incisions. The specifics are tailored to each patient’s needs. Also, some patients may choose to have cosmetic “add-on” procedures performed at the same time as functional (insurance) surgery. For example, they may choose to have their lower lid fat bags removed knowing that this is NOT covered by insurance.

In more severe cases a spacer graft may be used such as Alloderm (cadaveric dermis (tissue from someone who has passed away) or a dermis fat graft (tissue from underneath the superficial skin from your abdomen) and your surgeon will share with you the need for this addition. These grafts are used to help push the lower eyelid up if too much of the lower aspect of your eye is showing. Sometimes the tear duct has to be rotated toward the eye to improve the lid position and symptoms maximally. Additionally, sometimes a partial cheek lift may be used at the same time to further support the lower lid.

A repair of an upper lid ectropion can be done in a similar fashion as the lower lid by tightening the tendons of the eyelid or a “wedge” of the upper lid can be removed. The eyelid is then sewn back together to provide the desired shape to optimize its function. This can be done for patients with “floppy eyelid syndrome” where the upper lid is loose and unstable as well as in other cases. Sometimes this surgery is done in conjunction with or prior to a “ptosis” repair of a droopy lid surgery to try to optimize the outcome of a ptosis repair.

HOW WILL EYELID SURGERY AFFECT MY VISION OR APPEARANCE?

The results of ectropion repair depend upon each patient’s symptoms, unique anatomy, appearance goals, and ability to adapt to changes. Ectropion repair only corrects the droopiness and sagginess but is not considered a cosmetic procedure. By correcting this droopiness of the lower lid, the surgery typically improves tearing and mucous discharge. Ectropion repair does not improve blurred vision caused by problems inside the eye, or by visual loss caused by neurological disease behind the eye.

Because saggy inside-out lower eyelids are typical consequences of aging, most patients feel that ectropion repair improves their appearance and makes them look better.

WHAT ARE THE MAJOR RISKS?

Risks of ectropion repair include but are not limited to: bleeding, infection, an asymmetric or unbalanced appearance, scarring, difficulty closing the eyes (which may cause damage to the underlying corneal surface), double vision, tearing or dry eye problems, inability to wear contact lenses, numbness and/or tingling near the eye or on the face, over or under correction, and, in rare cases, loss of vision including blindness. You may need additional treatment or surgery to treat these issues. Due to individual differences in anatomy, response to surgery, and wound healing, no guarantees can be made as to your final result.

WHAT ARE THE ALTERNATIVES?

You may be willing to live with the symptoms and appearance of droopy saggy lower lids with tearing, red eyes and mucous discharge and decide not to have surgery on your lids at this time.

WHAT TYPE OF ANESTHESIA IS USED? WHAT ARE THE MAJOR RISKS?

Most lid surgeries are done with “local” anesthesia (lidocaine or novocaine), that is, injections around the eye to numb the area. You may also receive sedation from a needle placed into a vein in your arm or pills taken before surgery. Deeper anesthesia can be provided if the patient wishes but most do very well with light sedation. Risks of anesthesia include but are not limited to damage to the eye and surrounding tissue and structures, loss of vision, breathing problems, and, in extremely rare circumstances, stroke or death.

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