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Lower Eyelid Ectropion Patient Information

WHAT IS ECTROPION?

Ectropion is the medical term used to describe an outward turning of the lower eyelid.

The majority of ectropion are due to laxity of the tissues of the eyelid as a result of the ageing process. As we get older the eyelid stretches and becomes floppy allowing it to turn out.

Another reason this may happen is as a result of sun damage to the cheek skin causing it to contract and pull the eyelid down. This condition is known as a cicatricial (scarring) ectropion and is very common in Australia due to the large amount of sun exposure we experience.

WHAT ARE THE SYMPTOMS?

Ectropion can lead to excessive tearing, redness, mucous discharge and irritation of the eye. There is also a chance of damage to the surface of the eye.

WHAT IS THE TREATMENT FOR ECTROPION?

An operation is usually needed to fix an ectropion. The surgery lasts between 45 to 60 minutes and is performed with “freezing injections” (local anesthesia) with or without sedation as a day case procedure. If you have sedation, it will make you sleepy at the beginning of the operation so you will not feel any discomfort with the local anaesthetic injections. The surgery is also sometimes done with local anesthetic alone in which case you will feel some stinging for a few seconds as the “freezing injections” are given but the eyelids then become numb and you will not feel any discomfort.

This operation will involve tightening of the lower lid, which will correct the lid laxity. You may have a small incision of 10-15mm with a few stitches at the outer corner of the eye or extending down from the edge of the eyelid.

A small skin graft may be needed if there is sun damage to the lower lid skin. The graft is usually taken from in front of the ear, the upper eyelid or near the collar bone and you will then have some stitches in these areas. Professor Selva will inform you if it is likely you will need a graft when your surgery is booked.

Sometimes a watery eye may persist after successful ectropion surgery as the tear ducts may not be functioning and this may be corrected with further surgery if necessary.

WHAT SHOULD I DO IN PREPARATION FOR SURGERY?

Blood thinning medications such as aspirin, clopidrogel (Plavix, Iscover) and warfarin can make bleeding more likely during and after surgery. If you are taking these drugs your doctor will tell you if and when to stop these medications prior to surgery. You should also stop anti-inflammatory drugs like ibuprofen (Nurofen), fish oil, ginger, ginseng and garlic containing supplements 2 weeks before surgery.

If you smoke it is strongly recommended that you stop smoking for at least 3 days prior and 1 week after surgery. This is important as smoking impairs wound healing and increases the risk of infection.

Avoid alcohol for a day before and a day after surgery.

You are required to have nothing to eat or drink for at least six hours before surgery.
On the day of surgery please dress casually and wear a top which buttons at the front. Please wash your face on the morning of surgery and men should shave.

Do not wear any makeup, jewellery or contact lenses.

WHAT HAPPENS AFTER THE OPERATION?

The eye will be padded after surgery and you can then return home to rest. You will be instructed when to remove the dressing over the eye. If no skin graft has been used the eye pad is usually removed the next day. If a skin graft is present then the dressing may need to remain in place for a few days. Keep any dressings dry till they are removed.
Although the great majority of patients will have surgery as a day patient, some may elect to stay in hospital overnight. This will usually be for social reasons such as if you live alone. Professor Selva will discuss this with you as necessary at the consultation prior to surgery.
If you do stay overnight then you will be discharged the next morning by the nursing staff if you have no problems. You do not need to see Professor Selva.

Once you are home you should rest for the next 24 hours. You can then do most of your normal activities but avoid any vigorous activity, running, gym work or heavy lifting (>5kg) for 2 weeks.

If you have had sedation then you cannot drive, operate machinery, take sedative drugs or alcohol for 24 hours. Do not drive while the eye is covered with a dressing.

You will be given an antibiotic eye ointment to use on the stitches twice a day for 5 days and this can also be put in the eye if it is irritated. The eye may feel irritated or scratchy on the inside or the outer corner of the lower eyelid. The eye may also produce yellow-green discharge in the first week as a reaction to the surgery.

The eyelids and cheek will become very swollen and bruised (“black eyes”) and the eye may look “bloodshot” once the dressing is removed. This is normal and may get worse in the first 24-48 hours before it starts to get better. Icepacks (or frozen peas wrapped in a hand towel) can be used to help reduce the swelling. Hold the icepacks over the closed eyes for 10 minutes and repeat hourly for the first 3 days. The bruising and swelling often takes 2-3 weeks to settle.

There is usually no significant pain and most patients find panadol or panadeine is all that is needed for any discomfort. Take 2 tablets every 4 hours as necessary (maximum of 8 in a day).
If you have had a skin graft this may change to a dark colour; this is to be expected and will slowly improve with time. A skin graft can take a couple of months to blend into the surrounding skin. There may be some temporary numbness in the surrounding skin. Your vision may be slightly blurred in the first couple of weeks while the lids are swollen: this will improve once the swelling settles.

It is advisable to keep the operated area relatively dry for 7 days although showering is permitted once the dressings are removed.

Do not swim, wear your contact lenses or eye make-up for 2 weeks, and longer if the eye remains red. Avoid sun exposure by wearing a hat or dark glasses for up to six months.

You will usually need about one week off work.

WHAT IS THE FOLLOW-UP TREATMENT?

You will be given a clinic appointment for one week after surgery when the skin stitches will be removed by one of our nurses.
If a skin graft has been used then we may organise to see you in 2-3 days to remove the dressing. If you are from the country, we may organize for removal by your GP if possible. An appointment will be made for 1-2 months after surgery to see Professor Selva for a final check of the lid position

WHAT ARE THE MAIN COMPLICATIONS FOLLOWING ECTROPION SURGERY?

Ectropion surgery is generally very successful with 95% of patients corrected with one operation. A few people may require a second procedure some months later if the initial surgery fails to correct the lid position. The ectropion may also rarely occur again over the years usually due continued scarring of the eyelid skin due to sun damage. The surgery can be done again to fix this.

Wound healing issues such as the wounds splitting or coming apart are uncommon and can be managed by either letting the wound heal in by itself or by stitching the wound.

If you experience bleeding from the wound or eye use an ice pack (or frozen peas are a good alternative) wrapped in a towel to apply firm pressure (without releasing) to the eye for 15 minutes by the clock and then repeat if the bleeding continues. Almost all cases of bleeding will settle with pressure. If it does not then call the Adelaide Skin & Eye Centre during clinic hours. If after hours please call Professor Selva or attend your nearest hospital emergency department.

Infection is rare and is associated with a marked increase in pain, tenderness, swelling and redness. Most infections can be easily treated with a course of antibiotics.

Very rarely an internal stitch may rub against the surface of the eye causing an intense scratching pain every time the eye is moved. If this fails to settle, put some of the antibiotic eye ointment in the eye and contact the eye clinic to be seen within a day.

If you require any further information or advice about your operation, please call:
Monday to Friday 09.00 to 17.00 call: Adelaide Skin & Eye Centre 8211 0000

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