Ectropion of the lower eyelid, which is out-turning or sagging of the lower lid happens most commonly with age, needs thorough ectropion assessment to decide whether the treatment is uniquely medical or will require some small surgery under local anaesthetic done here at Clinica London.
A half hour consultation is arranged, and at that consultation, I will want to know what your symptoms are, whether you have watering, irritation, redness, or discharge. I want to know how long you have had it for, whether it has been getting progressively worse, whether it is on one side or both sides. In particular, I want to know if you have been on any eye drops because that can sometimes cause an ectropion. I want to find out if you have been in the sun a lot as actinic tightening of the skin can cause ectropion. I also want to know whether you have had any skin tumours or surgery on your lower lid which can cause an out-turning from a cicatricial origin which means scar tissue is pulling the skin of the lower lid tighter and hence then eyelid outwards.
In the ectropion assessment, I will then examine you and feel the skin, look with a microscope to make sure there is no tumour there, ensure that the punctum is functioning, syringe the lacrimal system and I will examine the surface of the eye and the inside of the lid with fluorescein drops on the slit-lamp. All of this is to build up a picture and work out what the origin of the ectropion is. If the origin is, for instance, allergy to the preservative in the eye drops, then that should come out in the history and examination.
Similarly, if there has been excessive sun exposure, previous tumour excision or even current tumour or trauma that could cause cicatricial ectropion, then that will become evident at the assessment. However, this is mainly an exclusion exercise as I am hoping that most of the ectropion I see will be involutional, but every so often I do get referred a patient who has another cause of ectropion. Once I have determined why you have got the ectropion, then we can talk about what the possible treatment is, medical or surgical.
The first medical treatment will be removing offending eye drops that could be causing the ectropion because of an allergy and the other medical care will be giving comfort relief from redness and irritation and watering because of the exposure of the inner surface of the eyelid.
Lastly, you may require surgery. The surgery can range from simple cautery or excision of a small amount of tissue to a bigger operation in which I may have to tighten the lid or even put in a skin graft. Surgery is always done under local anaesthetic here at Clinica London. It is outpatient or day case surgery depending on the complexity of it. It most commonly involves having sutures, and the eye is often added afterwards. However, if the vision of the other eye is not okay, then I would not stuff the surgical eye later. I usually do just one side at a time, but in exceptional cases can operate bilaterally. If the patient is infirm and finds it difficult to lie flat, this is no problem at all, because we can do the surgery under local anaesthetic with them sitting propped up halfway to make it more comfortable for them.
In the next blog, I will talk about a particularly interesting case of ectropion that I have treated.