With malposition of the lower eyelid, the lid margin may be turned inward toward the eye (entropion), or outward away from the eye (ectropion). In both cases, there may be significant symptoms involving impaired vision, irritation, undesirable appearance, or discomfort.
Analogy: Imagine the lower eyelid as a tennis net. If the tennis net gets loose, it can flop in or out. Similarly, when the lower eyelid tendon gets loose over time due to aging (or other causes), the eyelid can turn in (entropion) or out (ectropion).
ENTROPION
Entropion means the eyelid is turned inward, with the lashes rubbing against the eyeball. It most commonly occurs in the lower eyelids, but can also happen to the upper eyelids. There are various causes of eyelid entropion, including age, trauma, infections, congenital, and previous eye surgeries.
Below, a patient of Dr. Taban's before and after receiving surgery for eyelid malposition.
Symptoms
When the eyelid is turned in, the lashes rub against the eyeball, causing significant irritation, redness, and tearing. It may even cause scratching or scarring of the cornea.
If entropion exists, it is important to have a doctor repair the condition before permanent damage to the eye occurs.
Treatment
Entropion should be treated as the turned in lashes can cause damage to the cornea, with vision loss, in addition to eye irritation, redness, and tearing.
There are a number of nonsurgical and surgical techniques for treating entropion. Botulinum toxin (Botox) injection and eyelid taping can temporary relieve entropion. Permanent solution is obtained by surgery, by everting and tightening the eyelid. At times, if caused by scarring, grafts may be needed.
Surgery is usually performed under local anesthesia, with or without sedation, on an outpatient basis. As with most eyelid procedures, the recovery is quick and painless except for a "black eye" for a few days. Most patients experience immediate resolution of the problem following surgery.
The Quickert procedure is an excellent treatment for patients who are not suitable for surgery, or until more definitive surgery can be performed. The Quickert procedure requires 2-3 strategically placed sutures that will evert the eyelid. The sutures will keep the lashes from rubbing against the eye.
To see more pictures, visit the before and after eyelid entropion surgery photo gallery.
Before and After Entropion Surgery Pictures
To see more pictures, visit the before and after eyelid entropion surgery photo gallery.
ECTROPION
Ectropion means the eyelid is turned outwards, away from the eyeball. As with entropion, it occur in the lower eyelids much more commonly than in the upper eyelids. The rolled out eyelid causes the eyeball to be more exposed to air with eye irritation, redness, and tearing. If severe enough, the cornea can become affected with visual loss.
The most common cause of eyelid ectropion is age related relaxation of the eyelids. Other causes include scarring, sunlight, previous surgery, trauma, and facial palsy.
Symptoms
Normally, the upper and lower eyelids close completely, protecting the eyeball from air and dryness. When the eyelid is turned outwards, the eyeball becomes exposed to more air, which causes eye irritation, redness, discharge and reflex tearing. The inner side of the eyelid can also become exposed to air, causing chronic redness and redness. This can also interfer with the tear drainage system of the eye.
Treatment
The treatment for eyelid ectropion is typically surgery. The type of surgery needed can depend on the type of ectropion (involutional or age-related, cicatricial or scarring, paralytic, congenital).
The classical surgical technique is the tarsal strip method and canthoplasty. Dr. Taban also uses an alternative, minimally invasive approach to tight the lower eyelid, which provides better eyelid contour with hidden scars. To learn more about this technique, read Dr. Taban's article: Aesthetic Lateral Canthoplasty.
Cicatricial ectropion requires addition of skin to the lower eyelid (skin graft). Dr. Taban avoids the use of skin graft and uses a skin flap from the upper eyelid (“switch flap” technique) to provide a better tissue and color match, so that the added skin will best match surrounding skin and blend in.
Surgery is usually performed under local anesthesia, with or without sedation, on an outpatient basis. As with most eyelid procedures, the recovery is quick and painless except for a "black eye" for a few days. Most patients experience immediate resolution of the problem following surgery.
Please see the Photo Gallery for some examples.
Before and After Eyelid Ectropion Surgery
To see more pictures, visit the before and after eyelid ectropion surgery photo gallery.
Who Should Perform Entropion/Ectropion Surgery?
An oculoplastic surgeon, who is a member of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), is someone who is a board certified ophthalmologist who has completed additional 2-year fellowship training in cosmetic and reconstructive plastic surgery of the eyelids, orbits (eye socket), lacrimal system( tearing system) and surrounding structures. Dr. Taban is triple board certified by American Board of Cosmetic Surgery (ABCS), American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), and American Academy of Ophthalmology (AAO). Dr. Taban is an oculoplastic surgeon in Beverly Hills and Santa Barbara with expertise in eyelid malposition surgery.
To learn more about the procedure, schedule a consultation with Dr. Taban.
Next, learn about Eyelid Retraction.