What is eyelid malposition?
Eyelid malposition occurs when an eyelid is not positioned against the eyeball the way it should be. The malposition is called “ectropion” if the eyelid is turning outwards and “entropion” if it is turning inwards.
What causes my condition?
Most cases of ectropion and entropion are associated with ageing. They usually occur because the skin and muscles of the eyelids stretch as you get older.
Less common causes of ectropion include a lump on the eyelid or tightening/scarring of the skin around the eyelid, as a result of an injury, a burn, dermatitis, or previous surgery. Sometimes ectropion can be caused by a facial paralysis, such as Bell’s palsy. In rare cases, it can be present from birth.
Entropion can occasionally be caused by marked hollowing of the eye socket, tightening or scarring of the inner lining of the eyelid (conjunctiva), or spasm of the muscles around the eye.
Eyelid malposition correction surgery
Eyelid malposition is usually corrected with surgery. This is generally performed under local anaesthetic as a day case. The various factors that have contributed to your particular eyelid malposition are taken into account when planning the surgery. The details of your surgery will have been discussed with you in the clinic.
What are the benefits?
Untreated ectropion can cause the eyelashes to continually rub on the front of the eye (cornea), resulting in redness, discomfort, watering, discharge and blurry vision. In extreme cases, chronic damage to the cornea can result in a sight-threatening infection.
Untreated ectropion can result in unsightly redness along the edge of the eyelid, watering, discomfort, discharge and exposure of the eyeball.
Surgery to correct eyelid malposition usually reduces these problems.
What are the risks?
Eyelid malposition surgery is generally a safe and successful but, as with any surgery, there are some risks associated with it. They include:
Bruising and swelling of the eyelid - this is common and may remain for a few weeks after surgery.
Infection, bleeding and scarring.
Under correction or over correction - this is possible and may need re-evaluation and further surgery.
Worsening of vision - this is extremely rare and you should report any loss of vision to the hospital immediately.
Are there any alternatives?
You can choose to leave the eyelid as it is, particularly for an ectropion, and this will be discussed with you in your consultation with the doctor. Your doctor may recommend using eye drops during the day and eye ointment at night to reduce any irritation from the eyelid malposition and to protect the surface of your eye. Try not to wipe your eyes excessively, as this can pull on the eyelid and make the problem worse. You may be advised to tape your eyelids with special skin tape as a temporary measure, to help protect your eyes while you wait to have surgery.
How can I prepare for the treatment?
You will have a pre-operative assessment with a nurse where more information will be provided. If you are taking any medicines that thin your blood, such as antiplatelet medicines (for example aspirin or clopidogrel) or anticoagulant medicines (for example warfarin or rivaroxaban), please tell your doctor or the nurse as you may need to stop them temporarily before your surgery. Also tell your doctor or nurse if you have diabetes as you may need to alter the dose of your diabetes medicines, as you will need to fast before the procedure. Further information on stopping any medicines will be given to you when you come for pre-assessment. Please ask us if you have any questions. Please let us know if you are taking any regular medicines (including anything you buy yourself over the counter or any herbal or homeopathic medicines) and if you have any allergies to any medicines. Surgery under local anaesthetic If you are having the surgery under local anaesthetic, you can eat as normal before the treatment but you should only have a light meal. Please wear comfortable and loose-fitting clothing on the day of surgery. You may need to organise a responsible adult who can assist you on your way home. They may also need to stay with you for at least one day after the treatment.
What does the lid correction operation involve?
The surgery is carried out as a day case procedure, generally under local anaesthetic. This means that you will be awake throughout the surgery but will not feel anything. Occasionally, the surgery is performed under general anaesthetic or sedation. The whole treatment may last apx. 90 minutes and, usually, both eyes are treated at the same time.
You will lie on a couch in the operating room and anaesthetic drops will be put in your eyes. Your face will be cleaned with antiseptic solution and sterile cloth will be placed around your face. The surgeon will use a pen to mark out the skin to be removed. Local anaesthetic is then gently injected under the eyelid skin, which causes a sharp, stinging sensation for few seconds.
Once the anaesthetic has started to work, the eyelid will be numb and the surgery will not hurt. The exact surgical techniques used during the surgery will vary and will depend on how severe your condition is and what the underlying cause is.
Consent - asking for your consent
We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.
After your surgery
At the end of the surgery, a firm pad will be placed over the eye(s) to reduce the swelling and bruising. You can take this off the following day. If you have had surgery to both eyes, one of the pads will be removed before you are discharged. You will be given any necessary medication e.g. antibiotic ointment, together with details of your follow up review before you leave the hospital.
What do I need to do after I go home?
Your eyelids may be slightly painful for about one to two days after your surgery. You will need to rest and take normal painkillers e.g. paracetamol.
When the pad comes off, you will need to apply the antibiotic ointment that you were given to the wounds, as instructed. This is to minimise the risk of infection and improve wound healing. It is important to wash your hands before using this to prevent infection.
Your vision may be blurred for a few days after surgery and you may not be able to wear contact lenses. You may also notice some tenderness at the outer corner of the eye. However, if your eye becomes significantly more painful or red, your vision gets worse or you notice excess discharge from your eye, you should come your doctor or surgeon or go to your nearest Accident and Emergency department immediately.
You are advised not to drive, operate machinery, drink alcohol or take sedative drugs for 24 hours.You may want to take few days leave from work depending on your individual circumstances. You should not resume any strenuous activity, including swimming, for two weeks after surgery. It is best that someone stays with you to help you for at least a day after the treatment.
Generally, your skin sutures (stitches) will be removed around one to two weeks after surgery. An outpatient appointment for this will be given to you before you leave the day case unit on the day of treatment.
Will I have a follow-up appointment?
A follow-up appointment for a few days after your surgery will be booked for you before you leave the hospital.