Ectropion surgery (eyelid turned outward)

When the eyelids no longer lie close to the eyeball, we speak of a so-called ectropion. Mostly the lower eyelids are affected, more rarely the upper eyelids. The outward turning of the eyelids causes the edge of the eyelid to stand out from the eyeball. The eyes may then water or be constantly irritated due to the lack of protection. Prolonged ectropion often leads to chronic conjunctivitis. The risk of a dangerous corneal infection increases.

An ectropion can have various causes, which must be taken into account when planning treatment. In our eye clinic, we correct an outwardly turned eyelid in the course of an ectropion operation. There are various surgical techniques that can be used to reattach the eyelid to the eyeball. We can usually eliminate the ectropion permanently in this way.

What is an ectropion?

Ectropion is a malpositioning of the eyelid that often occurs in advanced age; over the years, the connective tissue slackens. As a result, the edge of the eyelid can lift off the eyeball and tilt outwards, so that the protective function of the eyelids is no longer given.

Other causes of outwardly turned eyelids are skin diseases, infections and scarring of the eyelid and conjunctiva. Facial paralysis can also affect the closure of the eyelids, as the ring muscle responsible for this can no longer perform its closing function. Even if facial paresis recedes, surgical correction of the ectropion may be necessary.

What complaints can an ectropion cause?

An eyelid that is turned outwards means that the cornea and conjunctiva are no longer sufficiently moistened. This can cause the eyes to become irritated and red. Many patients suffer from a foreign body sensation, itching, burning or watering eyes. If left untreated, chronic conjunctivitis often develops. A prolonged ectropion can lead to further complications, such as injuries or inflammation of the cornea. The drainage of the lacrimal fluid is also often disturbed, so that the eyes continuously water over the cheek. Chronic irritation of the skin by the salty tear fluid can cause additional discomfort.

In the worst case, an ectropion can result in corneal ulcers. Therefore, persistent problems with eyelid closure should be treated by an ophthalmologist as early as possible, either with ectropion surgery or with conservative measures.

When is ectropion surgery necessary?

We always recommend ectropion surgery when eyelid closure is permanently impaired and no improvement is foreseeable without surgical correction. In principle, it is possible to treat the acute symptoms with ointments or tear substitutes, for example. However, these usually only provide short-term relief without treating the cause of the problem.

For permanent eyelid malpositions, an ectropion operation is therefore usually unavoidable.

What is the procedure for an ectropion operation?

Since the causes of an ectropion can be very different, the ectropion operation in our clinic is always planned individually. Comprehensive ophthalmological examinations take place beforehand. The operation usually takes no longer than half an hour and is usually performed on an outpatient basis. In more complex cases, e.g. a skin deficiency, an in-patient stay may be necessary. The aim of the ectropion operation is to reattach the edge of the eyelid to the eyeball. For this purpose, the attending physician performs an eyelid lift, using different surgical techniques depending on the individual findings. The sagging tissue is shortened and modelled so that the eyelids are once again in their correct position against the eyeball. If the lower eyelid is shortened as a result of scarring or skin diseases, it may be necessary to reshape the lower eyelid by means of a skin graft. To do this, the surgeon takes a suitable graft from another area, e.g. from the upper eyelid or the region behind the ear. 

Often, several techniques are combined during the ectropion operation in order to provide the patient with an optimal and aesthetically satisfactory result. Afterwards, the eyes are dressed with a bandage. Depending on the surgical technique, the stitches are removed after 1-2 weeks in our clinic.

What should be observed after an ectropion operation?

After the ectropion operation you should take care of the eye area and use the prescribed ointments and drops as prescribed. The eyelids can be cooled carefully to counteract wound pain and swelling. You should only use cooling pads from the refrigerator and not from the freezer. Under no circumstances should you rub the eyes. You should refrain from using make-up and cosmetics in the area of the eyes for up to 3 days after the stitches have been removed. 

We recommend that you sleep in a supine position with your upper body slightly elevated after the ectropion operation. Physical exertion, sauna, solarium and swimming pool visits should be avoided for the first two weeks. Good UV protection is also important in the following months so that the scars heal well and do not discolour unsightly.

Before your ectropion operation, we will also give you detailed instructions on aftercare and scar care.

Are there any risks associated with ectropion surgery?

As a rule, ectropion surgery is uncomplicated, although complications cannot be completely ruled out, as with any surgery. In rare cases, infections can occur which have to be treated with antibiotics. Occasionally, suture reattachment may also be necessary if a suture has been torn out.

The greatest risk is that complete normalisation of the eyelid position will not be achieved. This is especially true for a prolonged ectropion. We therefore recommend having an outwardly turned eyelid treated at an early stage. It is also possible for an ectropion to recur over time. Then, in rare cases, a new operation may be necessary.

When will I be able to socialise again after the ectropion operation?

After the ectropion operation, the eyes may be temporarily red and swollen, which you should take into account when planning your daily life. Bruising may also occur in the days following the operation. Swelling and discolouration can be counteracted by careful cooling. As a rule, it takes about 14 days until all traces of the treatment have completely disappeared.

Can an eyelid that has been turned outwards occur again?

Excess tissue is permanently removed during the ectropion operation. Even if the eyelid closure is disturbed due to scarring and other skin changes, we achieve permanent results, e.g. by means of skin transplantation. In individual cases, problems with eyelid closure can occur again, especially if an underlying skin disease has not been treated. In our eye clinic, we therefore always keep an eye on the cause of your complaints. 

With age, a certain slackening of the connective tissue is quite normal. However, if your ectropion is due to age, you do not need to worry that your eyelids will slacken again to a similar extent as before the operation. The results of ectropion surgery are usually permanent.