COSMETIC EYE PROCEDURES

Ectropion and Entropion

Ectropion Repair

An ectropion is an outwardly turned (everted) eyelid. The condition most often is associated with aging, though it may also occur congenitally, as a result of scarring or other surgeries, or secondary to facial nerve paralysis (Bell's Palsy). If not repaired, the condition may lead to thickening of the mucosal surface on the inside of the eyelid (conjunctiva) with consequent inflammation of and danger to the health of the eye itself. 

The best method of repair for an ectropion often depends on the underlying cause. In the involutional type of ectropion (associated with aging), most surgeons elect to shorten and tighten the lower lid, thereby resolving the outwardly turned lid. This typically is completed with an incision of the skin at the lateral corner of the eye. The surgeon then excises a small segment of the lateral aspect of the lower eyelid, and subsequently reconnects the eyelid to underlying tissues and the upper eyelid. 

Usually only a few stitches are placed in the skin at the lateral corner of the eye, and these are often removed 7 to 14 days later. There is typically almost immediate resolution of the condition. Most patients have little if any discomfort with the procedure. There may be mild bruising and swelling following the procedure. This should resolve within about two weeks. 

Ectropion which occurs as a result of scarring (cicatricial ectropion) is most likely to follow another surgical procedure of the face or eyelids, especially excision of skin lesions such as skin cancers. This type of ectropion repair often requires skin grafting. The donor site for the skin graft is most often taken from the patient’s upper eyelid or from behind the ear. The skin from these sites will most closely match that of the patient’s lower eyelid skin. Both the donor site for the graft and the surgical site will usually heal nicely within two weeks following the surgery.

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Entropion Repair

An entropion is an inwardly turned (inverted) eyelid. The condition occurs primarily as a result of advancing age with consequent weakening of certain eyelid muscles. The imbalance between eyelid muscle groups results in the inward turning of the eyelid. The condition almost always affects the lower, rather than the upper, eyelids. 

Repair of involutional entropion (associated with aging) may be completed with a variety of procedures. Most cases are completed with an incision in the lateral corner of the eye or an incision just beneath the lower eyelashes. In either case, a tightening of tissues is required to resolve the imbalance between the muscle groups of the lower lid. 

Most patients experience immediate resolution of the problem once surgery is completed with little if any post-operative discomfort. Most cases will require subsequent removal of sutures located along the lower eyelashes or the lateral corner of the eyelid. Minor bruising or swelling may be expected and will likely resolve in one to two weeks following surgery. 

A non-incisional entropion repair, known as a Quickert procedure, may be completed as an in-office procedure. This form of entropion repair requires two or three strategically placed sutures which will evert the eyelid. The procedure can be completed under local anesthesia with little if any discomfort. 

The most important drawback of this procedure is that there is a significantly higher chance of recurrence of the entropion subsequently. The Quickert procedure, however, is an excellent procedure for patients who do not desire, or are not good candidates for, a trip to the operating room. 

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