Entropion correction
More information
Lower eyelid entropion is an eyelid malposition in which the lower eyelid margin is turned inwards against the globe causing discomfort from contact between the eyelashes and the surface of the eye. An entropion is usually involutional (age-related) and the majority are therefore seen in older patients.
Medical management
In the case of acute spastic entropion, the treatment is directed to the provoking stimulus e.g. ingrowing eyelashes, blepharitis, dry eye. Although a bandage contact lens or botulinum toxin injections may improve symptoms temporarily, these are rarely justified. The use of lower lid tape can be advised for use in primary care while the patient is waiting to be seen by an ophthalmologist.
Surgical management
These procedures are commonly used to manage this eyelid problem:
1. Everting sutures
2. Lower lid retractor advancement with lateral tarsal strip
These procedures are usually performed under local anaesthesia with or without mild sedation.
Everting sutures are offered to all older patients at the initial consultation and are used exclusively for the following patients:
1. Elderly patients with concomitant medical problems for whom surgery is contraindicated
2. Patients with a severe bleeding tendency e.g. patients taking warfarin
3. Patients unable to co-operate with surgery
4. Patients who are unable to lie in a semi-recumbent position e.g. due to breathing difficulties
Everting sutures have been commonly regarded as a temporary form of treatment but many patients achieve a permanent result with the sutures alone. If the entropion recurs they are offered a repeat procedure or a more definitive surgical procedure. The sutures are very quick and simple to insert in a clinic setting and provide instant relief for the patient.
For all other patients, a lower eyelid retractor advancement combined with a lateral tarsal strip procedure is performed in the operating theatre. This is a very convenient operation for the patient as no sutures need to be removed. It does, however, leave a sore tender lumpy area at the outer corner of the lower eyelid for a few weeks before this settles.
What happens before eyelid surgery?
You will visit the clinic a few days or weeks before the date of your surgery, to have a preoperative consultation with your surgeon. He or she will ask you questions about your current and past health, and will need to know about any allergies you may have, medications you are taking (including over the counter products e.g. aspirin, indomethacin or vitamin supplements), previous surgery, and whether you smoke.
All questions should be answered completely and honestly so that your surgery can be planned as carefully as possible. If you are unsure of the names of any medications, bring them with you and you will be told whether it will be necessary to stop any medications at this preoperative clinic visit. For example, if you are taking aspirin-containing medicines or anticoagulants, they may need to be temporarily withdrawn or reduced in dose for two weeks before the procedure. Your eyes will be carefully examined and your vision in each eye measured. The pressure within each eye will also be measured, and the back of the eye (the retina) examined, as well as the eyelids themselves.
The surgeon will also take a photograph of your face before surgery so that the results of surgery can be compared with the original appearance.
What should I expect at the clinic?
The procedure will be explained to you and you will then be asked to sign a consent form saying that you understand the procedure and that you have been told about any possible complications. Very rare complications will be described, as well as any more common ones, so that you can keep things in perspective. If you have any questions or worries, make sure they are answered, before you sign the consent form. You are quite free to go away and consider the options before committing yourself to any surgery. You can then write to us or email us requesting further information if required.
What happens at surgery?
A lower eyelid retractor advancement combined with a lateral tarsal strip procedure can be performed under local anesthesia. “Twilight anesthesia” (which is local anesthesia with intravenous sedation given by an anesthetist) is also available.
During surgery an incision is made below the lower eyelashes and the tendons of the eyelid are tightened. Dissolvable stitches are used.
How long will I stay in the clinic?
The eyelid surgery is performed on a day case basis where you arrive at the clinic and leave shortly after the surgery. Someone must be available to take you home (and stay with you until the next day if you have had any sedation).
What happens after the surgery?
You will be sent home with a compressive dressing in place. You will be given instructions on when to remove this (usually the following day).
You will be asked to clean the eyelids and repeat the application of ointment to the wounds 3 times a day for 2 weeks
The sutures (stictches) used are usually dissolvable but can be removed after 2 weeks
Postoperative bruising and swelling usually takes at least 2-3 weeks to subside. This should be taken into consideration when scheduling the operation. The scars gradually fade to fine marks within a few weeks.
Side Effects
Complications in the hands of a trained and experienced oculoplastic surgeon are very rare and all precautions are taken to minimise any risks. An oculoplastic surgeon undertakes entropion surgery routinely and is trained to prevent and to manage any problems.
Some blurred or double vision may be experienced for a few hours up to a day or two following surgery together with watery eyes due to irritation of the eye.
What are the possible common complications of eyelid surgery?
Complications in the hands of a trained and experienced oculoplastic surgeon are very rare and all precautions are taken to minimize any risks.
Complications after eyelid surgery could include:
Blurred or double vision, mainly for a few hours, up to a day or two after surgery. This may occur for several reasons - ointment put in the eye immediately after the operation, local anaesthetic used in the operation.
Watery eyes - this is common for the first few days after the operation due to irritation of the eye Injury to the surface of the eyeball (a corneal abrasion) that causes persistent pain. If the pain lasts longer than a few hours after the operation, the surgeon must be informed. Such a problem is extremely rare in the hands of an oculoplastic surgeon.
Collection of blood around the eyelids called a haematoma.
Acute glaucoma - this is raised pressure within the eye, which results in pain in the eye, haloes around lights or severe blurring of vision, a headache above the eye, and vomiting. A patient at risk of such a postoperative problem would be identified by an oculoplastic surgeon. An oculoplastic surgeon is trained to diagnose and treat such a problem.
Infection. An infection following this surgery is rare but it is important to follow postoperative wound care instructions to help to prevent such a problem These are given in writing to take home following surgery.
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