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Eyelid Malposition/
Ectropion/
Entropion

Eyelid Malposition with Dr. Amato

Eyelid malposition includes a variety of conditions such as in turning (entropion) or outward turning (ectropion) of eyelids, misdirected eyelashes irritating the eye (trichiasis), and eyelid laxity or inability to close the eyelids (lagophthalmos). These conditions can result from age, inflammation, scarring, facial paralysis, trauma, congenital malformation, or disease. Eyelid malposition can cause chronic eye irritation, poor eyelid closure and drying out of the eye, mucous discharge, blurred vision, excessive tearing, infection, corneal damage, and impaired vision.

What is Entropion?

Entropion is turning inward of the eyelid due to horizontal eyelid laxity, conjunctival scarring, aging, from inflammation, surgery, or trauma. Entropion can be very uncomfortable and result in eye irritation, infection, and scarring from the lashes rubbing on the surface of the eye called trichiasis. A congenital condition, called epiblepharon can be irritating in children who present with an extra fold of skin that may result in the inward turning of the eyelid margin. They may have red, irritated eyes due to lashes rubbing on the eye.

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What is Ectropion?

Ectropion is turning out or drooping of the eyelid that can result from aging, scarring of the eyelid skin, (cicatricial ectropion), mechanical pulling downward of the skin, congenital defect, or facial paralysis (Bell’s palsy).  Medical treatment usually involves lubrication or treatment of the underlying inflammation or infection. 

How is Eyelid Malposition Treated?

Eyelid malposition is often addressed surgically to reposition and tighten the eyelid as needed to protect the eye. The type of entropion or ectropion associated with aging is best corrected surgically by shortening or tightening the lower eyelid through an incision at the outer corner of the eye (near the eyelid) and some sutures below the eye (quickert) to rotate the eyelid. Sometimes there are scars following trauma or following the surgical removal of skin cancers, and your surgeon may need to use a skin graft taken from the upper eyelid or from behind the ear to repair the ectropion. On occasion, cicatricial ectropion repair involves the formation of a flap of tissue from the upper eyelid to the lower eyelid through an incision at the outer former of the eye (nearest the ear). Trichiasis treatment may involve office treatments to remove the lash follicles or a lash rotation surgery. Lagophthalmos may include the release of scar tissue or tight muscles, placement of a gold weight to help the eyelid close, or grafting.

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What should I expect at the time of surgery?

Eyelid repair is usually performed as an outpatient procedure under local anesthesia and with the patient lightly sedated with either oral or intravenous medications.  Your eye may be patched overnight.  Once the patch is removed, you will use an antibiotic ointment on the stitches for about one week.  Occasionally, your eyelids may have to be stitched together or have a prolonged patch placed for up to one week to allow the eyelid to heal underneath the bandage.  Your doctor can advise you whether this will be necessary.  After your eyelids heal, your eye will feel more comfortable.

What are the risks and complications of surgery?

Bleeding, infection, scarring, and recurrence of the condition, which are potential risks with any surgery, are very uncommon.  As with any medical procedure, there may be other inherent risks that you should discuss with your surgeon.

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What should I expect after surgery?

After surgery, pain is usually minimal, bruising and swelling may be expected and will likely go away within one to two weeks.  We encourage ice packs regularly especially the first 2 days after surgery and pain medication as needed. The results of surgery are usually permanent, and recurrence is rare. After your eyelids heal, your eye should feel more comfortable, and you will no longer have the risk for corneal scarring, infection, and loss of vision.