Entropion correction Procedure
There are a number of techniques available to an ophthalmic surgeon. Which approach is taken in the management of entropion depends upon the underlying cause.
Medical management
Sometimes the lower eyelid muscles may go into spasm causing an inturning, or entropion, of the lid. In the case of such acute spastic entropion, it is important to treat the underlying cause e.g. ingrowing eyelashes, blepharitis, dry eye. Whilst a bandage contact lens or botulinum toxin injections may improve symptoms temporarily, these are rarely required. The use of lower lid tape can be advised for symptomatic patients as a temporising measure.
Surgical management
These procedures are commonly used to manage this eyelid problem:
- Everting sutures
- Lower lid retractor advancement
- Lateral tarsal strip
These procedures are usually performed under local anaesthesia with or without mild sedation.
Everting sutures are offered to most older patients at the initial consultation and are typically used for the following patients:
- Elderly patients with concomitant medical problems for whom surgery is contraindicated
- Patients with a severe bleeding tendency e.g. patients taking warfarin
- Patients unable to co-operate with more invasive surgery
- 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 long-lasting 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 other patients, a lateral tarsal strip procedure, often combined with a lower eyelid retractor advancement, 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. Some patients may have a lateral tarsal strip procedure combined with everting sutures.
What happens before eyelid surgery?
A few days or weeks before the date of your surgery, you will attend the clinic to have a preoperative consultation with your surgeon who will ask you questions about your current and past health. It is important to mention any allergies you may have, medications you are taking (including over the counter products such as aspirin, ibuprofen or vitamin supplements), previous surgery, and whether you smoke.
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 up to two weeks before the procedure. Your eyes will be carefully examined and your vision in each eye measured.
The surgeon may 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, please make sure they are answered, before you sign the consent form. Whilst signing the consent form at this stage is an important part of the process, it does not commit you to having any treatment. 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?
Commonly, the procedure involves a lower eyelid tightening procedure carried out, typically, at the outer corner. This procedure can be performed under local anesthesia. During surgery an incision is made at the outer aspect of the eyelids and the tendon of the eyelid is tightened. Dissolvable stitches are used to close the skin. Additional procedures may also be necessary in some cases.
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 should 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 (stitches) used are usually dissolvable but can be removed after 2 weeks, if necessary. 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 ophthalmic surgeon are uncommon and all precautions are taken to minimise any risks. An ophthalmic surgeon undertakes entropion surgery routinely and is trained to prevent and to manage any problems. Some blurred or double vision may be experienced for 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 after eyelid surgery could include: Blurred or double vision, mainly for a few hours but up to a day or two, after surgery. This may occur for several reasons, e.g. 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 rare in the hands of an ophthalmic surgeon.
Bruising around the eyelids, or even a collection of blood, called a haematoma, may occur.
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.
Some patients may notice a slight out-turning (ectropion) of the eyelid in the initial period following surgery. This is not uncommon, and typically settles after the first 1-2 weeks.