Ectropion

Ectropion: Definition

Ectropion (ICD-10 H02.1) is a pathological outward turning (eversion) of the eyelid margin, predominantly of the lower eyelid. As a result, the conjunctiva facing the eyeball is exposed and may dry out or become inflamed. Furthermore, the normal drainage of tears via the lacrimal puncta is impaired.

The aim of treating ectropion is to restore the eyelid to its normal anatomical position. This is intended to protect the eye from drying out and infection, normalise tear drainage and alleviate associated symptoms such as irritation and watery eyes. In the long term, the aim is to maintain the health and function of the eye.

Causes: What causes an ectropion?

Ectropion can have various causes, with the age-related form being the most common:

Involutionary ectropion (ectropion senile): This is the most common form and occurs in older people. It is caused by a loss of tone in the eyelid structures, particularly the tarsus (eyelid plate), the horizontal eyelid ligaments (canthal ligaments) and the orbicularis oculi muscle (eye ring muscle). The eyelid loses its firmness and turns outwards.

Paralytic ectropion (Ectropium paralyticum): This is caused by paralysis of the facial nerve (facial nerve palsy), which innervates the orbicularis oculi muscle. As a result of the loss of function in this muscle, the lower eyelid becomes slack and turns outwards.

Scarring ectropion (Ectropium cicatriceum): Caused by scar tissue pulling on the eyelid skin following injuries, burns, skin conditions (e.g. ichthyosis) or previous surgery in the eyelid area. The scar shortens the outer layer of the eyelid and pulls it outwards.

Mechanical ectropion: Due to tumours or other space-occupying lesions at the edge of the eyelid, which push or pull the eyelid outwards.

Congenital ectropion (Ectropium congenitum): A very rare form that is present from birth and is often associated with other malformations (e.g. blepharophimosis syndrome).

Symptoms: How can you tell if you have ectropion?

• Visible outward rotation of the eyelid margin, often with exposed, reddened conjunctiva.
• Tearing (Epiphora): As the tear duct is no longer in contact with the eyeball, the tears cannot drain properly and instead run down the cheek.
• Eye irritation and a sensation of a foreign body: Due to the exposed conjunctiva and impaired lubrication of the ocular surface.
• Redness of the eye and the conjunctiva.
• Dry eyes: Paradox, a tear substitute, can dry out the surface of the eye as it disrupts eyelid closure and the distribution of the tear film.
• Sensitivity to light.
• Chronic conjunctivitis.
• In advanced or severe cases: Corneal damage (keratopathy) due to dehydration and a lack of protection, which can lead to impaired vision.

Treatment of ectropion

Treatment for ectropion depends on the cause and the severity of the symptoms.

Conservative treatment (symptomatic):

• Tear substitutes: Eye drops, gels or ointments to moisturise the surface of the eye and protect it from drying out.
• Eye ointments (especially at night): Form a long-lasting protective film.
• Adhesive plaster strip (temporary): The lower eyelid can be temporarily fixed in an upward and outward position using a plaster to improve the position of the eyelid (e.g. in the case of acute facial nerve paralysis).
• Treatment of the underlying condition: In cases of paralytic ectropion, the primary focus of treatment is on the facial nerve palsy. In cases of mechanical ectropion, the focus is on removing the tumour.

Surgical treatment (causal):
The definitive treatment, particularly for involutional and cicatricial ectropion, is usually surgical. The aim is to restore the correct position and tension of the eyelid. There are various surgical techniques, which are used depending on the cause:

• In the case of involutional ectropion: Techniques for horizontal eyelid lifting are frequently used, e.g. shortening the eyelid margin by excising a small wedge (wedge excision), lateral tarsal strip plasty or tightening the marginal ligaments. Sometimes, a suture to evert the lacrimal punctum (punctum eversion) or tightening of the lower eyelid retractors is also necessary.
• In cases of cicatricial ectropion: The scar must be released and the shortened skin replaced using skin grafts (e.g. from the upper eyelid on the opposite side or from behind the ear) or local flap procedures.
  The operations are usually carried out in Local anaesthesia are carried out and can often be performed on an outpatient basis.

Aftercare and recovery period following surgical correction of ectropion

After the operation

Aftercare: Immediately after the operation, an ointment dressing is often applied to the eye. Cooling compresses can help to reduce swelling. Antibiotic and anti-inflammatory eye drops or ointments are used as directed by the doctor. The stitches are usually removed after 7–10 days.

Recovery time: Mild swelling and bruising are normal and will subside within 1–2 weeks. Most patients are able to resume their normal social and working lives after a few days to a week, but should avoid physical exertion and rubbing their eyes. The final result will be visible after a few weeks.

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Coverage of the costs for ectropion correction

Surgical correction of ectropion is usually a medically indicated treatment, as the misalignment can lead to functional problems and potential damage to the eyes. Therefore, provided there is a corresponding diagnosis and symptoms, the costs of the operation are usually covered by the covered by statutory and private health insurance schemes. It is nevertheless advisable to check with your health insurance provider beforehand to see whether the costs will be covered.

Although the procedure is usually medically necessary, in cases where there are specific wishes or where the circumstances are borderline, it may be worth finding out about insurance to cover follow-up costs, which may apply in the event of procedures carried out for aesthetic reasons or any complications arising from them. However, this is less common here than with purely cosmetic surgery.