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We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
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Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.
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Ectropion is the medical term used to describe sagging and outward turning of the lower eyelid and eyelashes so that the eyelid no longer rests against the surface of the eye. Most cases of an out turned eyelid are due to relaxation of the tissues of the eyelid that result from aging and therefore it is most often seen in elderly people. This type of ectropion is known as involutional ectropion. Some forms of ectropion result from scarring of the eyelid caused by chemical and thermal burns, trauma, skin cancers, or previous eyelid surgery. This form of ectropion is referred to as cicatricial ectropion. Rarely, ectropion can result when a large skin lesion or undetected skin cancer pulls down on the lower eyelid. This form of ectropion is referred to as mechanical ectropion. Ectropion may develop in association with facial paralysis such as Bell’s palsy. This type of ectropion is known as paralytic ectropion.
An out turned lower eyelid results in redness of the delicate membrane that covers the eye and lines the under surface of the eyelid (this membrane is called the conjunctiva) and can lead to excessive tearing, crusting of the eyelid, mucous discharge and irritation of the surface of the eye. During blinking, the eyelids normally sweep across the surface of the cornea and assists in pumping of tears into the tear drainage ducts. When ectropion is present, tearing occurs because the eyelids are not able to wipe the surface of the eye properly and assist in tear clearance.
Screening and Diagnosis
Your doctor will perform a complete eye exam prior to recommending treatment. The exact cause of the eyelid ectropion will be determined. You doctor will determine whether any muscles or tendons are weak or if this is excess tightening of the lower eyelid skin. You will be asked about any previous eyelid or facial surgery.
An out turned eyelid should be repaired surgically before the rubbing damages the cornea by causing infection and scarring. Prior to surgery, taping the lower lid into normal position and using lubricating drops and ointments can protect the eye. A protective shield, known as a moisture chamber, can be worn at night to maintain moisture in the eye. In some cases, sutures can be placed through the lower eyelid until more definitive surgery can be performed.
If the out turned eyelid is due to laxity of the eyelid’s supporting structures, it is best treated surgically by reducing the horizontal laxity within the eyelid tissue. This can be accomplished by tightening the eyelid and its attachments to restore some of its elasticity. If the mal-positioned eyelid is a result of scarring, skin cancer, trauma, facial nerve palsy, or some other factor, treatment of the underlying condition may be necessary before or during surgical repair. In some instances a mid-face lift or cheek lift, skin graft or implantation of fibrous tissue for lower eyelid support taken from donated human or animal tissue or from the mucous membranes that form the lining of the patient’s own mouth may be needed. These materials have an excellent track record and have been selected because they are safe and minimize the risk of transmitted disease.
Ectropion repair is usually performed as an outpatient in your doctor's office or an ambulatory surgical center. Discomfort is usually minimal after surgery. Your surgeon may advise not taking aspirin products and blood thinners before and after surgery, as they may increase bruising. Following surgery your lids will feel a bit tight due to the swelling and bruising that normally accompanies surgery, and your eyes may tear and feel dry initially. Use cold packs after surgery to help reduce swelling and limit yourself to quiet activities for the first few days to help decrease bleeding or bruising. You can plan more vigorous activity about two weeks after your surgery. Most patients return to their work or social schedule in one to two weeks and the majority of healing is complete at about six weeks.
In general, complications of ectropion repair are rare and minor when performed by a surgeon trained in the surgical techniques. However, it is possible for the patient to experience problems including infection, prominent scarring or recurrence of the out turned eyelid necessitating further surgery.
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.