Overview

Eyelid malposition occurs when an eyelid is not positioned against the eyeball the way it should be.

The malposition is called ectropion if the eyelid is turning outwards, and entropion if it is turning inwards. 

Causes of your condition

Most cases of ectropion and entropion are associated with ageing. They usually occur because the skin and muscles of the eyelids stretch as you get older.

Less common causes of ectropion include:

• a lump on the eyelid
• tightening or scarring of the skin around the eyelid, as a result of an injury, a burn, dermatitis, or previous surgery

Sometimes ectropion can be caused by a facial paralysis, such as Bell’s palsy. In rare cases, it can be present from birth.

Entropion can occasionally be caused by:

• hollowing of the eye socket
• tightening or scarring of the inner lining of the eyelid (conjunctiva)
• spasm of the muscles around the eye

Surgery

Eyelid malposition is usually corrected with surgery. This is generally done under local anaesthetic as a day case, meaning you won't need to stay in hospital overnight. 

The details of your surgery will have been discussed with you in the clinic. 

Benefits of malposition surgery

Untreated ectropion can cause the eyelashes to continually rub on the front of the eye (cornea).

This can cause:

• redness
• discomfort
• watering
• discharge
• blurry vision

In extreme cases, chronic damage to the cornea can result in a sight-threatening infection.

Untreated ectropion can cause:

• unsightly redness along the edge of the eyelid
• watering discomfort
• discharge
• exposure of the eyeball

Surgery to correct eyelid malposition usually reduces these problems.

Risks of malposition surgery

Eyelid malposition surgery is generally safe and successful but, as with any surgery, there are some risks associated with it.

• Bruising and swelling of the eyelid. This is common and might remain for a few weeks after surgery.
• Infection, bleeding and scarring.
• Under correction or over correction. This is possible and might need reevaluation and more surgery.
• Vision getting worse. This is extremely rare and you should report any loss of vision to the hospital immediately.

Other treatment options

You can choose to not have treatment, particularly for an ectropion, and this will be discussed with you in your consultation with the doctor. Your doctor might recommend using eye drops in the day, and eye ointment at night. This is to reduce irritation and to protect the surface of your eye.

Try not to wipe your eyes excessively, as this can pull on the eyelid and make the problem worse. You might be advised to tape your eyelids with special skin tape as a temporary measure. This is to help protect your eyes while you wait for surgery.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the procedure or treatment, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.

Read more about our consent process.

Preparing for the treatment

You will have a pre-assessment appointment with a nurse where more information will be provided.

Tell your doctor or nurse if you: 

• are taking any antiplatelet medicines (like aspirin or clopidogrel), or anticoagulant medicines (like warfarin or rivaroxaban). These are medicines that help to prevent blood clots. You might need to stop them temporarily before the procedure
• are taking any regular medicines, including any that you buy in a pharmacy or shop, and herbal or homeopathic medicines
• are allergic to any medicines
• have diabetes, as you might need to alter the dose of your medicines before the procedure

Surgery under local anaesthetic

If you are having the surgery under local anaesthetic, you can eat as normal before the treatment, but you should only have a light meal.

On the day of surgery 

Please wear comfortable and loose-fitting clothing on the day of surgery.

You might need to arrange a responsible adult who can help you on your way home. They might also need to stay with you for at least a day after the treatment. 

During surgery

The surgery is done as a day case procedure, generally under local anaesthetic. This means that you will be awake during the surgery but will not feel anything. Sometimes, the surgery is done under general anaesthetic or sedation. The whole treatment might last 90 minutes. Usually both eyes are treated at the same time.

You will lie on a couch in the operating room and anaesthetic drops will be put in your eyes. Your face will be cleaned with antiseptic solution and sterile cloth will be placed around your face. The surgeon will use a pen to mark out the skin to be removed. Local anaesthetic is then gently injected under the eyelid skin, which causes a sharp, stinging sensation for few seconds.

When the anaesthetic has started to work, the eyelid will be numb and the surgery will not hurt. The exact surgical techniques used during the surgery will vary and will depend on how severe your condition is, and what the underlying cause is.

After surgery

At the end of the surgery, a firm pad will be placed over the eyes to reduce the swelling and bruising. You can take this off the next day. If you have had surgery to both eyes, 1 of the pads will be removed before you are discharged.

You will be given any necessary medicine, such as antibiotic ointment, together with details of your follow-up appointment before you leave hospital. 

Generally, your stitches will be removed 1 to 2 weeks after surgery. An outpatient appointment for this will be given to you before you leave hospital. 

After you leave hospital

Your eyelids might be slightly painful for 1 or 2 days after your surgery. You will need to rest and take normal painkillers, such as paracetamol. Always follow the instructions on the packet.

When the pad comes off, you will need to apply the antibiotic ointment that you were given, as instructed. This is to minimise the risk of infection and improve wound healing.

It is important to wash your hands before using the antibiotic ointment, to prevent infection.

Your vision might be blurred for a few days after surgery and you might not be able to wear contact lenses. You might also notice some tenderness at the outer corner of the eye. 

For 24 hours after your surgery:

When to get help

Resuming normal activities

You might want to take few days off work depending on your individual circumstances.

You should not resume any strenuous activity, including swimming, for 2 weeks after surgery.

It is best that someone stays with you to help you for at least a day after the treatment. 

Follow-up appointments

A follow-up appointment for a few days after your surgery will be booked for you before you leave the hospital. It will take place in the eye department at St Thomas’ Hospital.