OP07 Entropion and Ectropion Repair.Fm

OP07 Entropion and Ectropion Repair

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Expires end of December 2013 Issued December 2012 What is entropion and ectropion? If you have any questions that this Entropion and ectropion are document does not answer, you conditions that affect your eyelid (see should ask your surgeon or any figure 1). member of the healthcare team. • Entropion – Where your eyelid How does entropion or ectropion turns in and causes your eyelashes to happen? rub against the cornea (the clear, dome-shaped outer layer at the front Usually the problem is caused by of your eye). ageing. As you get older, the skin and • Ectropion – Where your eyelid soft tissues of your eyelids slacken, turns out and does not touch your causing them to tilt inwards eye. (entropion) or outwards (ectropion). Sometimes the problem is caused by a scar tissue pulling the eyelid out of position. Usually only the lower eyelid is affected. Your eyelid should usually wipe across your eye to keep it clean and moist. Entropion and ectropion cause irritation of your eye and eyelid leading to symptoms such as an b unsightly appearance, a watery eye, discomfort, dryness or redness. Entropion symptoms are usually more severe as the constant rubbing of the eyelashes can scratch the cornea, causing infection and scarring.

What are the benefits of surgery? Figure 1 If the operation is successful, the a Entropion – eyelid turned in eyelid should be in a better position and your symptoms should improve. b Ectropion – eyelid turned out Are there any alternatives to Both of these conditions can usually surgery? be successfully treated by a minor Artificial tears and ointments can be operation. Your surgeon will assess used to protect the surface of your you and let you know if surgery is eye and improve your symptoms. suitable for you. However, it is your Your surgeon may recommend a decision to go ahead with the special bandage contact lens for you operation or not. This document will to wear. However, this is usually a give you information about the temporary measure to protect your benefits and risks to help you make eye until you have an operation. an informed decision. If you have entropion, your surgeon may recommend one of the following simple treatments.

Copyright © 2012 OP07 Page 1 of 5 Expires end of December 2013 • Using tape to prevent your Your surgeon may need to remove a eyelashes from rubbing against your small section of the eyelid where the eye. However, the tape can irritate tissues have slackened most. If the your skin if it is used for more than a problem is caused by tight skin or few weeks. scar tissue, your surgeon may need • Using stitches (called everting to use a skin graft. sutures) to make the eyelid stop Your surgeon will close any cuts with turning in. stitches. • Injecting botulinum toxin into the muscle that turns your eyelid inwards What should I do about my (orbicularis muscle). It works by medication? paralysing the muscle and can relieve You should let your doctor know your symptoms for up to three about all the medication you are on months. and follow their advice. This includes herbal remedies and medication to What will happen if I decide not to control diabetes and blood pressure. have the operation? If you are on beta-blockers, you Your symptoms may get gradually should continue to take them as worse with time. normal. You may need to stop taking Sometimes ulcers can develop on the warfarin, clopidogrel, aspirin or other surface of your eye, leading to anti-inflammatory drugs before your infection, scarring and reduced vision. operation.

What does the operation involve? What can I do to help make the The healthcare team will carry out a operation a success? number of checks to make sure you • Keeping in the same position have the operation you came in for and on the correct side. You can help If your operation is being performed by confirming to your surgeon and the under a local anaesthetic, you will healthcare team your name and the need to lie still and flat during the operation you are having. operation. If you cannot lie still and An entropion or ectropion repair is flat, you should let your surgeon usually performed under a local know. anaesthetic that is injected in the • Lifestyle changes eyelid and using local-anaesthetic eye drops. However, a variety of If you smoke, stopping smoking anaesthetic techniques is possible, several weeks or more before an including a general anaesthetic. Your operation may reduce your chances anaesthetist or surgeon will discuss of getting complications and will the options with you and recommend improve your long-term health. the best form of anaesthesia for you. Try to maintain a healthy weight. You The operation usually takes between have a higher chance of developing half an hour and one hour, depending complications if you are overweight. on whether the operation involves both eyes.

Copyright © 2012 OP07 Page 2 of 5 Expires end of December 2013 Regular exercise should help prepare • Bleeding during or after surgery. you for the operation, help you Any bleeding should be mild. Your recover and improve your long-term eye may look bruised and your health. Before you start exercising, eyelids may swell but this usually ask a member of the healthcare team settles over the first few days. If you or your GP for advice. bleed afterwards, you should keep your head lifted up and press firmly What complications can happen? on the wound for a few minutes with a The healthcare team will try to make clean tissue and an ice-pack. (Do not your operation as safe as possible. put ice directly on the skin.) If the However, complications can happen. bleeding continues, keep pressing Some of these can be serious. You firmly on the wound and go to your GP should ask your doctor if there is or nearest Accident and Emergency anything you do not understand. Any department. numbers which relate to risk are from studies of people who have had this 3 Specific complications of this operation. Your doctor may be able to operation tell you if the risk of a complication is • Corneal abrasion, where the higher or lower for you. surface of your eye gets scratched during the operation or by a stitch 1 Complications of anaesthesia afterwards. You may need to wear a Your anaesthetist or surgeon will be special soft contact lens (bandage able to discuss with you the possible lens) until the discomfort settles. complications of having an • Lid notch, where a gap is left in anaesthetic. the line of the skin at the edge of the eyelid. 2 General complications of any • Cosmetic problems. It is difficult operation to predict exactly how the wounds will • Pain. However, pain after an heal. Although the scars will be visible entropion or ectropion repair should at first, after four to six months they only be mild and is usually easily will usually fade. treated with simple painkillers such as paracetamol. Your eyelid may feel slightly uncomfortable. If you are in severe pain, you should let your surgeon know, as this is unusual. • Infection in the surgical wound. It is usually safe to shower after 48 hours. However, you should check with a member of the healthcare team. Your surgeon may give you an antibiotic cream to use on the wound.

Copyright © 2012 OP07 Page 3 of 5 Expires end of December 2013 How soon will I recover? You should not get your eyelids wet or do any strenuous activity for the first • In hospital week until the stitches are removed. After the operation you will be The healthcare team will tell you if you transferred to the recovery area and need to have any stitches removed or then to the ward or day-case unit. You dressings changed. should be able to go home a few You should try to sleep with extra hours after the operation. However, pillows to keep your head raised up. your doctor may recommend that you You should then be very gentle with stay overnight. If you do go home the your eyelids for at least another same day, a responsible adult should month. Do not wear eye make-up or take you home in a car or taxi and drink too much alcohol for a few stay with you for at least 24 hours. weeks, and keep your face out of the You should be near a telephone in sun. case of an emergency. Regular exercise should help you to You may need a pad on your eye. return to normal activities as soon as Your surgeon may advise you to use possible. Before you start exercising, ice-packs on your eyelids for the first you should ask a member of the one to two days to reduce any healthcare team or your GP for bruising or swelling. advice. It is common to have watery eyes and Do not drive until you are confident to feel grittiness in your eye for the about controlling your vehicle and first one to two days. Your surgeon always check your insurance policy will give you lubricating eye drops to and with your doctor. help ease the discomfort. If you are worried about anything, in • The future hospital or at home, contact a Your surgeon will arrange for you to member of the healthcare team. They have follow-up visits to check on your should be able to reassure you or progress. It usually takes a few weeks identify and treat any complications. for your eyelid to look and feel more natural. The results of an entropion or • Returning to normal activities ectropion repair last for a long time. You should not drive, operate However, as you get older the skin machinery (this includes cooking) or and soft tissues of your eyelids will do any potentially dangerous continue to slacken and the problem activities for at least 24 hours and not may come back (risk: 1 in 10). until you have fully recovered feeling, movement and co-ordination. If you Summary had a general anaesthetic or An entropion or ectropion repair is an sedation, you should also not sign operation to correct an eyelid that legal documents or drink alcohol for at turns in or turns out. The operation least 24 hours. should improve symptoms caused by entropion or ectropion.

Copyright © 2012 OP07 Page 4 of 5 Expires end of December 2013 Surgery is usually safe and effective. However, complications can happen. You need to know about them to help you make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early.

Keep this information leaflet. Use it to help you if you need to talk to a healthcare professional.

Acknowledgements Author: Mr Anthony King MD FRCOphth Illustrations: Medical Illustration Copyright © 2012 Nucleus Medical Art. All rights reserved. www.nucleusinc.com This document is intended for information purposes only and should not replace advice that your relevant health professional would give you.