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Ectropion

Along with grey hair and wrinkled skin things to expect as you get older are:

•    Bones that shrink and lose density – osteoporosis

•    A less efficient heart trying to pump blood around fatty arteries

•    Failure to remember things

•    Muscles becoming weaker and become less flexible

The fact that muscles become weaker has an affect on many parts of the body, including of course the eye.

The eye itself has muscles maintaining its focussing capabilities and direction, but also surrounding the eye there many muscles that operate important functions including eye direction and importantly eyelids and their efficient lubrication.

When muscles that maintain the lower eyelid fail to work as they should then the sagging condition that results is called “ectropion”.

What is so bad about a sagging lower eyelid?

When the lower eyelid sags it fails to lubricate the eye which then becomes exposed and prone to drying out and open to infection.

The ectropion condition may be slight where only part of the eyelid sags; otherwise it can be quite severe when the entire eyelid sags and problems with drainage of tears can lead to complications.

Complications include irritation of the cornea and possible development of corneal ulcers. In the long term, if not treated properly, corneal ulcers can lead to blindness.

Symptoms of ectropion development

Initial and gradual sagging of the eyelid may not be noticed at first, and when it does begin to occur it’s quite usual to think of it as part of the inevitable process of aging. None the less, any sagging should be considered as a major symptom of something that needs attention.

Additional symptoms are:

•    A feeling of grittiness in the eyes due in part to the drying out of the eye

•    Continually watering eyes

•    Burning sensation in the lower eyelid

•    “Pink eye” or redness in the white part of the eye

Are only older people at risk?

No – whilst forming the large majority of cases, there are occasions when ectropion affects younger people:

No – anyone who has had small skin cancers removed from around the eyes (quite a usual place) is at risk

Treatment

Invariably some sort of surgery is going to be required to provide re-establishment of the eyelid to its correct position.

Before any surgery is carried out eye drops and ointments should be used to alleviate the symptoms, especially those of burning and grittiness. Eye drops will also provide lubrication and prevent corneal abrasion.

The surgery procedure to be used will of course depend on the cause of the ectropion:

•    If muscles and ligaments are to blame, then removal of a small piece of the bottom eyelid will usually tighten things up sufficiently.

•    If some kind of facial paralysis is to blame then more than one procedure might be needed to fully restore the eyelid back to normal.

Whatever the reason or procedure required, further application of antibiotic and steroid ointments protected by an eye patch should lead to a positive outcome within a couple of weeks.

About the Author

Dr Jim Kokkinakis (Optometrist) graduated in 1983 from the Optometry School University of NSW. He is currently a Senior Lecturer there and regular speaker to both Optometrists and Ophthalmologists in Australia and Internationally. He has a specialist clinical practice in the Sydney CBD with interests in Eye Strain, Computer Vision problems, Treatment of Eye Diseases and complex Contact lens Fittings.

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