Lid laxity surgery: Ectropion and entropion

Your eyelids may lose elasticity as you age, causing ectropion or entropion. At Oculase, we offer private lid laxity surgery to treat these problems. Book a consultation with one of our specialists to discuss your suitability for this procedure. Stay on this page to learn more about this treatment and why you might need it.

What is eyelid laxity?

Eyelid laxity refers to how elastic the upper or lower eyelids are. Elastin is a protein that helps our eyelids stretch and return to place, maintaining the eyelids’ shape. The muscles and fat surrounding our eyelids lose elasticity as we age.

As our eyelids become less elastic, they can loosen, lose strength, and develop a malposition (change position). Common eyelid malpositions include ptosis, ectropion and entropion.

Ectropion

If you have ectropion, your lower eyelids turn outward, drooping away from your eyes. It can affect the upper eyelids, though this is much less common. You may have a higher risk of conjunctivitis or develop a corneal ulcer if your condition is severe. People with severe cases may also struggle to close their eyes properly.

While both are often a result of ageing, there are additional less-common causes. Facial nerve palsy (paralysis of the seventh cranial nerve), eczema, a lump or tumour on the eyelid, and shortening of the surrounding skin from an injury or sun damage can lead to ectropion. In rare cases, some people are born with one of these conditions (congenital ectropion or entropion).

Entropion

Entropion causes your upper or lower eyelids to turn inward and your lashes to touch the surface of your eyes, which can irritate your cornea. However, like ectropion, it often affects the lower lids. Your eyelid may turn in when you blink or shut your eyes, though, for some, it is constant. This can cause a foreign body sensation (the feeling that something is in your eye).

In addition to ageing, blepharospasm (uncontrollable eyelid twitching or blinking) or excessive muscle contraction can cause entropion. You may also develop entropion if your conjunctiva is scarred. The conjunctiva is a mucous membrane that covers the white of your eyes and lines the inside of your eyelids. Conjunctival scarring can occur after surgery, an injury, a chemical burn, an infection, chronic blepharitis, or because of an autoimmune condition, such as Stevens-Johnson syndrome.

Congenital entropion can be mistaken for epiblepharon – a condition that causes a fold of skin and muscle to push the eyelashes toward the eye – and vice versa. Asian children are more likely to be born with epiblepharon.

Symptoms

We will perform a physical exam of your eyelids and the surrounding tissue to diagnose your condition. We may also ask questions about your symptoms, such as how severe they are and how often you get them. Both conditions have similar symptoms, including:

Irritation
Redness
Watering
Dry eyes
Soreness
Blurry vision
Light sensitivity
Loss of vision (rare)

We may need to conduct further tests to identify the cause of your condition or how it is affecting your eye, allowing us to provide the most suitable treatment. A slit-lamp exam, for example, can help us assess the health of your cornea.

Treatment options

If a temporary issue is causing ectropion or entropion, you may be able to reverse it without a surgical procedure, for example, by treating eczema or blepharitis.

You may experience short-term relief from your symptoms using lubricants, antibiotic eyedrops, and skin tape or stitches to hold the eyelid in place. However, lid laxity surgery might be necessary for permanent relief.

Botox ®

If you want to avoid surgery, or it is not an option, you may be suitable for Botox injections. We can use Botox to treat entropion by turning out your lower lid. It may be more beneficial in cases of congenital entropion. Some adults will only experience the effects of Botox for three to six months before needing it again.

Lid laxity surgery

Surgery is often the most effective way to treat lid malpositions such as ectropion and entropion. Before any procedure, we will explain what it involves and numb your eyelids to prevent pain. You can always ask us any questions to understand the surgery better and the side effects you might experience.

To treat ectropion or entropion, we may perform lid-tightening surgery. During ectropion surgery, we may need to use a skin graft if you have damage to your lower lid, such as from the sun. We may use a blepharoplasty approach for entropion or upper eyelid laxity to shorten your eyelid by removing excess skin or fat.

Another surgical option for entropion is retractor reinsertion. Retractor reinsertion involves tightening one of your lid retractors, the muscles that help open and close your eyes.

Book an appointment with Mr Daniele Lorenzano, our reconstructive and cosmetic surgery expert, to discuss your treatment options today.

Recovery

After surgery, you can usually go home as soon as we’ve assessed your eyes, as we use a local anaesthetic. However, if we use general anaesthesia, you’ll need to wait a few hours for it to wear off. You should ask someone else to take you home, such as a partner, friend, or family member, to allow your eyes to rest. We may also use an eye pad to assist the healing process.

You may experience some temporary side effects, such as swelling or bruising. These often last around two weeks and can be relieved with a cold compress. Your eyelid might also feel tight initially as you adjust to its new shape.

While your eye or eyes recover, you should avoid swimming, strenuous exercise, and heavy lifting. We also recommend not wearing eye makeup for two weeks.

Private lid laxity surgery

Lid laxity surgery can offer relief from the symptoms of ectropion and entropion. Without treatment, you may experience infections, inflammation, corneal ulcers or damage, and, in severe cases, loss of vision.

Our specialists offer a thorough consultation process to assess the health of your eyes and eyelids and determine the best treatment for you. Book an appointment today to prioritise your eye health and experience a better quality of life.

Contact us

Frequently asked questions

Smoking after can delay the healing process and increase the risk of complications. We recommend that you stop smoking for six weeks before and two weeks after your procedure.

If this is too hard, try stopping for at least three days before and two days after. The NHS provides a free smoking cessation programme if you want help to quit.

You may need to stop taking non-steroidal anti-inflammatory drugs (NSAIDs) or blood-thinning medications temporarily before your procedure. Discuss this with your doctor and eye specialist first.

No. Lid laxity surgery is not painful as we use local anaesthesia to numb your eye and the surrounding area. However, you may experience discomfort after the procedure as you heal, which you can address with lubricating eye drops.

We recommend taking a few days off work to rest at home. You may need up to a week off work to recover, depending on your job. Talk to your specialist about your specific circumstances.