Summary
In ectropion, the lower eyelid turns outwards so its inner surface is exposed to the elements. The eye runs constantly, the eyelid skin becomes red and rough, and over time the surface of the eye can be damaged.
Who is this for?
Common causes are:
- Age-related laxity, by far the most common.
- Cicatricial ectropion, where scarring of the lower-lid skin pulls the lid downwards (sun damage, previous skin cancer surgery, chronic dermatitis).
- Paralytic ectropion, from facial nerve weakness, for example after Bell’s palsy.
- Mechanical ectropion, where heavy tumours of the lower lid weigh it down.
Common symptoms include constant watering, a sore red eye, exposure of the inner pink lining (the conjunctiva), and recurrent infections.
Is this funded on the NHS?
Usually, yes. This is an operation for an eye that is being damaged, and most boards treat it that way. Hampshire funds it under Policy 53, but with a gate: chronic watering for at least two months and ocular irritation that topical treatment has not settled. Both limbs are required, which is worth knowing before your referral is written, because a letter that mentions the watering and not the irritation is the sort of thing that comes back. The North East Hampshire locality is more generous, needing any one of three findings and imposing no minimum duration, though it does require prior approval. Elsewhere the picture varies more than you would expect: some boards fund ectropion repair wherever it is clinically indicated with no criteria at all, and around a third have published nothing I can find. Tightening a lower lid for appearance alone is not funded anywhere. In practice, most people who genuinely need this operation will qualify. What your own board has published is listed with its source and the date it was checked.
What the procedure involves
For most age-related cases I perform a procedure to tighten the lower eyelid. Often this is combined with a mini face lift for added support to the lower eyelid. For cicatricial cases, additional skin grafting may be needed to release the scar tension.
Typical operating time is 45 minutes per eyelid under local anaesthetic, as a day case.
Recovery and what to expect
- Bruising and swelling for 1 to 2 weeks.
- Lubricants and antibiotic ointment for a week.
- Sutures absorb or are removed at 7 to 10 days.
- Watering improves rapidly once the lid sits against the eye again.
Risks and alternatives
As with any eyelid surgery, risks include asymmetry, under- or over-correction, infection, scarring and recurrence. Long-term success rates are above 90% for age-related ectropion.
Non-surgical management with intensive lubrication and taping can provide temporary relief but is not a long-term solution.