Entropion Surgery in London

Correction of rolling in eyelids

Entropion is the name given to a condition in which the eyelid turns inwards resulting in the eyelashes and eyelid margin rubbing against the surface of the eye. It can also be described as the rolling in of the eyelids. This leads to a feeling of discomfort and irritation and can cause a corneal ulcer.

The eyelid may be turned in when you blink hard or squeeze your eyes. Involutional entropion may also be present all the time and is usually found in older adults and elderly patients and the majority of cases are on the lower lid. It can affect the upper eyelid but this is less common. Dry eye drops and lubricating ointments can help relieve the symptoms. Botulinum toxin injections can give temporary relief. Usually surgical intervention is needed. If left untreated it can cause damage to the front part of the eye, lead to recurrent eye infections and in severe cases lead to vision loss with the development of corneal abrasions, corneal ulceration and scar tissue from the chronic inflammation which can cause permanent damage to the eye .

The symptoms caused by are the result of the eyelashes and eyelid margin rubbing against the eye. You may experience:

Entropion and rolling in of the eyelids can be caused by:

Muscle weakness – The muscles of the eyelid tend to weaken with age and the canthal tendons that support the eyelid become more stretched. The lower lid retractors that support the eyelids also loosen resulting in the eyelid malposition. This is the most common cause.
Scars and previous surgery – The eyelid skin can become scarred by injury, surgery and chemical burns that cause a change in the normal curvature of the eyelid.
Infection – In developing countries a condition known as trachoma is a common cause of entropion. It is prevalent in Africa, Asia and the Middle East. The scarring occurs to the inner surface of the eyelid, resulting in the eyelid urning inwards and causing entropion and in severe cases, blindness.
Inflammation – Irritation of the eye through dry eye syndrome or inflammation can lead to a person squeezing their eyes regularly or rubbing them on a regular basis. This can cause spasm of the muscles of the eyelid which results in entropion (spastic entropion).

There is an increased risk of developing entropion in the following:

Age – The you age the muscles become weaker and the risk of entropion increases.
Previous eyelid injury or burns – The scarring that forms after an eyelid injury can lead to the development of entropion.
Trachoma – Having a trachoma infection can lead to scarring of the inner surface of the eyelid and increases the risk of developing cicatricial entropion.
Congenital – Rare cases present at birth are known as congenital entropion.

It is important to seek immediate care for your entropion if you have any of the following:

These are possible signs of injury to the eye as a result of entropion which can harm your vision.

Why is entropion surgery done

Surgery is done with surgical techniques to correct the horizontal eyelid laxity of the eyelid allowing the lashes to turn outward and resorting the normal position of the eyelid as well as preventing any damage to the eye. The correction of the rolling in is then achieved. In most cases this is a permanent solution. To provide short term relief until the surgical correction artificial tears may be of benefit in mild cases. Entropion repair is usually done under local anesthesia.

What are the risks?

Possible risks of blepharoplasty surgery include:

To know which risks most apply to you talk to your doctor to understand more about entropion surgery as well as the benefits and if they apply to you. This way you can decide with your doctor if entropion surgery is a good option.

Non surgical treatments for entropion are often temporary in the correction of the rolling in of the eyelids and include:

Placing some sutures to the to the lower eyelid to pull the lashes away from the eye and giving temporary relief from the entropion

Placing a soft contact lens on the eye to protect it from the ingrowing lashes caused by entropion

Botulinum toxin injection to the eyelid to cause temporary weakening of the outer eyelid muscles to treat the entropion. The injections are given below the eyelid to roll out and bring the lashes way from the eye.

How you prepare

Before having entropion surgery you will meet your Oculoplastic surgeon who specialises in entropion surgery to discuss:

Your medical history including any previous surgery and current eye conditions.
Your expectations with an honest discussion about what can be realistically achieved.
A vision examination to check the eyes prior to surgery.
A physical examination of the eyelids to ensure that this is the correct procedure.
Eyelid photography which can help with surgical planning and to provide evidence for any insurance claim.

It is preferable to stop taking any blood thinner medication such as aspirin, ibuprofen, warfarin, apixiban and any other medication that can cause increased bleeding during entropion surgery. Your doctor will discuss these with you to ensure that it is safe for you to do so prior to your entropion surgery and will tell you how long before the operation.

Stoping smoking several weeks before surgery can help improve the healing after entropion surgery.

You should arrange for someone to take you home after the procedure and stay with you for the first night following the operation.

What can you expect before the procedure?

Entropion surgery is usually done as a day case where you can go home the same day. Your surgeon will inject anaesthetic into your eyelids to numb the area and you can also have medication through a drip to help you relax. You are also able to ask Mr Ahmad Aziz in the central london clinic any questions you have prior to surgery.

What you can expect during the procedure

A smaller operation is the placing of stitches to the lower eyelid to turn the eyelid outwards. The stitches cause scarring inside the eyelid that are usually not visible to help keep the eyelid in place once the stitches dissolve. This operation is relatively simple but can lead to the entropion and rolling in of the eyelids returning after a few months.

If the entropion is age related your oculoplastic surgeon will remove a small section of the eyelid to make it tighter. This may be associated with the placing of stitches on the eyelid to bring the eyelid outwards and provide additional support. If the entropion is more significant then an incision is made just under the eyelashes to access the eyelid muscles which are then tightened to give a better turning out of the lashes. The incision is then closed with stitches.

If your entropion is caused by scarring, injury or previous surgery a mucous membrane graft usually from the mouth is placed on the inner surface of the eyelid to help the eyelid turn outwards. This is commonly done under a general anaesthetic with you asleep.

What can expect during the procedure?

After surgery you are monitored for complications. You are able to leave later that day to recuperate and begin the healing at home.
After surgery you may temporarily experience:

Your doctor will likely suggest you take the following steps after surgery:

Use ice packs on your eyes every hour the night you go home after the operation. The following day, use ice packs on your eyes four to five times throughout the day to help reduce the swelling
Gently clean your eyelids and use prescribed medication.
Avoid straining, heavy lifting and swimming for a week after blepharoplasty.
Avoid strenuous activities, such as aerobics and jogging, for a week.
Avoid smoking.
Avoid rubbing your eyes.
Not to use contact lenses for about two weeks after surgery.
Wear darkly tinted sunglasses to protect the skin of your eyelids from sun and wind.
Sleep with your head raised higher than your chest for 3 days after the surgery.
After a few days, return to the surgeon to have stitches removed, if needed.

Seek medical attention immediately if you experience any of the following:

What are the results of surgery?

Many patients are satisfied with the results of entropion surgery, correcting the rolling in of the eyelids and benefit from a more natural appearance, better vision if the vision was affected. The results of the surgery can last a lifetime but for others the entropion may recur with time.

The bruising and swelling noticeably settle within 2 weeks resorting a more natural look giving you confidence in going out publicly and subtle swelling that the patient may notice will generally resolve over a period of 2 months in the majority of cases.

Scars from the surgery can take months to fully fade but should be within the skin crease or under the lashes and well covered. You should protect your eyelids from too much sun exposure as you should do for the rest of your skin.