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Ectropion (Eyelid Turning Outward): Causes and Managmemt

Ectropion means that the lower eyelid is “rolled out” away from the eye, or is sagging away from the eye. Analogy: Imagine the lower eyelid as a tennis net. If the tennis net gets loose, it can flop in or out. Similarly, when the lower eyelid tendon gets loose over time due to aging (or other causes), the eyelid can turn in (entropion) or out (ectropion).

The sagging lower eyelid leaves the eye exposed and dry. If ectropion is not treated, the condition can lead to chronic tearing, eye irritation, redness, pain, a gritty feeling, crusting of the eyelid, mucous discharge, and breakdown of the cornea due to exposure.

What Causes Ectropion?
Generally the condition is the result of tissue relaxation associated with aging (involutional ectropion). Other types of ectropion are paralytic and cicatricial. Paralytic ectropion results from paralysis of the facial nerve or muscle weakness from prior surgeries or trauma. The eyelid is unable to close and flops out. Cicatricial ectropion results from tightness or scarring of the eyelid skin, pulling the eyelid outward. Common causes of cicatricial ectropion include chronic sunlight exposure, previous surgeries or trauma, and skin cancer

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Causes of Tearing

The tear film on the surface of the eye is a critical component of maintaining vision. Tears nourish and lubricate the surface of the eye as well as wash away debris. If there is a disturbance of the tear film, patients will often experience tearing, burning, irritation and most importantly blurred vision. Patients who experience tearing, or epiphora, either have a problem with tear production or tear drainage, including dry eyes, blepharitis, eyelid malposition (ectropion, entropion, eyelid retraction), nasolacrimal duct(tear duct) obstruction (congenital and acquired).

Increased Tear Production and Dry Eyes

As odd as it sounds, the most common cause of tearing is dry eyes. If your eye doesn’t make enough tears, the lacrimal gland responds by secreting watery tears that don’t stick to the eye. So despite the tears spilling from your lids, the eye continues to be dry. The eye has two sets of structures that produce tears. Smaller tear glands help maintain a baseline level of moisture on the surface of the eye. Unfortunately, inflammatory conditions like rheumatoid arthritis, Sjogrens disease as well as aging and menopause lead to decreased tear production. As tear production diminishes, the surface of the eye starts to dry out.

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Types of Anesthesia For Oculoplastic or Eyelid Surgery

Here are three basic types of anesthesia that can be used during oculoplastic or eyelid surgery. From least invasive to most invasive are: local anesthesia, MAC anesthesia, and general anesthesia.

Local anesthesia involves injecting local numbing injection to numb the eyelid and surrounding structures and the surgery is performed is performed while the patient is fully awake, much like a dental work. MAC anesthesia combines local anesthesia with intravenous sedation, whereby the patient is relaxed and in “twilight sleep” during the surgery, much like how it is done during colonoscopy. Most oculoplastic surgeries can safely be performed using either local anesthesia or MAC anesthesia. The advantages are patient cooperation during the surgery which produces better results along with quicker postoperative recovery.

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Functional Versus Cosmetic Oculoplastic Surgery

Functional vs Cosmetic Eyelid Surgeries

The question of functional versus cosmetic surgery arises often. Here is the difference between the two:

More than 170,000 people in the US each year get some form of eyelid surgery. Most of those people average around 57 years of age. Sometimes , the need is more cosmetic and others, it’s more so for medical purposes like cancer and uncomfortable situations.

What Does “Functional” Surgery Mean?

Functional (or reconstructive) oculoplastic surgery is considered medically necessary and is usually covered by health insurances. It is designed to help with the function of the eyelid or periorbital areas. Examples include ptosis (droopy eyelid), eyelid malpositions (ectropion, entropion), eyelid retraction, eyelid tumors or skin cancer reconstruction, lacrimal tear duct (DCR) surgery, orbital tumors, bulgy eyes, thyroid eye disease, trauma (eyelid laceration, orbital fractures), orbital tumors, eye socket surgery, facial or eyelid paralysis, and facial or eyelid spasms.

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Why Do Eyelids Droop and How Can It Be Fixed?

Ptosis (pronounced “toe-sis”) is the medical term for drooping of the upper eyelid(s). This lowering of the upper eyelid margin may cause a reduction in the field of vision when the eyelid either partially or completely obstructs the pupil. Patients with ptosis often have difficulty keeping their eyelids open. To compensate, they will often arch their eyebrows in an effort to raise the drooping eyelids. In severe cases, people with ptosis may need to lift their eyelids with their fingers in order to see. Children with ptosis may develop amblyopia (“lazy eye”) or developmental delay from limitation of their vision.

 

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Are Your Tears As Healthy As You Think?

The tear film on the surface of the eye is a critical component of maintaining vision. Tears nourish and lubricate the surface of the eye as well as wash away debris. A smooth, balanced tear film (consisting of water, oil and mucus) also allows light to enter the eye in an optimal fashion. If there is a disturbance of the tear film, patients will often experience tearing, burning, irritation and most importantly blurred vision. Patients who experience tearing, or epiphora, either have a problem with tear production or tear drainage, including dry eyes, blepharitis, eyelid malposition (ectropion, entropion, eyelid retraction), nasolacrimal duct(tear duct) obstruction (congenital and acquired).

 

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Combined DCR and Rhinoplasty with Septoplasty

Dr. Mehryar (Ray) Taban is the ONLY surgeon in the world who performs combined tear duct surgery (DCR) and cosmetic rhinoplasty (plus functional nose surgery, septoplasty, etc) at the same time (“Rhino-DCR” or R-DCR operation).

Patients with tearing secondary to blocked tear ducts often have concurrent difficulty with breathing secondary to deviated septum or other nasal problem. They often require concurrent nose surgery (septal deviation surgery, turbinate surgery, nasal collapse surgery) along with tear duct surgery (DCR). This is usually done by two different surgeons (oculoplastic surgeon and nose surgeon) at different times, requiring two separate surgeries with two postoperative recoveries. Moreover, many patients are unhappy about the appearance of their nose and for many years, they have thought about undergoing cosmetic rhinoplasty but haven’t done it due to cost, recovery period, or stigmata of having had a “nose job”.

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Your Options in a Lower Eyelid Blepharoplasty

OPTIONS IN LOWER EYELID BLEPHAROPLASTY Under-eye bags and dark circles are common patient complaints. They can make the individual look older and more tired and are most often, as a result of genetics or aging. Depending on the individual, bags or dark circles are simply caused by fullness or relative fullness of the lower eyelids and/or hollowness or … Read more

Eliminate Under Eye Bags & Dark Circles: Without Surgery

TREATMENT OF LOWER EYELID “BAGS” OR “DARK CIRCLES” During the aging process, the lower eyelid fat pads become more prominent (orbital fat herniation), causing relative fullness of the lower eyelids. Moreover, there is fat deflation (loss) and descent of the midface/cheeks which results in relative hollowness below the lower eyelids. It can also be congenital … Read more