Do I Have Lower Lid Retraction or Ectropion? (photo)

Question

I had lower eyelid surgery with lateral canthopexies 13 months ago. I am concerned I have either lower lid retraction or ectropion. If I have either of these issues, what are my options for correction? I would appreciate any feedback.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thank you for your photographs. It may appear that you have increased scleral show but the photos are at angles instead of straight on. A good examination will tell the story. If you do have ectropion at this point in time then a canthoplasty is recommended. A canthoplasty reconstructs the tendon at the corner of your eye by detaching it and appropriately repositioning it slightly within the orbital bone. A canthopexy supports/lifts the the tendon in lieu of repositioning it.

Vincent N. Zubowicz, MD · Answer

The photographs are taken with the eyes not in the neutral position. It is impossible to make an evaluation. Your surgeon would best be able to address your concerns.

Kenneth Hughes, MD · Answer

You may not have either, but you are looking up in the pictures and the camera angle is directed downward. Everyone should have scleral show in these situations. A physical exam or photos with direct forward gaze and appropriate camera angle will be needed to more accurately assess this. Kenneth Hughes, MD Los Angeles, CA

Amiya Prasad, MD - Account Suspended · Answer

Ectropion is when the eyelid is everted away from the eye. In other words, the margin of the eyelid which normally sits fused with the eye is everted away. Eyelid retraction is when the entire margin of the eyelid is pulled downward. With the photos you submitted, I have to say that you have both ectropion and eyelid retraction.

	If there is ectropion after lower eyelid surgery, it’s typically the result of a relative shortage of skin for the eyelid to be turned towards the eye, or the result of scarring and the healing process.  If the eyelid is everted, you need skin. To solve this, we need to recruit skin from the cheek area, or do some kind of skin grafting procedure.

	Eyelid retraction is a complex situation where, because of the healing process after eyelid surgery, some form of scarring occurred that causes pulling down of the lower eyelid. Routinely in my practice, if it’s a mild retraction, I release the scar tissue and manage the healing process to prevent the eyelid from pulling down. More commonly I have to do some kind of grafting procedure. I use a material called Enduragen which is the dermis of the backbone of the skin that is derived from a pig. It’s used in a lot of reconstructive procedures and it’s safe for human use. I’ll place it on the underside of the eyelid from the inside so that there’s some vertical support. It’s almost like a bridge where there’s a pillar supporting the eyelid.

	Last but not least, I will typically do a lateral tarsal strip to support the lower eyelid. The end of the eyelid that is attached to a structure called lateral canthal tendon has to be attached to the inside of the bone where it originates. Sometimes that area is not that strong enough to hold and the stitch can come apart. In such cases I do another procedure called a drill hole canthopexy, which means drilling very tiny holes on the bone where the tendon needs to be attached so there’s a strong and stable point of fixation for the support of the eyelid. These are the typical procedures I perform to help people improve their appearance after having cosmetic eyelid surgery done elsewhere.

	With your photos alone, I can’t do physical examination. When I do an examination with ectropion and lower eyelid retraction, I move the eyelid upward and try to see the elasticity and the quality of the skin. That’s part of the decision-making process to know what kind of procedure someone would need. I hope that was helpful to you, and thank you for your question.

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