Ectropion - lower eyelid pulled away no longer protecting the eye (from Radiation Therapy for Basal Cell Carcinoma)

Eyelid cancer can be so extensive that radiation therapy is the best option. The balance of tissues that help protect the eye that even radiation therapy resulted in an ectropion. See the surgical results of eyelid reconstruction after radiation therapy for basal cell carcinoma. Explore the eyelid for both reconstructive and cosmetic (blepharoplasty) surgery.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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Ectropion (Drooping of the lower eyelid)

Recurrent ectropion after multiple cancer resections and then skin cancer excision with Mohs' chemosurgery and full thickness skin grafts.

Reconstruction of the lower eyelid

Facelift surgery (rhytidectomy)

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Ectropion - from extensive eyelid basal cell carcinoma treated with Radiation Therapy

The tumors on this patient were extensive the first time I saw this patient as seen in these photographs. Surgery was not an option. The tumor went into the orbit and onto the globe on the right. Radiation therapy was the only choice for this patient.

basal cell cancer Bermant Plastic surgery Extensive Basal cell cancer - Bermant Plastic surgery

Extensive Basal Cell Cancer
Both eyelids involved on left

Both eyelids involved on right

The extensive tumors contracted during therapy as expected exposing the left eye. Artificial tears provided temporary protection normally provided by the lid.

radiation therapy Bermant plastic surgery Ectropion after radiation therapy Bermant Plastic Surgery

Ectropion left lower eyelid
early after Radiation Therapy

Left Picture
Right eyelid pulled away

Right Picture
After ectropion surgery 

Conservative treatment and eye protection continued until tissues softened. There was enough eye protection that the lids did not need to be temporarily sewn together.

Ectropion after radiation therapy Bermant Plastic Surgery

Ectropion Worsened

Preop lower lid surgery

This patient has a scar contracture lid ectropion, the scar shortened the eyelid skin and the lid pulls away from the eye. The patient complained of tearing, burning of the eye, and sensitivity to wind.

  • A. The eyelid has pulled away from the eye
  • B. The punctum pulled away from the eye
  • C. Scleral show
Eyelid recostruction for ectropion Bermant Plastic Surgery Eyelid recostruction for ectropion Bermant Plastic Surgery

After ectropion reconstruction

Eyelid back against eye
No further tearing

This reconstruction was done by tightening the lower eyelid and resuspending it from the lateral bony wall of the orbit. Exposure was through a blepharoplasty incision. Redundant lower lid tissue was removed and the remaining lid resuspended to bone on the side. The drooping of the upper left lid is a result of the radiation therapy. This slight ptosis (droop of upper lid) was left alone. Vision was not affected and eye protection was too important.

See another case of recurrent ectropion after multiple cancer resections and then skin cancer excision with Mohs' chemosurgery and full thickness skin grafts.

See other cases of ectropion.

 

Learn more about blepharoplasty

Ptosis of the eyelid (drooping of the upper eyelid)

Eyelid Cancer and Reconstruction

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This page last updated on: August 3, 2008

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