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TOC Informational Series

Blepharoplasty Ectropion Entropion

Eyebrow and Forehead Lift Eyelid Ptosis

Additional topics available at our website: toceyeandface.com

TOC Main Office3705 Medical Parkway, Suite 120

Austin, Texas 78705 Medical Spa: 3705 Medical Parkway, Suite 130

TOC North Office1130 Cottonwood Creek Trail, #C4

Cedar Park, Texas 78613

TOC South Office4207 James Casey Street, Suite 306

Austin, Texas 78745

TOC Eye and Face has over 16 locations in Central Texas.Please visit www.toceyeandface.com

to select an office near you.

Tel: 512-458-2141Fax: 512-458-4824

ABOUT USTOC Eye and Face is one of the nation's premieresurgical practices specializing in high-qualitycosmetic and reconstructive facial, eyelid, andorbital surgery. TOC surgeons are board-certifiedophthalmologists who have completed advancedfellowship training in eyelid, orbital, lacrimal andfacial cosmetic and reconstructive surgery.

Services provided cover a broad range of aestheticand reconstructive procedures to include eyelidsurgery, eyebrow and forehead lifts, face lifts, necklifts, rhinoplasty, liposuction, laser skin treatment,facial and body fat transfer, facial fillers, Botox,management of eyelid and facial skin cancers, scarrevision, orbital surgery, correction of tearingdisorders, and management of maxillo-facial trauma.The majority of the surgery is performed in TOC'sadjoining outpatient ambulatory surgery center, theCenter for Aesthetic and Reconstructive Eyelid andOrbital Surgery (CAREOS).

TOC is also committed to teaching, research, and the education of ophthalmologists specializing in facial cosmetic and reconstructive surgery. More than thirty American, Canadian, and internationalphysicians have completed training at TOC whereour fellowship is accredited by the American Societyof Ophthalmic Plastic and Reconstructive Surgery(ASOPRS). The training program is recognizedas one of the premier private practice fellowshiptraining programs in the country.

TOC Eye and Face, TOC Medical Spa, and CAREOS are located in the Austin Medical Plaza adjacent to Seton Medical Center in Austin, Texas. The practiceprovides outreach consultative services in multiplesatellite offices.

The physicians of TOC Eye and Face are committedto providing convenient comprehensivesub-specialty surgical care in a private, patientfriendly setting by a staff focused on our patientsand their families.

ECTROPION(EYELID TURNING OUT)

Information Series

OCULOFACIAL PLASTIC SURGERYOculofacial Plastic or Ophthalmic Plastic Surgeryis a surgical subspecialty of Ophthalmology thatseeks to improve physical appearance and function,or minimize disfigurement resulting fromaccidents, disease, or birth defects. The wordplastic comes from the Greek meaning "molding"or "giving form".

ECTROPIONEctropion is a condition in which the lower eyelidsags or turns outward . The affected eye is exposedand dry, and is often uncomfortable. The eyelids may crust with excess mucus or appear red along the edge. The patient may be sensitive to light, have blurred vision, may experience a gritty, irritated sensation and often complains of tearing that interferes with activities such asreading.

CAUSES OF ECTROPIONThe most common cause of ectropion is normalaging with progressive laxity of the tendons thathold the corners of the eye to the bone, but itmay also result from injury, stroke, Bell's palsy, tumor, or physical trauma. Long-term sun exposurecan cause skin changes that pull the eyelid awayfrom the eye, called cicatricial ectropion.

TREATMENT OF ECTROPIONEctropion is a condition demanding propertreatment. Left untreated, ectropion can resultin permanent eye damage due to infection andcorneal scarring, and may even lead to loss of theeye. Eye irritation and redness can be temporarilytreated with artificial tears and ointments tolubricate the eye. In most instances the ectropionrequires corrective surgery. The specific surgicalprocedure to correct ectropion depends on theunderlying cause. The type of ectropion associatedwith aging is best corrected surgically byshortening or tightening the lower eyelid attachments through an incision at the outer corner

of the eye. Sometimes there are scars followingtrauma or following the surgical removal of skincancers. Suspending midfacial tissues may beenough to allow the tightening of the lower lidin a standard fashion; however, in more severecases, your surgeon may need to use a skin grafttaken from the upper eyelid, behind the ear, orother parts of the body to repair the ectropion .On occasion, cicatricial ectropion repair involvesthe formation of a flap of tissue from the upper tothe lower eyelid through an incision at the outercorner of the eye.

WHAT TO EXPECT AT THE TIME OFSURGERYWe perform most ectropion repair surgery in ouron-site ambulatory surgery center, the Center forAesthetic and Reconstructive Eyelid and OrbitalSurgery (CAREOS). This state-of-the-art, certifiedoutpatient surgical facility was designed for yoursafety, convenience and comfort. It is run by ourdedicated and professional nursing staff. Ectropionrepair is usually performed under local anesthesiawith the patient slightly sedated with oralmedication; however, board certified anesthesiologistsare available for those patients in need ofmonitoring and intravenous sedation. The optionfor hospital based surgery remains for thosepatients requiring more extensive work. The decisionrests on your medical condition, length andcomplexity of surgery, and other factors. Our goalis to provide the best possible care in a safe andcomfortable environment.

POTENTIAL RISKS AND COMPLICATIONSBleeding, infection, and scarring are potentialrisks with any surgery, but are very uncommon.Recurrence of ectropion can rarely occur; especiallyif the patient continues to wipe the eye frequently. As with any medical procedure, there may be other inherent risks that you should discuss with your surgeon.

WHAT TO EXPECT AFTER SURGERYIf surgery is only performed on one side the eyemay be patched overnight. Once the patch is re-moved you will use an antibiotic ointment on thesutures for about one week. Occasionally, youreyelids may have to be sutured together or havea prolonged patch placed for up to one week toallow the eyelid to heal underneath the bandage.Your doctor can advise you whether this will benecessary. After your eyelids heal, your eye willfeel more comfortable.Following surgery, there is some soreness andmild tenderness at the outer corner of the eye. Inmost cases, pain is not significant and usuallycontrolled with ice compresses, although aprescription for a narcotic pain medication is provided.Bruising and swelling can occur and usuallyresolves within 1-2 weeks. You will be instructedto keep your head slightly elevated and to applycold compresses to your eyelids for several daysfollowing surgery.The results of surgery are usually permanent andrecurrence is rare. After your eyelids heal, youreye should feel more comfortable and you will nolonger have the increased risk of corneal scarring,infection and loss of vision.

Ectropion of thelower eyelid ischaracterized byan outward turningof the lid margin.

After surgery theeyelid is in properanatomic positionup against the eye.