Massage for Ectropion

By Linda LePelley, RN, NMT
July 12, 2016

Massage for Ectropion

By Linda LePelley, RN, NMT
July 12, 2016

A 68-year-old client asked if there was anything I could do to help keep her from developing what she called, "Hound-Dog Eyes." She explained that her father had coined the name after suffering from ectropion in his final years. He had suffered not only discomfort, but had also been embarrassed by his appearance. She had noticed that her lower eyelids had begun to droop slightly, and there was a slight area of puckering at the medial margin of each lower lid. Small areas under the lids were becoming exposed to dry air, causing irritation.

Her doctor told her it was not serious and could possibly resolve on its own. He told her that if her condition were to worsen, at some point they could talk about surgical options, and he gave her some eye drops for the irritation. She was very interested in avoiding surgery if possible, and hoped that massage might help. I told her I wanted to investigate possible contraindications before deciding if it was safe to attempt.

Ectropion, a condition where the lower eyelid becomes weak and begins to sag, causes the lower lid to hang forwardly down, exposing the normally moist inner lid area to air and possible infection as the condition worsens. Ectropion can be caused by trauma or as a response to eye surgery, but it is often considered a condition of old age. The sclera, or white of the eye, below the iris is not normally visible, but once entropion has progressed, the white under the eye becomes visible. Ectropion has a sister condition, called entropion, where the eyelid turns inward. The eyelashes then cause a great deal of irritation to the eye (Grossman & Porth, 2014, p.576). In my opinion, entropion massage should not be considered, or left entirely to the direction of an ophthalmologist, to prevent damage to the cornea.

Blepharoplasty is the surgical procedure commonly called an eye-lift. Carraway and Mellow (1990), discuss the prevention of post-blepharoplasty ectropion and state, "Postoperative ectropion should initially be treated conservatively with massage." Massage for the eye is also included as an intervention for the condition of dry eyes. Among other suggestions for the relief of dry eyes, Miller, S. (2013), an Opthalmic Nurse Practitioner suggests, "Wet a cloth with warm water and hold it against your closed eyes for five to ten minutes. The heat warms up the oil in the glands, making it flow more easily," and "Massage your eyes by gently rolling your first finger over them in a circular motion" (p.33).

Making sure she understood that I could not promise the results she was hoping for, I agreed to attempt to reverse my client's signs of developing ectropion. I placed a warm, damp towel over her cheeks, eyes and forehead for several minutes. Using olive oil, and light circular movements with my fingertips, I palpated her neck, face, around and under her eyes, her forehead into her scalp, and all around her ears. Looking for changes in the density of her tissues, I noted that while the superficial skin was sagging and becoming limp, the tissues underneath were taut, and tender in areas, particularly under her eyes. It felt as if the deeper tight areas, which seemed almost hardened, had shrunken back and away from the outermost layers of skin and subcutaneous tissue.

The first session I focused on gentle movement of those hardened tissues, to encourage circulation. After an hour, I could feel that these tissues were beginning to soften. My client stated that her face felt, "wonderful, rejuvenated," and she believed her eyelids felt more relaxed. Special considerations include having the client apply their eye drops if they need them, and remove contacts before the massage. After three more sessions, my client's lower eyelids were no longer showing any sign of puckering or droop along the margins. All of the tissues of her head, neck and face were soft and malleable, and as a bonus, the skin of her face had healthy pink undertones. After teaching her self-massage and the importance of adequate hydration, she is able to maintain her good results.

References:

  1. Carraway, J.H., & Mellow, C.G. (1990). The prevention and treatment of lower lid ectropion following blepharoplasty. Plastic Reconstructive Surgery, 85(6), 971-981.
  2. Grossman, S.C., & Porth, C.M. (2014). Porth's pathophysiology: Concepts of altered health states (9th ed.). Philadelphia, PA: Wolters Klewer Health | Lippencott Williams & Wilkins.
  3. Miller, S. (2012). Dry eye requires a little TLC – Tear layer care. Primary Health Care, 23(9), 30-33.