Ectropion

What is ectropion?

Ectropion is a condition that occurs when your eyelid turns outward away from your eyeball. This drooping of your eyelid exposes your eye, causing issues with the drainage of your tears and irritation to the front of your eye. When your eyes aren’t fully lubricated, it can lead to severe dryness and inflammation. Ectropion is the opposite of entropion, the inward turning of your eyelid.

Ectropion can happen to your upper or lower eyelid, but it most often affects your lower lid. It can occur in one or both eyes. If you’ve developed the condition, treatment is available. An eye care specialist may recommend a noninvasive option, like artificial tears. If the problem persists, they may recommend surgery.

Types of ectropion

There are a variety of types of ectropion that can affect your eyes. They’re broadly divided into groups called congenital (something you’re born with) and acquired (something that happens over time). The congenital type is the least common. There are four acquired types:

• Involutional. Involutional ectropion is the most common type. It happens because muscles and ligaments get lax (loose) as you get older.
• Paralytic. Paralytic ectropion is related to an injury involving your facial nerve or nerves that control your eyelid.
• Cicatricial. Cicatricial ectropion occurs due to damage to your skin following an injury, surgery or sun exposure, leaving behind scar tissue, which contracts and pulls your eyelid outward.
• Mechanical. Mechanical ectropion occurs when something like a tumor or mass weighs down and displaces your lower eyelid.

What are the symptoms of ectropion?

Your eyelids protect your eyes and keep them clean. The signs and symptoms of eyelid ectropion happen when your lid droops down, exposing your eye. There’s more opportunity for irritation to occur. Signs and symptoms of ectropion may include:

• Feeling like you have something in your eye (foreign body sensation)
• Dryness
• Redness
• Tearing (watering) of your eye
• Mucous-like discharge from your eye
• Crusting of your eyelashes

What causes ectropion?

Causes of ectropion differ based on the type. The types and causes of ectropion are:

• Involutional ectropion. Constant eye rubbing can cause this type, but it’s most often due to aging. Your muscles and ligaments — including the ones in your eyes — get looser as you age.
• Paralytic ectropion. This type of ectropion happens along with facial nerve palsy, like Bell’s palsy. This type of palsy comes on quickly. It often causes drooping of one side of your face.
• Cicatricial ectropion. Scarring due to skin damage causes this type. It may occur if you’ve had blepharoplasty (eyelid surgery) or any type of eye injury, like a cut, burn or chemical irritation.
• Mechanical ectropion. This type happens when some type of heavy weight pulls your lower eyelid away from your eye. This could be a tumor, a mass of fat or edema (swelling).
• Congenital ectropion. This is a type of outward-turning eyelid that you’re born with. Down syndrome and blepharophimosis syndrome are two congenital conditions that may make ectropion more likely.

What are the risk factors for developing ectropion?

Risk factors for ectropion may include:

• Aging
• Sun exposure
• Rubbing or pulling your eyelids frequently
• Wearing contact lenses
• Having skin conditions that affect your eyelids
• Having injuries or surgeries that affect your eyelids
• Having facial nerve palsy or facial paralysis
• Using certain types of eye drops over a long period of time

How is ectropion diagnosed?

A healthcare provider will start by asking you about your medical history and performing an eye exam. They’ll probably be able to see ectropion of your eyelid. Sometimes, the diagnosis is subtle, but other times, it may be obvious.

Your lower lid may appear to be lower in position than it should be. The lid may appear to be inside out. Your eye may look redder than it should, especially where the exposure is occurring. Your lower cornea may be visible and may seem irritated or inflamed, a condition called keratitis.

Your provider may pull your eyelid even farther away and count how long it takes to return to its position. This is called the snap-back test. If ectropion is severe, you might have to blink repeatedly to get it to return to position.

How is ectropion treated?

Your provider will almost always begin your treatment by prescribing artificial tears or other types of drops or ointments to add moisture to your eye. If lubrication alone doesn’t clear up the condition, they may recommend other treatment options, including:

• Eliminating eye drops. If your provider thinks that the eye drops you’ve been using over a long period of time are related to the ectropion, they’ll ask you to stop using them.
• Treating other conditions. If the ectropion is related to a skin condition, your provider may treat that first to stop the ectropion. This may involve the use of anti-inflammatory medication, like a steroid.
• Surgery. Your provider will remove part of your eyelid (usually at the outer edge of your eye) and reattach the ligaments in a tighter position.

Some ectropion surgeries may require a skin graft, like surgery to correct scarring that causes ectropion. In some cases, you may need more than one surgery to fix the ectropion completely.

How can I prevent ectropion?

Most of the time, you can’t prevent ectropion. But you can take some steps to protect your eyes and eyelids. For instance, you can be careful about how often and how firmly you rub your eyes, taking care not to stretch your skin. Avoid sleeping on your stomach with your face in the pillow, as this will increase the laxity of your eyelids. If you have sleep apnea, wear your CPAP machine. If you think you may have sleep apnea, talk to your primary care doctor to arrange a sleep study.

You can also protect your skin and eyes from harsh sunlight and wear sunglasses. Always wear safety glasses when you need them for work.

If you wear contact lenses, make sure you clean them properly and dispose of them when you should. Always make sure your hands are clean when you’re putting lenses in and taking them out. Try to be gentle with your lids.

What can I expect if I have ectropion?

Ectropion is a very treatable condition. If necessary, surgery can cure the condition and make your eyelid muscles stronger.

Without treatment, severe ectropion can lead to scarring or ulcers (sores) on your cornea. This can cause permanent vision loss and even loss of an eye in the worst cases.

When should I see my healthcare provider about ectropion?

Keep regular eye care appointments. Contact your provider about any changes in how well you see or how your eyes look or feel. Signs and symptoms that could cause concern include:

• Redness
• Feeling like you have something in your eye
• Watery eyes
• Feeling like your eye isn’t closing correctly

What questions should I ask my healthcare provider?

Questions you may want to ask your eye care specialist include:

• What type of ectropion do I have?
• What was the cause of my condition?
• What treatment options do you recommend?
• How can I prevent ectropion from returning?