Ectropion

If your upper or lower eyelid isn’t fitting right and is turned so you can see the inner part, you may have ectropion. Call your provider so you can get treatment and avoid any damage to your sight.

Overview

What is ectropion?

Ectropion is the medical name for outward-facing eyelid. Eversion is the medical name for describing the outward-facing state. When you have ectropion, the inside of your eyelid can become irritated. The condition can happen to an upper or lower eyelid, but it often happens to the lower lid.

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, which is the most common type and happens because muscles and ligaments get lax (loose) as we get older.
  • Paralytic, which is related to facial nerve injury.
  • Cicatricial, which is related to scarring.
  • Mechanical, which is related to lid weight.

How common is ectropion?

Outward-facing eyelids are more common among older adults. It may affect about 2.9% of people who are ages 60 or older. Ectropion is less common among children and adults younger than 60.

What are the risk factors for developing ectropion?

Risk factors for ectropion may include:

  • Aging.
  • 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 paralysis.
  • Using certain types of eye drops over a long period of time.
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Symptoms and Causes

What are the symptoms of ectropion?

The eyelids protect your eyes and keep them clean. The signs and symptoms of eyelid ectropion happen because the eye is exposed. There’s more opportunity for it to become irritated and dry. Signs and symptoms of ectropion may include:

What causes ectropion?

The different types of ectropion are caused by different things. These types and causes are:

Involutional ectropion

This type is the most common type of ectropion. This can be associated with constant eye rubbing, but it’s most often related to aging eyelids. The eyelids get looser because muscles and ligaments get looser.

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. A stroke can also cause cranial nerve paralysis.

Cicatricial ectropion

This type of ectropion can be caused by scars and by excessive and repeated sun exposure. You may have this type of ectropion if you’ve already had blepharoplasty (eyelid surgery) or any other type of eye injury, like burns or chemical irritation.

Mechanical ectropion

This type of eyelid ectropion happens when your lower eyelid is pulled away from the eye by some type of heavy weight. This could be a tumor, a mass of fat or edema (swelling, water retention).

Congenital ectropion

This type of ectropion is the least common type. 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.

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Diagnosis and Tests

How is ectropion diagnosed?

Your healthcare provider will probably be able to see ectropion of your eyelid. However, they will start by taking a medical history and doing an eye exam.

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. The cornea is the clear protective covering for the whites of your eyes.

Your provider may pull your eyelid even further 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.

Management and Treatment

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 your provider thinks that eye drops you’ve been using over a long period of time are related to the ectropion, they will ask you to stop using these drops. Your condition may improve when the drops are stopped.

If the ectropion is related to a skin condition, your provider may first treat the skin condition and that may stop the ectropion.

After that, your healthcare provider is likely to suggest surgery to treat ectropion if you’re well enough to have surgery. Most of these kinds of surgeries are on an outpatient basis, meaning you can go home the same day.

If your healthcare provider is doing surgery on your lower eyelid for ectropion, they’ll remove part of the lid (usually at the outer edge of the eye) and reattach the ligaments in a tighter position. They’ll want to make sure that the lids fit together again and that the punctum (the hole where tears flow into the nasal cavity) is in the correct place.

Some ectropion surgeries may require a skin graft, such as surgery to correct scarring that causes ectropion.

In some cases, you may need more than one surgery to fix the ectropion completely.

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Prevention

How can I prevent ectropion?

Most of the time, you really can’t prevent ectropion. However, 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 there.

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 do 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.

Outlook / Prognosis

What can I expect if I have ectropion?

Ectropion can be cured by surgery to make your eyelid muscles stronger. If you don’t treat ectropion, your cornea can become dry and develop sores. These things could damage your vision.

Living With

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 and watery eyes. This also includes feeling like your eye isn’t closing correctly.

A note from Cleveland Clinic

Your eyes are important to you. When you notice something is different about your eyes, or your eyesight, you should contact your healthcare provider. Something that may not seem important, like a small change in your eyelid where it’s turning inside out, may be something that can become a problem. Outward-facing eyelids (ectropion) may not seem significant, but the condition can be uncomfortable in the present and can harm your sight in the future if it’s not treated.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 11/02/2022.

Learn more about our editorial process.

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