What is ectropion?
Ectropion is a condition in which the lower eyelid turns outward, away from the surface of the eye. When the eyelid loses its normal position, the inner lining of the lid becomes exposed, leaving the eye vulnerable to dryness, irritation, and injury.
Ectropion most commonly affects the lower eyelid and is seen most often in older adults. In a healthy eye, the eyelid rests flush against the eyeball, helping to distribute tears evenly and protect the eye’s surface. When ectropion is present, this protective function is disrupted – often leading to a watery eyes condition, chronic irritation, or vision discomfort.
Types of ectropion
Ectropion is broadly divided into two categories: congenital (present from birth) and acquired (develops over time). Congenital ectropion is the lead common type. There are four acquired types:
- Involutional – The most common type of ectropion. It occurs when the muscles and ligaments of the eyelid become lax with age.
- Paralytic – Caused by injury or damage to the facial nerve or the nerves that control eyelid movement.
- Cicatricial – Results from damage to the skin following injury, surgery, or sun exposure. The scar tissue that forms contracts over time, pulling the eyelid downward.
- Mechanical – Occurs when a tumor or mass weighs down the lower eyelid and displaces it from its normal position.
What are the symptoms of ectropion?
Because the eyelid no longer sits properly against the eye, patients typically experience symptoms related to tear drainage problems and surface exposure. Common symptoms include:
- Excessive tearing or watery eyes
- Chronic eye redness
- A gritty, sandy, or burning sensation in the eye
- Sensitivity to light and wind
- Crusting along the eyelid
- Mucous discharge
- Irritation or a feeling that something is in the eye
- Difficulty closing the eyelid completely
In severe or untreated cases, the cornea can become damaged due to prolonged dryness and exposure.
What causes ectropion?
Ectropion occurs when the muscles and connective tissues that hold the eyelid in place weaken or are disrupted. The most common causes include:
- Aging – The most frequent cause of ectropion is the natural loosening of eyelid tissue over time. As the muscles and tendons of the eyelid weaken with age, the lid can gradually sag and turn outward.
- Facial nerve palsy – Weakness or paralysis of the facial nerve can reduce muscle control around the eye, causing the lower lid to droop outward.
- Scarring or previous surgery – Scar tissue from burns, trauma, skin condition such as eczema, or prior eyelid surgery can pull the lower lid away from the eye.
- Skin cancer or growths – Tumors or lesions on or near the eyelid can distort the normal anatomy of the lid.
- Congenital causes – In rare cases, ectropion is present from birth, often associated with symptoms such as Down syndrome.
How is ectropion diagnosed?
Ectropion is typically diagnosed through a clinical eye examination. A provider will examine the position and movement of the eyelid, assess the tone and laxity of the lid tissue, and evaluate the surface of the eye for signs of dryness or damage.
In some cases, additional testing may be performed to evaluate tear production or tule out underlying conditions contributing to eyelid changes. If a skin lesion or tumor is suspected as a cause, a biopsy may be recommended.
How is ectropion treated?
Treatment for ectropion depends on the underlying cause and severity of the condition. The goal of treatment is to restore the normal position of the eyelid, protect the eye’s surface, and relieve symptoms.
Mild or temporary cases – such as those caused by Bell’s palsy – may be managed with lubricating eye drops or ointments to reduce irritation and protect the cornea while the underlying cause resolves. In some cases, medical tape may be used to temporarily hold the eyelid in a more normal position.
For most patients, a lower eyelid repair surgery is the definitive treatment for ectropion. This procedure is typically done as an outpatient procedure under local anesthesia.
The specific surgical approach depends on the cause:
- Age-related ectropion is most often corrected by tightening the tendons and tissues of the lower eyelid to restore proper positioning.
- Scar-related ectropion may require a skin graft or flap to release tension caused by scarring and allow the lid to return to its normal position.
- Paralytic ectropion may involve procedures to support or suspend the lower eyelid when muscle function is diminished.
After ectropion surgery, patients may experience temporary swelling or bruising from the procedure. Most patients experience significant improvement in symptoms once the eyelid has healed in its corrected position.
Your eyelids protect your eyes and keep them healthy – and when something changes, it’s worth getting checked. Left untreated, ectropion can lead to chronic irritation and long-term damage to your vision. Our oculofacial plastic surgeons can evaluate your symptoms and help you find the right path forward. Call 515.875.9480 to schedule an appointment today.