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Ectropion: Causes, Symptoms & Treatment

Ectropion is a condition in which the eyelid turns outward, exposing the inner surface. It most often affects the lower eyelid and can cause tearing, irritation, and eye discomfort.

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Things worth knowing about "Ectropion"

Ectropion is a condition in which the eyelid turns outward, exposing the inner surface. It most often affects the lower eyelid and can cause tearing, irritation, and eye discomfort.

What is Ectropion?

Ectropion is a condition in which the eyelid turns outward and sags away from the surface of the eye. It most commonly affects the lower eyelid. When the lid no longer lies against the eyeball, the sensitive inner lining (conjunctiva) is exposed to air and environmental irritants. Without treatment, ectropion can lead to significant discomfort and, in severe cases, lasting damage to the eye surface.

Causes

Ectropion can arise from several different causes, and it is classified accordingly:

Age-related (involutional) ectropion: The most common form. As a person ages, the muscles and connective tissues supporting the eyelid lose tone and elasticity, causing the lid to sag outward.
Cicatricial ectropion: Scarring caused by injuries, burns, or surgery near the eyelid can contract the skin and pull the lid outward.
Paralytic ectropion: Paralysis of the facial nerve (cranial nerve VII) reduces muscle control of the eyelid, allowing it to fall away from the eye.
Mechanical ectropion: Tumors or growths near the lid can physically push the eyelid outward.
Congenital ectropion: Very rare; present from birth and often associated with genetic conditions.

Symptoms

Symptoms result from reduced eyelid protection and impaired tear drainage:

Excessive tearing (epiphora), as the tear drainage point no longer contacts the eye
Burning, irritation, and redness of the eye
Sensation of dryness or paradoxical overproduction of tears
Conjunctivitis (inflammation of the conjunctiva)
Corneal damage in severe, untreated cases
Light sensitivity and blurred vision

Diagnosis

Ectropion is diagnosed by an ophthalmologist through clinical examination. Common assessment steps include:

Slit-lamp examination: Detailed evaluation of the eyelid, conjunctiva, and cornea.
Eyelid laxity tests: Assessment of lid tension and muscle tone (e.g., snap-back test, distraction test).
Underlying cause workup: If nerve palsy or a tumor is suspected, further investigations are initiated.

Treatment

Conservative Management

For mild cases or as a bridge to surgery, the following measures can provide symptomatic relief:

Artificial tears (eye drops or gel) to lubricate the conjunctiva and cornea
Eye ointments, especially for use at night
Adhesive tape to temporarily hold the eyelid in place

Surgical Treatment

Surgery is the only permanently effective treatment. The procedure chosen depends on the underlying cause:

Lid tightening (lateral canthopexy or canthoplasty): The lid is repositioned by tightening the supporting connective tissue. This is the standard approach for age-related ectropion.
Skin grafting: In cicatricial ectropion, missing or contracted skin is replaced with a graft to restore normal lid position.
Weight or spring implants: In paralytic ectropion, small gold weights or spring implants are placed in the upper eyelid to assist lid closure and protect the cornea.

After surgery, most patients experience significant improvement in symptoms and lasting protection of the ocular surface.

References

Kanski, J. J. & Bowling, B.: Clinical Ophthalmology: A Systematic Approach, 8th edition, Elsevier, 2015.
American Academy of Ophthalmology (AAO): Ectropion - Preferred Practice Pattern, available at: https://www.aao.org (accessed 2022).
Collin, J. R. O.: A Manual of Systematic Eyelid Surgery, 3rd edition, Elsevier Churchill Livingstone, 2006.

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