Description
Ectropion is where the lower eyelid droops away from the eye and turns outwards. It’s not usually serious, but can be uncomfortable. Ectropion mainly affects the lower eyelid and can happen in 1 or both eyes. Ectropion (ek-TROH-pee-on) is a condition in which your eyelid turns outward. This leaves the inner eyelid surface exposed and prone to irritation. Ectropion is more common in older adults, and it generally affects only the lower eyelid. In severe ectropion, the entire length of the eyelid is turned out. In less severe ectropion, only one segment of the eyelid sags away from the eye. Artificial tears and lubricating ointments can help relieve symptoms of ectropion. But usually surgery is needed to fully correct the condition.
Symptoms for Ectropion
Normally when you blink, your eyelids distribute tears evenly across your eyes, keeping the surfaces of the eyes lubricated. These tears drain into small openings on the inner part of your eyelids (puncta).
If you have ectropion, your lower lid pulls away from your eye and tears don’t drain properly into the puncta. The resulting signs and symptoms can include:
• Watery eyes (excessive tearing). Without proper drainage, your tears may pool and constantly flow over your eyelids.
• Excessive dryness. Ectropion can cause your eyes to feel dry, gritty and sandy.
• Irritation. Stagnant tears or dryness can irritate your eyes, causing a burning sensation and redness in your eyelids and the whites of your eyes.
• Sensitivity to light. Stagnant tears or dry eyes can irritate the surface of the cornea, making you sensitive to light.
Causes of Ectropion
An ectropion mainly occurs in older people. It is thought that the small muscles around the eyelid become weak with ageing. In most cases there is no other underlying problem. Additional images of the condition can be found under Further Reading and References below.
An ectropion may also be caused by any condition that causes scarring of the eyelid or near the eyelid. For example, a burn, infection, tumour or injury to the eyelid.
• Muscle weakness. As you age, the muscles under your eyes tend to weaken, and tendons stretch out. These muscles and tendons hold your eyelid taut against your eye. When they weaken, your eyelid can begin to droop.
• Facial paralysis. Certain conditions, such as Bell’s palsy, and certain types of tumors can paralyze facial nerves and muscles. Facial paralysis that affects eyelid muscles can lead to ectropion.
• Scars or previous surgeries. Skin that has been damaged by burns or trauma, such as a dog bite, can affect the way that your eyelid rests against your eye. Previous eyelid surgery (blepharoplasty) can cause ectropion, particularly if a considerable amount of skin was removed from the eyelid at the time of surgery.
• Eyelid growths. Benign or cancerous growths on your eyelid can cause the lid to turn outward.
• Genetic disorders. Rarely is ectropion present at birth (congenital). When it is, it’s usually associated with genetic disorders, such as Down syndrome.
Diagnosis
Ectropion can usually be diagnosed with a routine eye exam and physical. Your doctor may pull on your eyelids during the exam or ask you to close your eyes forcefully. This helps him or her assess each eyelid’s muscle tone and tightness.
If your ectropion is caused by a scar, tumor, previous surgery or radiation, your doctor will examine the surrounding tissue as well. Understanding how other conditions cause ectropion is important in choosing the correct treatment or surgical technique. Ectropion can usually be diagnosed with a routine eye exam and physical. Your doctor may pull on your eyelids during the exam or ask you to close your eyes forcefully. This helps him or her assess each eyelid’s muscle tone and tightness.
Treatment
• The usual treatment is an operation to tighten the skin and muscles around the eyelid. The operation may be done using local anaesthetic to numb the eyelid, and a mild sedative to help you relax.
• The type of surgery you have depends on the condition of the tissue surrounding your eyelid and on the cause of your ectropion:
• Ectropion caused by aging. Your surgeon will remove a small part of your lower eyelid at the outer edge. When the lid is stitched together, the tendons and muscles of the lid will be tightened, causing the lid to rest properly on the eye.
• Ectropion caused by scar tissue from injury or previous surgery may require a skin graft to help support the lower lid. Some patients with facial paralysis or significant scarring need a second procedure to completely correct your ectropion.
If you cannot shut your eye properly then you may be prescribed some lubricating eye ointment to help protect the cornea. You may also be advised to tape the lower and upper eyelids together overnight to protect your cornea when you are asleep.
Surgery
The type of surgery you have depends on the condition of the tissue surrounding your eyelid and on the cause of your ectropion:
• Ectropion caused by muscle and ligament relaxation due to aging. Your surgeon will likely remove a small part of your lower eyelid at the outer edge. When the lid is stitched back together, the tendons and muscles of the lid will be tightened, causing the lid to rest properly on the eye. This procedure is generally relatively simple.
• Ectropion caused by scar tissue from injury or previous surgery. Your surgeon might need to use a skin graft, taken from your upper eyelid or behind your ear, to help support the lower lid. If you have facial paralysis or significant scarring, you might need a second procedure to completely correct your ectropion.
These lifestyle tips may relieve your discomfort from ectropion:
• Use eye lubricants. Artificial tears and eye ointments can help keep your cornea lubricated and prevent vision-threatening damage. Using an eye ointment and wearing a moisture shield over your eye is particularly useful overnight.
• Wipe your eyes carefully. Constantly wiping watery eyes can make your under-eye muscles and tendons stretch even further, worsening your ectropion. Wipe from the outer eye up and in toward the nose.