When part or all of the lower eyelid turns outwards away from the eye, the condition is known as an ectropion. There are various causes but the most common cause is an ageing effect of the eyelid that occurs in some older people. A straightforward operation can usually cure the problem.
What is an ectropion?
When part or all of the lower eyelid turns outwards away from the eye, the condition is known as an ectropion. Someone looking at you might be able to see part of the pink inner surface of the affected eyelid.
What is the cause of an 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.
Any condition that causes weakness of the facial muscles, including facial paralysis, may also affect the eyelid and cause an ectropion.
What are the symptoms of an ectropion?
- One eye alone may be affected, although age-related ectropion most commonly affects both eyes.
- The inner lining of the eyelid that droops forward may become dry and sore.
- In severe ectropion the whole length of the eyelid may turn outwards; milder cases may just involve part of the lid.
- The affected eye makes more tears to protect the surface (cornea) of the eye and so the eye may become constantly watery.
- The part of the eyelid next to the nose usually droops the most. This is next to the tear duct where tears normally drain into the nose. Tears may roll off the drooping part of the eyelid.
- Damaged cornea. The cornea is the transparent front part of the eye. The eyes may not close properly if you have an ectropion. Therefore, the cornea is not fully protected and can become dry and sore. A corneal ulcer may develop. As the cornea is vital for vision, this can affect your eyesight.
What is the treatment for an ectropion?
- 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.
- If your ectropion causes watery eyes, when wiping your eyelids do it in a direction up and in (towards the nose). This prevents you from pulling the eyelid downward and making the ectropion worse.
Further reading and references
Bergstrom R, Czyz CN; Ectropion Lower Eyelid Reconstruction
Guthrie AJ, Kadakia P, Rosenberg J; Eyelid Malposition Repair: A Review of the Literature and Current Techniques. Semin Plast Surg. 2019 May33(2):92-102. doi: 10.1055/s-0039-1685473. Epub 2019 Apr 26.
Borrelli M, Geerling G; Current concepts of ocular adnexal surgery. GMS Interdiscip Plast Reconstr Surg DGPW. 2013 Feb 272:Doc06. doi: 10.3205/iprs000026. eCollection 2013.