Ectropion

What is an ectropion?

Eye with 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 surfaces of the eyes

What causes an ectropion?

An eye ectropion mainly occurs in older people. It is thought that the small eyelid muscles around the eye 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 nerves and muscles, including facial paralysis, may also affect the eyelid and cause an ectropion.

Ectropion symptoms

Symptoms of ectropion include:

• 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 might have excessive tearing to protect the surface (cornea) of the eye and keep the eye lubricated, 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.

When to see a doctor about ectropion

You should see a doctor if you think you have ectropion. If necessary, your GP will refer you to an eye specialist (ophthalmologist) for further assessment and treatment.

If your eye is very red and painful or you have reduced vision or sensitivity to light, you should contact a GP or NHS 111 immediately, or go to your nearest hospital A&E department.

Ectropion treatment

Treatment for ectropion depends on the severity and the underlying cause.

• Mild ectropion may not need any treatment.

• Minor problems with an ectropion may respond to simple measures such as eye drops or eye ointment to help reduce irritation.

• It's also best to avoid rubbing or wiping your eyes as far as you can.

• Antibiotic eye drops may be needed for any episodes of infective conjunctivitis.

For severe ectropion, an operation will be recommended:

• Ectropion surgery aims 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 eyelid 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.

Complications with ectropion

An ectropion may interfere with the drainage of tears, which can make the eyes more vulnerable to bacterial infections (eg, infective conjunctivitis).

If you have a severe and untreated ectropion, you may develop a corneal ulcer (an ulcer on the surface of the eye). A corneal ulcer may affect your vision.

Can you prevent ectropion?

It is often not possible to prevent an ectropion but if the ectropion has been caused by a condition that causes scarring of the eyelid or near the eyelid (eg, burn, infection, tumour or injury), then early and effective treatment of the potential cause may help to prevent an ectropion from developing.

Dr Mary Lowth is an author or the original author of this leaflet.