What is ectropion?

Ectropion is a sagging or outward turning of an eyelid margin. Ectropion most often affects either one or both lower eyelids. But it can affect the upper eyelid as well.

Your eyelids help protect the outer part of your eye. The cornea is the clear part of the eye. It covers your iris and your pupil. The conjunctiva is a thin layer of tissue. It covers the inside of your eyelids and the white part of your eye (the sclera). The eyelids help keep your cornea and your conjunctiva moist with tears. This helps prevent eye irritation and infection.

When your eyelids turn outward, the cornea and conjunctiva are exposed. They can get dry, irritated, and even infected. This can lead to serious symptoms. In some severe cases, it can lead to vision loss.

What causes ectropion?

Ectropion is caused by many things. There are different types that depend on the cause. Some types of ectropion are present from birth (congenital), which is rare. Other types happen later in life (acquired). These are the types of acquired ectropion:

• Involutional ectropion. This often occurs as you get older. Over time, the collagen and elastic fibers in your eyelid can get weak. This causes your eyelid tissue to become very loose. Gravity can then cause your eyelid to fall open. This is the most common type of ectropion. It is most common in older adults. The other types of ectropion are rare.

• Cicatricial ectropion. This is caused by an abnormal contraction of your lower lid, often from scarring. This makes your lid open in an outward direction. It can be due to an eye infection, an eye injury, or problems after eye surgery. A bacterial infection called trachoma is a leading cause of this type of ectropion.

• Paralytic ectropion. This is due to a problem with the facial nerve. This nerve sends signals to the muscle right under your eye. Problems with the facial nerve can cause other problems with facial movement. Cranial nerve paralysis may happen as a result of a stroke.

• Mechanical ectropion. This happens when a tumor or other mass in your eyelid pulls the eyelid down.

Who is at risk for ectropion?

Being older raises your risk for ectropion. Your child may be more likely to have ectropion if they have a health condition from birth that can cause it. This includes Down syndrome.

What are the symptoms of ectropion?

Symptoms are caused by the cornea and conjunctiva being exposed. Symptoms can include:

• Excess tearing

• Dry eyes

• Inability to close the eyelids completely (especially with paralytic ectropion)

• Eye and eyelid itching, burning, or crusting (from chronic conjunctivitis)

• Blurry vision, sensitivity to light, and eye pain (from infection or ulceration of the cornea)

Sometimes ectropion is part of something called floppy eyelid syndrome. With this syndrome, your upper eyelids may easily turn inside out. You may often wake up with an eyelid that has turned inside out. Floppy eyelid syndrome can lead to symptoms like those of ectropion.

How is ectropion diagnosed?

Your eye care provider will ask about your health history and give you a physical exam. This will include an eye exam. Specialized eye tests are usually not needed to diagnose ectropion.

How is ectropion treated?

You may first use treatments, such as:

• Lubricating eye drops

• Steroid ointments

• Antibiotics (if there is an eye infection)

• Taping the eyelid back (especially at night)

Over time, many people with ectropion will need surgery. The type of surgery will depend on the cause of the ectropion. For example, your surgeon may need to remove excess skin. Your surgeon might need a donor skin graft to lengthen the skin under your eye. You may need a tumor removed from your eyelid. In most cases, surgery eases symptoms completely.

What are possible complications of ectropion?

Corneal infection leading to corneal ulcer is the most serious possible complication of ectropion. It can sometimes cause long-term damage. If your cornea gets scarred, light can't pass through it normally to reach the rest of your eye. Corneal infection and corneal ulcer can severely damage vision. This needs emergency evaluation and treatment.

It's important to follow your provider’s instructions after treatment. This may help reduce your risk for corneal infection and corneal ulcer. Seek medical care right away if you have any symptoms. Symptoms of corneal infection and corneal ulcer include:

• Blurry vision

• More sensitivity to light

• Severe eye pain and soreness

• Increased eye redness

• Eye discharge

• Swollen eyelids

• White spot on your cornea that you may not be able to see

When should I call my healthcare provider?

Contact your eye care provider right away if you have rapidly increasing pain, redness, light sensitivity, or decreasing vision. These might be signs of a corneal infection. You will need treatment right away to prevent permanent vision damage or even blindness.

Key points about ectropion

• Ectropion is a sagging or outward turning of an eyelid. It more often affects a lower eyelid.

• Various causes can lead to ectropion. The most common cause is getting older. With age, the muscle and skin under your eye become weak.

• Sometimes it is present at birth (congenital), which is rare. It may be linked to another health problem, such as Down syndrome.

• Over time, you may need surgery. This often relieves symptoms completely.

• Seek medical care right away if you have any symptoms of corneal infection or corneal ulcer. This can prevent permanent vision damage or loss.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.