What is ectropion?

Ectropion is a sagging or outward turning of an eyelid. It usually affects a lower eyelid. Ectropion often affects both lower eyelids. Sometimes it only affects one side.

Your eyelids help protect the outer portion of your eye. The cornea is the transparent part of the eye that covers your iris and your pupil. The conjunctiva is the thin layer of tissue that covers the inside of your eyelids and the sclera (the white part of your eye). 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 become exposed. They can become dry, irritated, and even infected. This can lead to serious symptoms. In some cases, it can lead to vision loss.

What causes ectropion?

Ectropion is caused by many things. There are different types that depend on the causes. Congenital ectropion is present from birth. Acquired ectropion happens later in life. There are different types of acquired ectropion. These are:

• Involutional ectropion. This type often results from aging. 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 elderly people. The other types of ectropion are rare. Congenital ectropion may be more common in infants from the Afro-Caribbean and certain other regions.
• Cicatricial ectropion. This is caused by an abnormal contraction of your lower lid. This is often from scarring. This causes your lid to open in an outward direction. This might happen because of an eye infection, an eye injury, or problems after eye surgery. An infection called trachoma is a leading cause of cicatricial ectropion. It is caused by bacteria.
• Paralytic ectropion. This results from a problem with your seventh cranial nerve (the facial nerve). This nerve sends signals to the muscle right under your eye. Problems with the nerve can cause other problems in 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.
• Congenital ectropion. This type is present from birth. It is often due to a lack of skin in the area under the eye. This may happen because of problems with certain genes. This type of ectropion most often happens with other medical conditions. These conditions include blepharophimosis syndrome, Down syndrome, and ichthyosis.

Who is at risk for ectropion?

Increased age raises your risk for ectropion. Your child may be more likely to have ectropion if he or she has a medical condition from birth that can cause ectropion. This includes Down syndrome.

What are the symptoms of ectropion?

The symptoms are caused by the cornea and conjunctiva being exposed, and 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 healthcare provider will ask about medical history and give a physical exam. This will include an eye exam. Other tests are 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)

Most people with ectropion will need some sort of surgery. The type of surgery may differ. It depends 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 beneath your eye. You may need a tumor removed from your eyelid. In most case, surgery relieves symptoms completely.

What are the complications of ectropion?

Corneal infection leading to corneal ulcer is the most significant possible complication of ectropion and can sometimes cause long-term damage. If your cornea becomes scarred, light cannot pass through it normally to reach the rest of your eye. Corneal infection and corneal ulcer can significantly damage vision and require prompt evaluation and treatment.

Following your provider’s instructions after treatment may help reduce your chance for corneal infection and corneal ulcer. To decrease your chance of permanent vision loss, see your eye care professional right away if you have any symptoms of corneal infection or corneal ulcer. Symptoms of corneal infection and corneal ulcers can include:

• Blurry vision
• Increased sensitivity to light
• Eye pain
• Increased eye redness
• Discharge from the eye

When should I call my healthcare provider?

Call 911 if you have rapidly increasing pain, redness, light sensitivity, or decreasing vision. These might be signs of a corneal infection, which might need immediate treatment.

Key points about ectropion

Ectropion is an abnormally sagging or outwardly turning eyelid, usually the lower eyelid.

• Various causes can lead to ectropion. The most common cause is advancing age. With age, the muscle and skin beneath your eye become lax.
• Sometimes, ectropion is present at birth. It may be a component of another medical problem, such as Down syndrome.
• If you have ectropion, you will probably need surgical treatment eventually. Surgery usually relieves symptoms completely.
• Call your healthcare provider immediately if you have any signs of corneal infection or corneal ulcer. This can cause permanent vision loss and needs prompt treatment.

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.