Ectropion

What is an ectropion?

Ectropion is when your lower eyelid turns outwards and droops away from your eye, exposing the surface of the inner eyelid.

What causes ectropion?

The main cause of ectropion is muscle weakness or tissue laxity that develops as part of the normal ageing process; the risk increases with age.

Other causes include:

• Stroke
• Skin cancer
• Injury
• Scar tissue from injuries or burns
• Growths on the eyelid (either cancerous or benign)
• Genetic abnormalities (from genetic disorders such as Down syndrome)
• Bell’s palsy – which damages the nerve that controls the facial muscles – or other types of facial paralysis
• Previous eyelid surgery or radiotherapy
• Rapid and significant weight loss

What are the symptoms of ectropion?

When you blink, your eyelids spread tears across the eye to protect and lubricate it. The tears drain through the lacrimal puncta, small openings on the inner edge of the eyelids that lead into the nasolacrimal duct.

When the lower eyelid turns outwards, this drainage is disrupted, which can lead to a variety of symptoms, including:

• excessive watering
• excessive dryness
• irritation
• a burning sensation
• redness
• chronic conjunctivitis

If you have symptoms of ectropion, seek medical attention promptly, as a delay in treating the condition can lead to serious complications. See your doctor immediately if you experience any of the following:

• sudden sensitivity to light
• eye pain
• rapidly increasing redness of the eye
• decreased vision

What are the complications associated with ectropion?

Long-standing irritation, excessive dryness and corneal exposure can lead to conjunctivitis or an eye infection, with pus or discharge around the eye and on the eyelashes, especially on waking in the morning.

Other complications may include:

• corneal abrasions (scratches on the cornea, at the surface of the eye)
• corneal ulcers (open sores on the cornea, at the surface of the eye)
• impaired vision
• permanent vision loss

What are the treatment options for ectropion?

While you are waiting for surgical treatment, lubricating eye drops can provide relief and protect the cornea from further damage.

Note, however, that wiping your eyes incorrectly can make the problem worse. Always wipe from the outer corner of the eye inwards towards the nose, using an “up and in” motion.

Skin tape can be used to lift the lower eyelid and hold it in place, relieving some symptoms — but always ask your ophthalmologist for instructions and advice first.

Surgery

In most cases surgery is necessary. It is usually performed under local anaesthesia.

During the operation the surgeon usually removes a small section of the lower eyelid, with stitches placed under the eyelid or at the outer corner of the eye. In most cases the operation is highly effective and resolves the problem.

If your ectropion is due to scar tissue or a shortage of eyelid skin, you may need a skin graft (skin transplant). Your oculoplastic surgeon will take skin from behind your ear or from your upper eyelid and attach it to the lower lid.

If you have previously had facial paralysis, or have extensive scarring, more than one operation may be needed to achieve the best result and fully resolve the problem.

Some patients feel relief immediately, while others notice it within days or a few weeks. Once treatment and healing are complete, most patients have no further symptoms.