Ectropion

Overview

Ectropion (ek-TROH-pee-on) is a condition in which your eyelid turns outward. This leaves the inner eyelid surface exposed and prone to irritation.

Ectropion is more common in older adults, and it generally affects only the lower eyelid. In severe ectropion, the entire length of the eyelid is turned out. In less severe ectropion, only one segment of the eyelid sags away from the eye.

Artificial tears and lubricating ointments can help relieve symptoms of ectropion. But usually surgery is needed to fully correct the condition.

Symptoms

Normally when you blink, your eyelids distribute tears evenly across your eyes, keeping the surfaces of the eyes lubricated. These tears drain into small openings on the inner part of your eyelids (puncta).

If you have ectropion, your lower lid pulls away from your eye and tears don't drain properly into the puncta. The resulting signs and symptoms can include:

• Watery eyes (excessive tearing). Without proper drainage, your tears may pool and constantly flow over your eyelids.
• Excessive dryness. Ectropion can cause your eyes to feel dry, gritty and sandy.
• Irritation. Stagnant tears or dryness can irritate your eyes, causing a burning sensation and redness in your eyelids and the whites of your eyes.
• Sensitivity to light. Stagnant tears or dry eyes can irritate the surface of the cornea, making you sensitive to light.

When to see a doctor

See your doctor if your eyes are constantly watering or irritated, or your eyelid seems to be sagging or drooping.

Seek immediate care if you have been diagnosed with ectropion and you experience:

• Rapidly increasing redness in your eyes
• Sensitivity to light
• Decreasing vision

These are signs and symptoms of cornea exposure or ulcers, which can harm your vision.

Causes

Ectropion can be caused by:

• Muscle weakness. As you age, the muscles under your eyes tend to weaken, and tendons stretch out. These muscles and tendons hold your eyelid taut against your eye. When they weaken, your eyelid can begin to droop.
• Facial paralysis. Certain conditions, such as Bell's palsy, and certain types of tumors can paralyze facial nerves and muscles. Facial paralysis that affects eyelid muscles can lead to ectropion.
• Scars or previous surgeries. Skin that has been damaged by burns or trauma, such as a dog bite, can affect the way that your eyelid rests against your eye. Previous eyelid surgery (blepharoplasty) can cause ectropion, particularly if a considerable amount of skin was removed from the eyelid at the time of surgery.
• Eyelid growths. Benign or cancerous growths on your eyelid can cause the lid to turn outward.
• Genetic disorders. Rarely is ectropion present at birth (congenital). When it is, it's usually associated with genetic disorders, such as Down syndrome.

Risk factors

Factors that increase your risk of developing ectropion include:

• Age. The most common cause of ectropion is weakening muscle tissue associated with aging.
• Previous eye surgeries. People who have had eyelid surgery are at higher risk of developing ectropion later.
• Previous cancer, burns or trauma. If you've had spots of skin cancer on your face, facial burns or trauma, you're at higher risk of developing ectropion.

Complications

Ectropion leaves your cornea irritated and exposed, making it more susceptible to drying. The result can be abrasions and ulcers on the cornea, which can threaten your vision.

Diagnosis

Ectropion can usually be diagnosed with a routine eye exam and physical. Your doctor may pull on your eyelids during the exam or ask you to close your eyes forcefully. This helps him or her assess each eyelid's muscle tone and tightness.

If your ectropion is caused by a scar, tumor, previous surgery or radiation, your doctor will examine the surrounding tissue as well.

Understanding how other conditions cause ectropion is important in choosing the correct treatment or surgical technique.

Treatment

If your ectropion is mild, your doctor might recommend artificial tears and ointments to ease the symptoms. Surgery is generally required to fully correct ectropion.

Surgery

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 muscle and ligament relaxation due to aging. Your surgeon will likely remove a small part of your lower eyelid at the outer edge. When the lid is stitched back together, the tendons and muscles of the lid will be tightened, causing the lid to rest properly on the eye. This procedure is generally relatively simple.
• Ectropion caused by scar tissue from injury or previous surgery. Your surgeon might need to use a skin graft, taken from your upper eyelid or behind your ear, to help support the lower lid. If you have facial paralysis or significant scarring, you might need a second procedure to completely correct your ectropion.

Before surgery, you'll receive a local anesthetic to numb your eyelid and the area around it. You may be lightly sedated using oral or intravenous medication to make you more comfortable, depending on the type of procedure you're having and whether it's done in an outpatient surgical clinic.

After surgery you might need to:

• Wear an eye patch for 24 hours
• Use an antibiotic and steroid ointment on your eye several times a day for one week
• Use cold compresses periodically to decrease bruising and swelling

After surgery you will likely experience:

• Temporary swelling
• Bruising on and around your eye

Your eyelid might feel tight after surgery. But as you heal, it will become more comfortable. Stitches are usually removed about a week after surgery. You can expect the swelling and bruising to fade in about two weeks.

Lifestyle and home remedies

These lifestyle tips may relieve your discomfort from ectropion:

• Use eye lubricants. Artificial tears and eye ointments can help keep your cornea lubricated and prevent vision-threatening damage. Using an eye ointment and wearing a moisture shield over your eye is particularly useful overnight.
• Wipe your eyes carefully. Constantly wiping watery eyes can make your under-eye muscles and tendons stretch even further, worsening your ectropion. Wipe from the outer eye up and in toward the nose.

Preparing for an appointment

If you have signs and symptoms of ectropion, you're likely to start by seeing your primary care doctor. He or she may refer you to a doctor who specializes in treating eye disorders (ophthalmologist).

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment take these steps:

• List symptoms you've been having and for how long.
• Find a photo of yourself before the appearance of your eyelid changed that you can bring to the appointment.
• List all medications, vitamins and supplements you take, including the doses.
• List key personal and medical information, including other conditions, recent life changes and stressors.
• List questions to ask your doctor.
• Ask a relative or friend to accompany you, to help you remember what the doctor says.

For ectropion, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• What kinds of tests do I need? Do they require any special preparation?
• Is this condition temporary or long lasting?
• Can ectropion damage my vision?
• What treatments are available, and which do you recommend?
• What are the risks of surgery?
• What are the alternatives to surgery?
• I have these other health conditions. How can I best manage them together?
• Do you have any brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• When did you begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• Have you had any previous surgery or procedures on your eye or eyelid?
• Have you had any radiation treatments of your head and neck?
• Have you had any other eye problems, such as an eye infection or an injury?
• Are you taking any blood thinners?
• Are you taking aspirin?
• Are you using any eyedrops?