Ectropion (ek-TROH-pee-on) is when your lower eyelid turns or sags outward, away from your eye, exposing the surface of your inner eyelid.
This condition can cause dryness, excessive tearing, and irritation. Ectropion can be caused by several factors, including facial paralysis and injury. The most common cause is muscle relaxation due to aging.
If you have symptoms of ectropion, you should seek medical attention. Without treatment, ectropion can lead to serious problems with your cornea and can even lead to blindness. Eye lubricants can help ease symptoms, but surgery is usually required. Most people who have the surgery experience a positive outcome.
The primary cause of ectropion is the muscle weakness or tissue relaxation that occurs as part of the normal aging process. Other triggers include:
- skin cancer
- scar tissue from injuries or burns
- growths on the eyelid (either cancerous or benign)
- birth defects due to genetic disorders like Down syndrome
- Bell’s palsy (a condition that damages the nerve that controls facial muscles) or other types of facial paralysis
- prior surgery or radiation treatment of the eyelids
- rapid weight loss
Your risk of developing ectropion increases with age.
When you blink, your eyelids help to distribute tears that protect and lubricate your eyes. The tears drain into the tear ducts that are inside your eyelids. When the lower lid turns outward, it affects the way tears drain. This can result in a variety of symptoms, including:
- excessive tearing
- excessive dryness
- chronic conjunctivitis (inflammation also known as “pink eye”)
Long-term irritation, excessive dryness, and exposure of the cornea can lead to infection of the eye, called conjunctivitis, or pink eye. This can result in infected pus or fluid around your eye and on your eyelashes, especially when you wake up in the morning. Other complications include:
- corneal abrasions(scratches on the cornea or surface of the eye)
- corneal ulcers (sores on the cornea or surface of the eye)
- impaired vision
- permanent blindness
If you have symptoms of ectropion, prompt medical care is needed. Delay in treating this condition can lead to serious complications. If you experience any of the following symptoms, they should be immediately addressed by your doctor:
- sudden sensitivity to light
- eye pain
- rapid increase in redness
- decreased vision
A routine eye exam and physical check of the face are usually all that is needed to make the diagnosis.
While awaiting treatment, lubricating drops can provide relief and protect your cornea from further damage. However, note that improper wiping of your eyes can aggravate the problem. Always wipe from the outer eye up to the nose, using an "up-and-in" motion.
Using skin tape—an adhesive made specifically for the skin—to lift the lower lid and hold it in place may relieve some symptoms. However, be sure to ask your doctor for instructions and recommendations first.
Stretching of Scar Tissue
If the problem was caused by scar tissue, your doctor may recommend scar tissue stretching. This involves steroid injections and/or scar tissue massaging. However, this procedure does not always work.
Most of the time, surgery is required. It may be performed during a hospital stay, but is usually done as an outpatient procedure under local anesthetic.
During the operation, the surgeon generally removes part of the lower eyelid. This procedure requires stitches below the eyelid or on the outside corner of your eye. In most cases, this surgery is quite effective and resolves the problem.
If your ectropion was due to scar tissue, you may need a skin graft (skin transplant). The skin is usually taken from behind your ear or from your upper eyelid and attached to your lower lid.
If you previously had facial paralysis or a lot of scarring, it may take multiple surgeries to get the best result and fully resolve the problem.
You may need to wear a temporary eye patch after surgery. You may also be given a steroid ointment and antibiotics to prevent infection. Over-the-counter pain relievers and cold compresses can help with pain and swelling. Some patients feel relief immediately, others within days or a few weeks. Following treatment and healing, most patients have no further symptoms.
Most of the time, it is not possible to prevent the conditions that lead to ectropion. However, seeking treatment early can help to minimize damage and avoid serious complications.