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 eye dryness, excessive tearing, and irritation. Ectropion may be due to several factors, including facial paralysis and injury. The most common cause is muscle weakness or slipping 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 cause blindness.
Eye lubricants can help ease symptoms, but surgery is usually necessary to achieve full correction. Most people who have the surgery experience a positive outcome.
The primary cause of ectropion is muscle weakness or tissue relaxation that occurs as part of the normal aging process. Your risk of developing ectropion increases with age.
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 such as Down syndrome)
- Bell’s palsy — which damages the nerve that controls facial muscles — or other types of facial paralysis
- prior surgery or radiation treatment of the eyelids
- rapid and significant weight loss
When you blink, your eyelids help distribute tears that protect and lubricate your eyes. The tears drain into the puncta, which are openings inside your eyelids that lead to the tear ducts.
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”)
If you have symptoms of ectropion, you need prompt medical care. 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 of eyes
- decreased vision
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 inward to the nose, using an “up-and-in motion.”
Skin tape, an adhesive made specifically for the skin, may be used to lift the lower lid and hold it in place to relieve some symptoms. However, be sure to ask your doctor for instructions and recommendations first.
Stretching of scar tissue
If the problem is due to scar tissue, your doctor may recommend scar tissue stretching. This involves steroid injections and scar tissue massaging. This procedure, however, doesn’t always work.
Most of the time, surgery is necessary. Surgery can occur during a hospital stay, but it’s usually done as an outpatient procedure under local anesthetic.
During the operation, the surgeon usually removes part of the lower eyelid. This 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 is due to scar tissue or insufficient eyelid skin, you may need a skin graft (skin transplant). Your doctor will take skin from behind your ear or from your upper eyelid and attach it 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 receive 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, and others find relief within days or a few weeks. Most patients have no further symptoms after treatment and healing,
Long-term irritation, excessive dryness, and exposure of the cornea can lead to conjunctivitis, or infection of the 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 may 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
Most of the time, it’s not possible to prevent the conditions that lead to ectropion. However, seeking treatment early can help minimize damage and avoid serious complications.