Ectropion

An ectropion (ek-TROW-pee-on) is an outward-turned eyelid that leans away from its natural position against the eyeball.  Usually only the lower lids (one or both) are involved, though the upper lids can also be affected.  Most people find the condition only annoying, but occasionally it can pose a problem, even a danger to the eye. 

What Makes an Ectropion Serious?

The eyelids protect and help lubricate the eyeball.  When you sleep, they cover the eyes and keep them from drying out.  When you are awake, each blink of the upper lid moving over the eyeball acts as a “windshield wiper”, moistening and cleansing the eyeball.  The lower eyelid helps cover and moisten the lower part of the eyeball.  When an ectropion develops, there is a loss of moisture due to exposure, the surface of the eye can dry which can lead to infections.

Symptoms

Ectropion of the lower eyelid:  A normal lid maintains a thin layer of tears over the eyeball and aids their natural flow toward the tear drainage channels near the nose.  If the lid falls away from its normal position, the eye feels full of tears and waters all the time, sometimes tears may even run down your cheek.  Despite the excess tears, you may have a continuous sensation of irritation, burning or dryness of the eye.  As the condition progresses the lid pulls farther away from the eye.  If the eyeball dries too much or begins to ulcerate, it will become bloodshot, irritated, and painful.

Ectropion of the upper eyelid:  Loss of the “windshield wiper” effect causes continual dryness and blurry vision. Your eye compensates by generating more moisture, which can cause further blur and also adds to the feeling that the eye is watering all the time.  However, most of the watering occurs because the lid is not positioned properly, which prevents normal tear drainage in the nose.

What Causes an Ectropion?

The eyelids are held against the eyeballs by the natural tension of the eyelid muscles and the tendons that support them.  With aging, these muscles do not function as well, and the lids fall way from the eyeball, especially when you lean forward.  An ectropion may also result from scars after cuts or surgery near the eyes, from burns, from disease (such as facial paralysis), or from some degenerative skin conditions that cause the lids to pull away from the eye.

Treatment

Treatment varies according to the cause, your age and occupation, the severity of the condition and the symptoms, whether it is progressing, and whether you have had previous treatment or surgery.

If your ectropion is slight, various eye drops may offer relief.  If the lid is actually falling outward, dryness of its inner surface may be relieved with lubricant ointments.  Depending on your symptoms, you may choose to live with a mild ectropion. That choice is satisfactory if the appearance doesn’t bother you, if drying is not excessive, and if there is no ulceration or infection of the eyeball.

For a severe case with severer symptoms and discomfort, of if there is ulceration of the eyeball, plastic surgery of the lids becomes necessary.  In most cases, surgery involves removing the excessive tissue and tightening the remaining tissue.  Although surgery is usually curative, some patients achieve only partial improvements.

Sometimes the ectropion recurs as the tissues continue to age and lose elasticity, and surgery may again be needed to solve the problem.