Ectropion

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who have ectropion, or who would like information about it.

Ectropion is a condition which causes the eyelid to turn outwards and droop away from the eye. It can happen to one or both eyes, and usually affects the bottom lid.

About ectropion

Ectropion is a condition where your eyelid turns outwards and droops away from your eyeball.

                                                            Ectropion

Ectropion can develop in either your upper or lower eyelid, but gravity means that it's more likely to develop in your lower eyelid. It usually starts in the middle of your eyelid, but if you have had the condition for a while it may also affect the outside edge of your lid.

Your top and bottom eyelid usually meet in the middle and fit together tightly when you blink or close your eyes. This protects your eye and helps to keep it moist and healthy. If you have ectropion your lids don't meet properly, and this means that your eye can become dry.

If your eyelid droops then the tear duct, which usually sits on the surface of your eye, is dragged down. This means that your tears can't drain away properly. This can make your eyes water and cause tears to overflow onto your cheek.

Ectropion can develop in people of any age, but it mostly affects older people.

Symptoms of ectropion

You may be able to see changes to your eyelid when you look at your eye in a mirror. Common symptoms of ectropion include:

• irritated, red eyes
• watering eyes - you may need to keep wiping your eyes.

Complications of ectropion

Complications usually affect either your cornea, the clear dome that forms the front of the eyeball, or your conjunctiva, the lining of the inside of your eyelid and the white part of your eyeball.

Some of the main complications are listed below.

• Keratitis. This is when your cornea becomes inflamed. This is sometimes caused by an infection and can be painful.
  
• Corneal ulceration. Corneal ulceration is an ulcer or sore on your cornea. Your eye may be red and painful, you may find bright lights uncomfortable and you may have blurred vision. A corneal ulcer can be very serious and can cause loss of sight, so it's important to see your GP immediately if you have these symptoms.

Causes of ectropion

There are a number of possible causes of ectropion. Some of the main ones are listed below.

• Ageing. The most common cause of ectropion is ageing. As you get older the tendons and muscles around your eyes start to weaken, and this can cause your eyelids to droop.
• Facial palsy. This is a paralysis or weakness of muscles in your face. Weakness usually affects one side of your face and can be caused by conditions such as a stroke or Bell's palsy.
• Damage or injury. Burns, surgery to your face, or a skin condition, such as dermatitis or eczema, can all cause ectropion. This is usually due to scarring of your skin which contracts and pulls the edge of the eyelid down.
• Tumours. Large growths on the skin of your eyelid can pull it down.
• Congenital conditions. Ectropion can be something that you're born with, though this is rare.

Diagnosis of ectropion

Your GP will ask about your symptoms and examine your eyes. He or she may also ask you about your medical history.

If your condition is severe, your GP may refer you to an ophthalmologist, a specialist who identifies and treats eye conditions (including surgical treatments).

Treatment of ectropion

Your treatment will depend on the cause of your ectropion and how severe it is. If you have mild symptoms or a facial palsy such as Bell's palsy which is expected to get better on its own, you may not need any treatment.

Self-help

It's important to keep any exposed areas of your cornea moist and lubricated. If your cornea is always exposed you may need to wear contact lenses to cover it. You can also use eye drops called preservative-free artificial tears to keep your eye moist. You can buy these from your pharmacist. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Taping your eyelid upwards with surgical tape can help stop your eyeball being exposed. Taping may also help if you can't close your eye fully to sleep.

Rubbing your eye can make the condition worse so try not to touch it. If your eye is watering and you want to dry it, wipe your eyelid upwards and inwards (toward your nose).

Surgery

There are a number of different operations that can return your eyelid to its normal position. The operation you have will depend on the cause of your ectropion. Most operations involve tightening the skin, cartilage and muscles around your eyelid to prevent it from sagging. If your conjunctiva is red and inflamed your surgeon may ask you to use a lubricating ointment for a few days or weeks before your operation. This helps to prevent any infections or ulcers.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.