Ectropion is a condition in which the eyelid (usually the lower lid) turns out. The inner eyelid surface is left exposed and prone to irritation. Ectropion more commonly occurs in older adults.
In mild ectropion only one part of the eyelid sags away from the eye while in severe cases, the entire length of the eyelid is turned out.
Artificial tears can help relieve some of the symptoms associated with ectropion until surgery is available to correct the condition.
Symptoms
The eyelids distribute tears evenly across the eye through blinking. The tears keep the eyes lubricated and drain into little openings on the inner part of the eyelids (puncta). In ectropion, the lower lid pulls away from the eye and tears don’t drain properly causing the following symptoms:
- Irritation: Stagnant tears or dryness causes irritation to the eyes and a burning sensation and redness in the eyelids and the whites of the eyes.
- Excessive tearing: Without proper drainage, the tears can pool and constantly flow over the eyelids causing watery or weepy eyes.
- Excessive dryness: Ectropion may cause the eyes to feel dry, gritty and sandy.
Causes
Ectropion may result from several different causes:
- Muscle weakness: The muscles under the eyes get weaker as age increases. The muscles and tendons hold the eyelid taut against the eye so when they relax the eyelid may begin to droop and turn outward.
- Facial paralysis: If some of the facial nerves and muscles are paralyzed it can affect the eyelid muscles and cause ectropion.
- Scars or skin problems: Scarred skin from facial burns or trauma may affect the way the eyelid rests against the eye.
- Eyelid growths: Benign or cancerous growths on the eyelid can cause ectropion.
- Previous surgery, radiation or cosmetic procedures can lead to the development of ectropion later on.
- Congenital ectropion: In rare cases, ectropion is present since birth but it is usually associated with genetic disorders such as Down syndrome.
- Drug reaction: Certain medications (ex. Drops to treat glaucoma) may cause ectropion.
Risk factors
Risk factors for ectropion include:
- Age: Increasing age increases the risk of developing ectropion.
- Previous eye surgeries: Previous eyelid surgery (blepharoplasty) increases the risk of ectropion.
- Previous cancer, burns or trauma: Spots of skin cancer on the face, facial burns or trauma increases the risk of developing ectropion.
Complications
The most serious complications associated with ectropion are irritation and damage of the cornea. Ectropion leaves the cornea irritated and exposed making it more prone to drying. This can result in corneal abrasions and ulcers, which can cause permanent vision loss. Lubricating eye drops and ointments can protect the cornea and prevent damage until the ectropion is corrected.
Surgery
There are several types of surgical procedures for ectropion depending on the cause and the condition of the tissue surrounding the eyelid.
An ectropion caused by muscle and ligament weakness due to aging can be corrected by a surgical procedure in which a small part of the lower eyelid at the outer edge is removed to tighten the muscles and tendons of the lid.
An ectropion caused by scar tissue from an injury or previous surgery can be corrected by placing a skin graft taken from the upper eyelid or behind the ear to create support for the lower lid.
Following the surgery, wearing an eye patch for 24 hours may be necessary along with an antibiotic and steroid ointment for the eye.
Bleeding and infection are possible risks of surgery. However, it is more likely to experience some temporary swelling and bruising after the procedure.
