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Disease: Ectropion Ectropion
Category: Eye diseases

Disease Definition:

When one of the eyelids, usually the lower one, turns out and leaves the inner eyelid surface exposed and prone to irritation, a condition called ectropion results.


Usually, this condition occurs in older people, and it affects men more than women. In some severe cases, the entire length of the eyelid could be turned out. However, when the condition is not so severe, only one segment of the eyelid sags away from the eye.

Work Group:

Symptoms, Causes


Usually, the eyes are lubricated by the eyelids, which distribute tears evenly across them whenever someone blinks. The tears drain into the little openings on the inner part of the eyelids called puncta. However, the tears don’t drain into the puncta properly in case someone has ectropion and their lower lid is pulling away from their eye. This condition could cause a number of signs and symptoms, such as:

Excessive tearing:

Most people with ectropion complain of watery or weepy eyes because without proper drainage, the tears may pool and constantly flow over the eyelids.


A burning sensation and redness in the eyelids and in the whites of the eyes could be caused by irritation due to stagnant tears or dryness.

Excessive dryness:

Someone’s eyes could feel dry, gritty and sandy because of ectropion.


A person should see a doctor for an evaluation in case they notice that their eyes are constantly watering or irritated, or if their eyelid seems to be sagging or drooping.


In case a person knows that they have ectropion, they should be careful for symptoms of cornea exposure or ulcers, such as pain, light sensitivity, rapidly increasing redness or decreased vision. They should also seek immediate medical care in case they notice any of these vision-threatening signs and symptoms.


Some of the causes of ectropion include:

Facial paralysis:

The eyelid muscles could be affected when some of the facial nerves and muscles are paralyzed, as with Bell’s palsy and some types of tumor. This could cause ectropion.

Muscle weakness:

The muscles under the eyes usually get weaker when the tendons stretch out as a person ages. These muscles and tendons are responsible for holding the eyelid tight against the eye, so that when they relax, the eyelid can begin to droop and turn outward.

Eyelid growths:

The lid could turn outward due to benign or cancerous growths.

Scars or skin problems:

The way that the eyelid rests against the eye could be affected due to scarred skin from facial burns or trauma, including dog bites or lacerations. Ectropion could also be caused by chronically irritated or inflamed skin (dermatitis), or previous skin cancer in the facial area.

Rapid weight loss:

Ectropion can sometimes be caused by rapid weight loss.

Congenital ectropion:

In some rare cases, ectropion could be congenital in case it is associated with genetic disorders, such as Down syndrome.

Previous surgery, radiation or cosmetic procedures:

In case someone has had previous eyelid surgery (blepharoplasty) during which too much skin was removed, they could develop ectropion later in life. Ectropion could also develop if someone has had radiation of the eyelid for a cancerous growth. In some cases, cosmetic laser skin resurfacing can shrink the eyelid too much and pull it away from the eye causing ectropion.



Irritation and damage of the cornea is the most serious complication associated with ectropion. Permanent loss of vision could be caused because ectropion leaves the cornea irritated and exposed, making it more susceptible to wear (corneal abrasions) and ulcers. In order to help protect the cornea and prevent damage until a person’s ectropion is corrected, they should use lubricating Eyedrops and ointments.


In order to manage symptoms and protect the cornea until a permanent treatment is done, eyedrops and ointments could be used. However, ectropion usually requires surgery.



When the ectropion is caused by a developing scar that’s tightening or pulling on the skin, then this treatment could be considered. In order to help modify the scar and relieve the ectropion the patient should massage the scar tissue or inject it with steroids or both, but sometimes this treatment is not effective.



Depending on the cause and the condition of the tissue surrounding the eyelid, there are several different surgical techniques for ectropion. The patient will receive a local anesthetic before the surgery in order to numb the eye and the area around it, and in order to make them more comfortable, they will be lightly sedated by oral or intravenous medication.


A small part of their lower eyelid will be removed in case the ectropion is caused by muscle and ligament relaxation due to aging, which will tighten the tendons and the muscles of the lid. This procedure will leave a few stitches on the outside corner of the eye or just below the lower eyelid. Usually, this relatively simple procedure may be all that is needed.


The surgeon may need to use a skin graft taken from the patient’s upper eyelid or behind the ear to help support the lower lid in case the patient has scar tissue from an injury or previous surgery. The outcome of the surgery is less predictable in case facial paralysis or significant scarring is present. In this case it is likely that the patient will need more than one procedure in order to resolve the ectropion completely.


Wearing an eye patch may be required for 24 hours after the surgery and later the use of an antibiotic and steroid ointment on the affected eye several times a day for one week. Cold compresses could also be used periodically in order to decrease bruising and swelling, along with acetaminophen for pain relief. Because acetylsalicylic acid tends to increase bleeding, it should be avoided along with any drug that contains it.


Although the eyelid might feel tight at first, but it will become more comfortable as it heals. In most cases, the ectropion symptoms are relieved immediately after surgery. One week after the surgery the stitches will be removed, and in two weeks the swelling and bruising will fade.


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