Ectropion: Eyelids That Turn Out

Lower lid ectropion

This patient actually has an ectropion of both lower eyelids. His left one is worse than his right.

What is an Ectropion?

Ectropion refers to when the eyelid no longer lies snugly against the eyeball and turns outwards and most commonly affects the lower eyelid.

What causes an Ectropion?

  • default_titleAgeing: As we grow older the tendons of the lower eyelid, which normally keep the eyelid taut against the eyeball, can start to loosen resulting in laxity of the eyelid itself. Furthermore, the cheek can start to descend due to the loosening of its deep attachments from the underlying cheek bone. This leads in increased downward pull on the lower eyelid resulting in it being pulled downwards and outwards.
  • default_titleA blocked tear duct: Sometimes prolonged watering of the eye can cause sufficient irritation of the eyelid skin leading to tightening of the skin. This in turn leads to downward tension on the eyelid causing it to turn outwards.
  • default_titleScarring of the skin around the eyelid can cause the lids to turn outwards. There are many causes of scarring, for example, burns, chemical splashes, certain skin diseases.
  • default_title Damage to the facial nerve can result in weakness of the muscles of the lower eyelid, leading to ectropion.
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What are the Signs and Symptoms of an Ectropion?

  • default_titleWatering of the eye with sensitivity to wind and light
  • default_titleIrritation of the eye
  • default_titleOutward turning of the eyelid
  • default_titleRecurrent infection of the eye- for this reason eyelid ectropions ideally need to be repaired prior to any intraocular surgery such as cataract surgery to minimise the risk of endophthalmitis (severe infection inside the eye)
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How is Ectropion treated?

  • default_titleThe best option for treating ectropion is by surgery. The type of surgery performed is varies from patient to patient depending on the reasons why that patient has an ectropion in the first place.
  • default_titleFor most patients, surgery tightens up the lower eyelid horizontally and reduces any downward pull on the eyelid. This will result in restoring the lower eyelid to its normal position, so that it fits snugly against the eyeball.
  • default_title If the ectropion is caused by scarring then the operation may involve more extensive surgery- sometimes involving the use of skin grafts or skin flaps to relieve the tension caused by the scar tissue. Most operations can be done quite comfortably and quickly using a local anaesthetic injection as a day case procedure.
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Do All Ectropions Need Treatment?

No. Not all ectropions need treatment. Indeed many patients opt to leave their ectropions alone and decline the option of surgery.
However common reasons for ectropion treatment include:
  • default_titleCosmetic: the patient simply does not like the look of their out turning eyelid.
  • default_titleFunctional: the patient is bothered by symptoms of irritation or watering of the eye
  • default_titlePreventative safety: the patient needs to undergo intraocular surgery in the future such as a cataract surgery. As an ectropion prevents normal drainage of one's tears away into the tear duct, theoretically the tears contain more bacterial organisms. The presence of an ectropion thus results in a theoretically higher risk of post cataract surgery vision threatening bacterial eye infection (endophthalmitis). Thus treatment of the ectropion first prior to the intraocular surgery would be recomended.
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- Click images for further information

Age related ectropion
Age related ectropion
Age related ectropion
1 week after ectropion correction surgery
Cicatricial ectropion
Severe ectropion due age related descent of the cheek.
Severe ectropion due age related descent of the cheek.
1 week following complex surgery
A skin flap reduces the gravitational tension
After 1 month, the flap has become invisible