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Ectropion

Published by Bupa's health information team, July 2008.

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

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

Ectropion can affect people of any age, but it's mostly seen in older people.

• About ectropion
• Symptoms of ectropion
• Complications of ectropion
• Causes of ectropion
• Diagnosis of ectropion
• Treatment for ectropion
• Questions and answers
• Related topics
• Sources

About ectropion

Ectropion is a condition affecting your eyelids. It can occur in your upper or lower lid, making it sag away from your eye and causing the rim to turn outwards. Gravity means that most often it happens to your lower eyelid, and it usually starts in the centre of your eyelid before affecting the outside edge of your lid.

A drooping lower eyelid can leave the bottom part of your cornea (the clear structure at the front of your eye), which is usually covered by your eyelid, visible and exposed.

The sagging of your eyelid can also cause your tear duct, which usually sits on the surface of your eye, to be dragged down. This means that your tears are unable to drain away properly. This can make your eyes water and cause your tears to overflow onto your cheek.

Symptoms of ectropion

Often you will be able to see changes to your eyelid when you look at your eye in a mirror.

Symptoms of ectropion include:

• irritated, red eyes
• watering eyes - you may need to keep wiping your eyes
• you may be unable to close your eye fully
• difficulty blinking
• loss of vision (in severe cases)

Complications of ectropion

The main complications of ectropion are related to your cornea being exposed and your eye being open to infection.

Keratitis

This is when your cornea becomes inflamed, usually due to an infection. If the normally covered part of your cornea is left uncovered, it will be at risk of infection.

Corneal ulceration

Corneal ulceration is when ulcers (sores) develop on your cornea. It's a serious condition that can cause loss of sight. It's important to seek treatment from your GP immediately if you develop a red eye, a painful eye or it feels like something is in your eye.

Conjunctivitis

Conjunctivitis is an inflammation of your conjunctiva, the transparent layer that covers the white of your eye and lines your eyelids. If your conjunctiva becomes exposed and dried out or your cornea becomes inflamed or infected, the part of your conjunctiva that lines the inside of your eyelid may appear reddened and the white of your eye may become bloodshot.

Causes of ectropion

Ageing

The most common cause of ectropion is ageing. As you get older the skin 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 your facial muscles, usually affecting one side of the face. It can be caused by conditions such as a stroke, Bell's palsy or, less commonly, brain tumours. The sagging of your eyelid can be quite pronounced making it difficult for you to fully close your eye.

Damage or injury

Damage or injury to the skin around your eyes as a result of facial burns, surgery or a chronic skin condition, such as dermatitis or eczema, can cause ectropion. This is usually due to scarring in the area which pulls the edge of the eyelid down.

Tumours

Large growths on the skin of your eyelid can cause it to sag.

Blepharospasm

This is a condition which causes your eyelids to wink fitfully due to contractions of your eyelid muscles. It's a relatively rare cause of ectropion, and can be treated using botulinum A toxin (eg Botox) injections into your eyelid muscle.

Congenital conditions

Ectropion can be part of a condition that you are born with. This may include:

• Down's syndrome
• blepharophimosis - narrowing of the eyelid opening
• microphthalmos - unusually small eyes
• buphthalmos - unusually large eyes
• ichthyosis - a skin condition

Very rarely ectropion can occur on its own, without any of these congenital conditions.

False eye

Occasionally, wearing a false eye can put long-term pressure on your lid causing ectropion.

Glasses

Wearing poorly fitting glasses that drag down on your eyelids, can cause ectropion.

Diagnosis of ectropion

Your GP or optometrist (a health professional who examines eyes, tests sight and dispenses glasses and contact lenses) can diagnose your ectropion. He or she will ask about your symptoms and examine you, and may also ask you about your medical history.

You may be referred to an ophthalmologist, a specialist who identifies and treats eye conditions (including surgical treatments).

Treatment for ectropion

Your treatment will depend on the cause of your ectropion and how severe it is. If you only have mild symptoms or a facial palsy such as Bell's palsy which is expected to fix itself, there may be no need for treatment. There are simple self-help measures that you can use to reduce your symptoms.

Self-help

It's important to keep any exposed areas of your cornea moist and lubricated. You can do this using eye drops called preservative-free artificial tears, such as Celluvisc or GelTears. You can buy these from your pharmacist.

Taping your eyelid upwards with surgical tape can help stop your cornea being exposed if your lower eyelid is drooping. Taping will also help if you are unable to close your eye fully to sleep.

If your eyes keep watering, you should try to wipe your eye upward towards your nose rather than downwards, otherwise you may drag on your eyelid and make your symptoms worse.

Surgery

Surgery can be used to return your drooping eyelid to its normal position. This is done by tightening the skin, cartilage and muscles around your eyelid preventing it from sagging. It's usually done under local anaesthetic as an out-patient.

Occasionally a skin graft may be needed, especially if your ectropion is caused by damage or injury to the skin around your eyelid - a graft is usually taken from behind your ear. A skin graft is a cosmetic surgery technique that uses skin from another part of your body to repair a damaged area of skin that isn't going to be able to heal itself.

Before your surgery, it's very important to keep any exposed areas of your cornea moist and lubricated to prevent any infections or ulcers. You can do this by using preservative-free artificial tear drops in your eye which you should initially apply hourly. Alternatively, your GP may prescribe a lubricating eye ointment (eg LacriLube). However, you may only be able to use these drops at night as they can blur vision.

 

Related topics

• Bell's palsy
• Conjunctivitis
• Down's syndrome
• Local anaesthesia and sedation
• Stroke

Sources

• Ectropion and its management. Optometry Today. www.optometry.co.uk, accessed 17 April 2008
• Ectropion. eMedicine. www.emedicine.com, accessed 11 April 2008
• Simon C, Everitt H, and Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007
• Ectropion. American Academy of Ophthalmology. http://one.aao.org, accessed 11 April 2008
• Keratitis (eye). GP Notebook. www.gpnotebook.co.uk, accessed 15 April 2008
• Khaw PT, Elkington AR. ABC of Eyes. London: BMJ Publishing Group, 2002

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2008.