Ectropion

Ectropion occurs when the lower eyelid droops away from the eye and turns outwards.

The condition is common and can affect anyone, but it most often occurs in older people. It can affect either eyelid or both at the same time.

Ectropion can lead to a watery eye, which may also become red and sore as the tears cannot drain away (see Symptoms, above).

What is the cause?

The most common cause of ectropion is a weakening of the tendon at the outer corner of the eye, which supports the lower eyelid. Also, the muscle of the lower eyelid becomes slack over time. This is why ectropion happens in older people.

It can be caused by injury to the skin around the eye or a condition called Bell's palsy (see Causes, above).

Ectropion cannot be prevented.

How serious is it?

Ectropion ranges from a subtle slackness of the lower lid to severe drooping of the whole lid from the eyeball. It may leave the surface of the eye exposed, making it vulnerable to infection.

If ectropion is not treated, it may lead to exposure of the cornea or, in more serious cases, an ulcer and possibly loss of vision.

Ectropion is usually treated with surgery to tighten the lower eyelid (see Treatment, above).

Once any swelling and bruising has settled after surgery, the eyelids will feel more comfortable and appear more natural.

The most common cause of ectropion is the tissues of the eyelids becoming slack. The condition occurs more in older people, whose eye tendons and muscles have weakened to the point where the eyelid no longer sits against the surface of the eye.

Ectropion can also be caused by:

  • Injury to the skin around the eyes. If the delicate skin around the eyes is wounded or burned, the body forms a scar in an attempt to heal the injury. This can draw in the skin and pull the eyelids out of their normal position. Skin cancer or previous surgery to the eyelid can also lead to scarring.
  • Bell's palsy (also known as facial palsy). The muscles of the face, including the muscles that control the eyelids, become paralysed or weak. Bell's palsy is usually temporary and most people make a full recovery within a few months without treatment.
  • A birth defect. Very rarely, ectropion can be present at birth, when the eyelids have not developed properly. This can happen in babies with Down's syndrome.

See your GP if you develop symptoms of ectropion.

Your GP will be able to diagnose the condition after an examination of the eyes and eyelids. Special tests are usually not necessary as the symptoms and signs of ectropion are quite distinctive.

Whether or not you think you may have ectropion, see your doctor immediately if you have decreasing vision, eye pain, sensitivity to light or rapidly increasing redness of the eye.

An ectropic eyelid sags away from the eye and often turns outwards, leading to one or more of the symptoms listed below.

Watery eyes

Watery eyes are the most common symptom.

The tear duct is a tiny tunnel in the eyelid that drains tears from the surface of the eye to the back of the nose. If your eyelid droops and turns outwards, the opening of the tear duct is pulled away from the surface of the eye.

This prevents the tears from draining properly, so they build up inside the drooping eyelid, often causing discomfort, redness and more watering.

Dry, red and sore eyes

Eyes can become dry, sore and red because the drooping lower eyelid prevents the eye from closing properly and old tears from draining away. The eye becomes exposed to the air and is not bathed in fresh tears.

Infection

If your tears cannot properly drain, bacteria are not cleaned away from the surface of the eye. This makes the surface of the eye vulnerable to infection (conjunctivitis), a condition that causes further redness and irritation with a build-up of mucous on the eye.

Infection leads to further watering, often with redness and swelling of the eyelids, which may become crusty.

Ectropion is usually treated with a minor operation under local anaesthetic and as outpatient surgery (meaning you can go home the same day). The operation lasts between 30 and 60 minutes.

The most common and effective treatment is surgery to tighten the tendon that holds the outer eyelid in place. This gives extra support and lift to the eyelid.

If the ectropion is mostly in the inner corner of the eyelid, surgery may only be necessary in this area.

If there has been previous surgery or injury, the operation may be more complex but is still usually performed under local anaesthetic.

Before surgery

While you wait for surgery, there are ways you can relieve symptoms and discomfort:

  • Daily eye cleansing with cooled, boiled water or with eyewash solution (from your pharmacy) will help to keep the eye clean.
  • Your GP may prescribe some lubricant, such as artificial tears or ointment, to moisten the eye and relieve any irritation, redness or soreness.
  • Your GP can also prescribe an antibiotic ointment or dropsto clear up an infection, such as conjunctivitis.

After surgery

After surgery, your eye will be padded to help prevent swelling or bruising. Depending on the extent of surgery, the pad may either be removed within a few hours at the hospital or you may be asked to remove it at home the next day. 

Once the pad is removed, take care to keep the eye area clean and free from infection. Usually, the hospital will give you antibiotic drops to use for a week or two.

It is important to avoid rubbing the eye or putting pressure on it and to prevent any water getting into it. Do not swim for at least three weeks after the operation.

Most people will have had stitches in the eyelid tissues. These are often dissolvable but are usually still removed at the hospital after one to two weeks.

When your eyelids have healed they will look more normal and feel comfortable. You may experience:

  • some bruising around the eye,
  • some redness and swelling around the eye, and
  • a feeling that there is something in the eye.

These symptoms will normally clear within a couple of weeks. If your wound is getting increasingly red and swollen, see your GP as soon as possible.