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Ectropion

 

Ectropion is the turning out of the eyelid so that the inner surface is exposed. It most often affects the lower eyelid.

Causes

Ectropion is very often caused by the aging process. The connective (supporting) tissue of the eyelid becomes weak. This causes the lid to turn out so that the inside of the lower lid is no longer against the eyeball. It can also be caused by:

  • A defect that occurs before birth (for example, in children with Down syndrome)
  • Facial palsy
  • Scar tissue from burns

Symptoms

 

Symptoms include:

  • Dry, painful eyes
  • Excess tearing of the eye (epiphora)
  • Eyelid turns outward (downward)
  • Long-term (chronic) conjunctivitis
  • Keratitis
  • Redness of the lid and white part of the eye

If you have ectropion, you will most likely have excess tearing. This happens because the eye gets dry, then makes more tears. The excess tears can't get into the tear drainage duct. Therefore, they build up inside the lower lid and then spill over the edge of the lid onto the cheek.

 

Exams and Tests

 

The health care provider will make a diagnosis by doing an exam of the eyes and eyelids. Special tests are not needed most of the time.

 

Treatment

 

Artificial tears (a lubricant) may ease dryness and keep the cornea moist. Ointment may be helpful when the eye can't close all of the way, such as when you are asleep. Surgery is very often effective. When ectropion is related to aging or paralysis, the surgeon can tighten the muscles that hold the eyelids in place. If the condition is due to scarring of the skin, a skin graft or laser treatment may be used. The surgery is most often done in the office or at an outpatient surgery center. A medicine is used to numb the area (local anesthesia) before the surgery.

 

Outlook (Prognosis)

 

The outcome is very often good with treatment.

 

Possible Complications

 

Corneal dryness and irritation may lead to:

  • Corneal abrasions
  • Corneal ulcers
  • Eye infections

Corneal ulcers can cause vision loss.

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of ectropion.

If you have ectropion, get emergency medical help if you have:

  • Vision that is getting worse
  • Pain
  • Sensitivity to light
  • Eye redness that is getting worse quickly

 

Prevention

 

Most cases are cannot be prevented. You may use artificial tears or ointments to prevent injury to the cornea. 

 

 

References

Nicoli F, Orfaniotis G, Ciudad P, Maruccia M, et al. Correction of cicatricial ectropion using non-ablative fractional laser resurfacing. Lasers Med Sci. 2018. [Epub ahead of print]

Olitsky SE, Hug D, Plummer LS, Stahl ED, Arris MM, Lindquist TP. Abnormalities of the lids. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 624.

Robinson FO, Richard J, Collin O. Ectropion. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 12.7.

Yanoff M, Cameron JD. Diseases of the visual system. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 423.

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  • Eye

    Eye - illustration

    The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

    Eye

    illustration

    • Eye

      Eye - illustration

      The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

      Eye

      illustration

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      Review Date: 8/28/2018

      Reviewed By: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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