Ectropion is where the lower eyelid droops away from the eye and turns outwards. The degree of droopiness can range from mild to severe.
Ectropion mainly affects the lower eyelid and can occur in one or both eyes.
The drooping eyelid can disrupt the normal production of tears, which causes symptoms such as:
redness and irritation of the eye
excessive tear production, which can lead to a very watery eye
excessive dryness, which can cause the eye to feel gritty and sandy
Entropion is where the eyelid rolls inwards. It usually affects the lower lids, but can also affect the upper lids.
What causes ectropion?
In most cases, ectropion is age-related. As you get older, the ligament (tough band of tissue) at the outer corner of your eye, which supports the lower eyelid, can weaken. Over time, the muscle of the lower eyelid can also become slack.
Ectropion can also be the result of temporary damage to the facial nerves that are used to control the eyelid (known as Bell's palsy), or damage to the eyelids caused by burns or another injury.
When to visit your GP
Visit your GP if you think you have ectropion. It’s usually straightforward to treat using ointment or eye drops (see below).
Your GP or ophthalmologist (a specialist in diagnosing and treating eye conditions) will be able to diagnose ectropion by examining your eye. Pulling the eyelid down to see how quickly it returns is a way of assessing whether the ligaments are weak.
If you have mild ectropion you may not need treatment. Eye drops or ointment may be recommended to reduce any inflammation in your lower eye lid and help keep your eye lubricated.
Sometimes, a minor operation is needed to correct the position of the eyelid. Most people are able to leave hospital on the day they have surgery.
The procedure involves removing a small section of the ligament that connects your eyelid to your skull, which makes it tighter so that it supports your eyelid better.
Complications of ectropion
Ectropion does not often lead to complications because it’s usually identified and treated at an early stage.
However, if your symptoms are severe and they’re not treated, it’s possible that you could develop further problems such as an eye infection or corneal ulcer (a sore on the eye’s surface), which could affect your vision.
Ectropion affects the lower eyelid which droops and turns outwards
Who is affected by ectropion?
Ectropion is common in older people. It's estimated that 1 in 14 people who are 60-69 years of age will develop the condition. This increases to 1 in 6 people over 80 years of age.
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Symptoms of ectropion
In ectropion, the lower eyelid droops outwards, causing redness, irritation and watering of the eye.
There may also be a mucous discharge from your eye and crusting of the lids.
Each time you blink, your eyelids coat your eyes with tears. The tears lubricate and protect your eyes and drain into tiny openings called tear ducts on the inside of your eyelids.
However, if your eyelid droops away from your eye, it can disrupt the draining process which can trigger symptoms such as:
redness and irritation of the eye
a dry eye, which can be sore and may feel gritty
These are described in more detail below.
Redness and irritation
The drooping of the lower lid away from your eyeball may cause the lid lining to become red and swollen due to being exposed to the air. Your lid may also discharge mucous and crust over.
Watery eyes are another common symptom of ectropion. The affected eye may water if tears build up inside the drooping eyelid and do not drain properly.
If your eye waters, it’s likely that you will have to constantly wipe tears away from your eye. This can lead to increased redness, discomfort and more watering.
Your eye may also become dry and sore if your drooping lower eyelid prevents your eye closing properly and stops old tears draining away. As your eye is exposed to the air it will not be lubricated by fresh tears.
If your tears are unable to drain properly, bacteria will not be cleaned away from the surface of your eye, making it vulnerable to infection. If the tissue at the front of your eye becomes infected it is known asconjunctivitis.
Some of the symptoms of conjunctivitis, such as redness and watering of the eye, are similar to those of ectropion. You may also experience mild eye pain and have a sticky coating on your eyelashes when you wake up.
Visit your GP if you think you have ectropion.
Mild cases may not require treatment, although ointment or eye drops may be recommended. In more severe cases, a minor operation may be needed
Causes of ectropion
Most cases of ectropion are associated with ageing. It's usually caused when the ligament (band of tissue) that connects the eyelid to the eye socket becomes weakened with age.
As you get older, the ligament that connects your eyelid to your skull, and the muscles that sit under and around your eyelid, can weaken. This can cause your eyelid to droop.
Other, less common causes of ectropion include:
damage to the nerves that control the eyelid (this is often seen in the neurological condition, Bell’s palsy)
a lump or cyst that develops in the lower eyelid
damage to the eyelid caused by trauma or burns, or as a complication of a skin condition, such as contact dermatitis, or from previous surgery
Ectropion from birth
In rare cases, ectropion is present at birth due to the muscles under the eyelid not developing properly. This may be associated with an underlying developmental disorder, such as Down syndrome.
Treatment may not be needed in mild cases of ectropion.
How the condition is managed will depend on its severity and the underlying cause.
Eye drops or ointments may be recommended to reduce inflammation in your lower eyelid and help keep your eye lubricated.
In some cases, an operation may be needed to tighten the lower eyelid.
This is a relatively minor procedure that takes about 45 minutes and is carried out under local anaesthetic. It’s usually carried out on an outpatient basis which means that you won’t need to stay in hospital overnight.
In cases where ectropion is caused by scarring from an injury or from previous surgery, a more extensive operation, such as a skin graft, may be needed.
This will involve removing a section of skin, either from your top eyelid or the back of your ear, and attaching it under your lower eyelid to support it. You may be given a sedative (medication to help you relax).
Following surgery, a pad will be placed over your eye to prevent inflammation. It will need to remain in place for at least a day. Antibiotic drops or ointment will usually be prescribed to help prevent infection.
You will have a follow-up appointment a week or so after your operation. This is to remove any stitches and to check on the position of your eyelid.