Ectropion

What is Ectropion?

Ectropion is when your lower eyelid turns or sags outward, away from your eye, exposing the surface of your inner eyelid.

Ectropion is more common in older adults, and it generally affects only the lower eyelid. In severe ectropion, the entire length of the eyelid is turned out. In less severe ectropion, only one segment of the eyelid sags away from the eye.

What are the causes of Ectropion?

The primary cause of ectropion is muscle weakness or tissue relaxation that occurs as part of the normal ageing process. Your risk of developing ectropion increases with age. Other triggers include:

• stroke
• skin cancer
• injury
• scar tissue from injuries or burns
• growths on the eyelid (either cancerous or benign)
• birth defects (due to genetic disorders such as Down syndrome)
• Bell’s palsy (a condition that damages the nerve that controls facial muscles) or other types of facial paralysis
• prior surgery or radiation treatment of the eyelids
• rapid and significant weight loss

What are the symptoms of Ectropion?

When you blink, your eyelids help distribute tears that protect and lubricate your eyes. The tears drain into the tear ducts that are inside your eyelids. When the lower lid turns outward, it affects the way tears drain. This can result in a variety of symptoms, including:

• excessive tearing
• excessive dryness
• irritation
• burning
• redness
• chronic conjunctivitis (inflammation is also known as “pink eye”)

If you have symptoms of ectropion, you need prompt medical care. Delay in treating this condition can lead to serious complications. If you experience any of the following symptoms, they should be immediately addressed by your doctor:

• sudden sensitivity to light
• eye pain
• the rapid increase in redness of eyes
• decreased vision

What are the complications associated with ectropion?

Long-term irritation, excessive dryness, and exposure of the cornea can lead to conjunctivitis or infection of the eye. This can result in infected pus or fluid around your eye and on your eyelashes, especially when you wake up in the morning. Other complications may include:

• corneal abrasions (scratches on the cornea or surface of the eye)
• corneal ulcers (sores on the cornea or surface of the eye)
• impaired vision
• permanent blindness

How can ectropion be diagnosed?

Ectropion can usually be diagnosed with a routine eye exam and physical. Your doctor may pull on your eyelids during the exam or ask you to close your eyes forcefully. This helps him or her assess each eyelid's muscle tone and tightness.

If your ectropion is caused by a scar, tumour, previous surgery or radiation, your doctor will examine the surrounding tissue as well.

Understanding how other conditions cause ectropion is important in choosing the correct treatment or surgical technique.

What are the treatment options for ectropion?

While awaiting treatment, lubricating drops can provide relief and protect your cornea from further damage. However, note that improper wiping of your eyes can aggravate the problem. Always wipe from the outer eye up to the nose, using an "up and in" motion.

Skin tape, an adhesive made specifically for the skin, may be used to lift the lower lid and hold it in place to relieve some symptoms. However, be sure to ask your doctor for instructions and recommendations first.

Stretching of Scar Tissue

If the problem is due to scar tissue, your doctor may recommend scar tissue stretching. This involves steroid injections and scar tissue massaging. However, this procedure doesn’t always work.

Ectropion Surgery

Most of the time, surgery is necessary. Surgery can occur during a hospital stay, but it is usually done as an outpatient procedure under local anaesthetic.

During the operation, the surgeon usually removes part of the lower eyelid. This procedure requires stitches below the eyelid or on the outside corner of your eye. In most cases, this surgery is quite effective and resolves the problem.

If your ectropion is due to scar tissue, you may need a skin graft (skin transplant). Your doctor will take skin from behind your ear or from your upper eyelid and attach it to your lower lid.

If you previously had facial paralysis or a lot of scarring, it may take multiple surgeries to get the best result and fully resolve the problem.

Aftercare following the surgery

You may need to wear a temporary eye patch after surgery. You may also receive a steroid ointment and antibiotics to prevent infection. Over-the-counter pain relievers and cold compresses can help with pain and swelling. Some patients feel relief immediately, and others find relief within days or a few weeks. Most patients have no further symptoms after treatment and healing.

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