Ectropion

Page last reviewed: 13/07/2011

Ectropion occurs when the 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 develop in one or both eyes.

The drooping eyelid can disrupt the normal production of tears, which can sometimes cause 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

Read more about the symptoms of ectropion.

Most cases of ectropion are age-related. As a person gets older, the ligament at the outer corner of the eye, which supports the lower eyelid, can sometimes weaken. Ligaments are tough bands of tissue that link two bones together at a joint. The muscle of the lower eyelid can also become slack over time.

Ectropion can also be caused by temporary damage to the facial nerves that are used to control the eyelid (medically known as Bell's palsy), or damage to the eyelids due to burns or another injury.

Read more about the causes of ectropion.

When to seek medical advice

Contact your GP if you think that either you or your child has developed ectropion. The condition is relatively straightforward to treat. However, if left untreated it could result in some permanent vision loss.

Treating ectropion

In mild cases of ectropion, no treatment may be needed. Moderate cases can often be controlled using eye drops or ointments to keep the eye lubricated.

However, most cases of ectropion will require surgery to correct the position of the eyelid. A minor operation is usually needed and most people can leave the hospital on the same day that the surgery is performed.

Read more about the treatment of ectropion.

Who gets ectropion?

Ectropion is a common condition in older people. It is estimated that 1 in every 14 people who are 60 to 69 years of age will develop ectropion. This figure increases to 1 in every 6 people who are over 80 years of age.

Page last reviewed: 13/07/2011

Each time you blink, your eyelids coat your eyes with tears. This helps to lubricate and protect your eyes. The tears drain away into tiny openings called tear ducts, which are located on the inside of your eyelids.

However, if your eyelid droops away from your eye, it can disrupt the process of draining the tears away, which can trigger a number of possible symptoms, such as:

  • watery eyes
  • dry eyes
  • infection

These are briefly described below.

Watery eyes

Watery eyes is the most common symptom of ectropion. It occurs when tears do not drain properly and build up inside your drooping eyelid. If you have the condition it is likely that you will have to wipe tears away from your eye constantly. This often leads to discomfort, redness and more watering.

Dry eyes

Alternatively, your affected eye can become dry, sore and red because your drooping lower eyelid prevents your eye from closing properly and old tears from draining away. Your eye will become exposed to the air and will not be bathed in fresh tears.

Infection

If your tears cannot drain properly, bacteria are not cleaned away from the surface of your eye. This makes the surface of your eye vulnerable to infection.

This is known as infective conjunctivitis. Some of the symptoms of infective conjunctivitis are similar to those of ectropion, such as redness and watering of the eye. You may also experience mild eye pain and a sticky coating on your eyelashes when you wake up.

See Infective conjunctivitis for more information.

When to seek medical advice

Contact your GP if you think that either you or your child has developed ectropion. The condition is relatively straightforward to treat.

However, if left untreated, it could result in some permanent vision loss.

Bacteria
Bacteria are tiny, single-cell organisms that live in the body. Some can cause illness and disease and others are good for you.

Page last reviewed: 13/07/2011

There are two types of ectropion. They are acquired ectropion and congenital ectropion.

Acquired ectropion

Ectropion that is acquired is most commonly linked to ageing. As you get older, the band of tissue (known as a ligament) that connects your eyelid to your skull can weaken, as can the muscles that sit under and around your eyelid. Both of these factors can cause your eyelid to droop downwards.

Other, less common causes of acquired ectropion include:

  • damage to the nerves that are used to control the eyelid (this is often seen in the neurological condition, Bell's palsy)
  • damage to the eyelid that is caused by trauma or burns, or that develops as a complication of a skin condition, such as contact dermatitis
  • previous surgery to the eyelid, which can sometimes cause scarring 
  • skin cancer that develops near to the eyelid

Congenital ectropion

Congenital ectropion is a much rarer type of ectropion than acquired ectropion. This type of ectropion is present at birth and is usually caused by the muscles under the eyelid not developing properly.

It is rare for congenital ectropion to develop by itself. It is usually associated with an underlying developmental disorder, such as Down's syndrome.

Page last reviewed: 13/07/2011

Ectropion can usually be diagnosed during a physical examination. This may be carried out by your GP or an ophthalmologist (a specialist in diagnosing and treating eye conditions).

During the examination, the doctor may pull down on your eyelid to see how quickly it snaps back after being released. This is an effective method of assessing whether the muscles and ligaments that support your eyelid have weakened.

Page last reviewed: 13/07/2011

Ectropion is often treated with a minor operation that is carried out under local anaesthetic. The procedure is usually carried out as outpatient surgery, which means that you will not have to stay in hospital overnight and can return home the same day.

Before surgery

While you wait for surgery, there are several ways that you can relieve your symptoms and discomfort. For example, you can:

  • cleanse your eye on a daily basis using cooled, boiled water or eyewash solution (available from your pharmacy) to help keep your eye clean
  • use lubricant, such as artificial tears or ointment, to moisten your eye and relieve any irritation, redness or soreness (available on prescription from your GP)
  • use antibiotic drops or ointment to clear up an infection, such as conjunctivitis (your GP can also prescribe this for you)

Surgery

A number of different surgical techniques can be used to correct ectropion. Most techniques involve removing a small section of the ligament that connects your eyelid to your skull. Shortening the ligament will also make it tighter so that it will be better able to support your eyelid.

If ectropion is caused by scarring that is the result of an injury, a skin graft can be used to support your eyelid. A skin graft involves removing a section of skin, either from your top eyelids or from the back of your ear, and connecting it into place under your eyelid.

Surgery will be performed using a local anaesthetic, which will numb the area around your eye so that you will not feel any pain during the operation. In most cases, surgery takes no more than an hour to complete.

After surgery

Following surgery, a pad will be placed over your eye to help prevent swelling and bruising. Depending on the extent of the surgery, the pad might be removed within a few hours at the hospital or you may be asked to remove it at home the following day.

Once the pad has been removed, you should take care to keep the area around your eye clean and free from infection. The hospital will usually give you antibiotic drops or ointment to use for 7-10 days.

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

Most people will have stitches in the tissue of their eyelid. They are often dissolvable, but will usually still need to be removed at hospital after one to two weeks.

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

  • some bruising around your eye
  • some redness and swelling around your eye
  • a feeling that there is something in your eye

These symptoms will usually clear up within a couple of weeks. If your wound becomes increasingly red and swollen, you should visit your GP as soon as possible because it could be infected.

Antibiotics
Antibiotics are medicines used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.
Inflammation 
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Local anaesthetic
A local anaesthetic is a drug injected by needle or applied as a cream that causes a loss of feeling in a specific area of the body.

Page last reviewed: 13/07/2011

Corneal ulcer

If ectropion is left untreated and is preventing your eye from closing properly, your eye may become progressively more uncomfortable. In rare cases a corneal ulcer may develop.

A corneal ulcer is an open sore that develops on the surface of the eye. It is usually caused by a bacterial or viral infection. People with untreated ectropion are vulnerable to corneal ulcers because their eyes are not properly protected by germ-fighting tears.

Symptoms of a corneal ulcer include:

  • eye pain and redness
  • blurry vision
  • sensitivity to bright lights
  • swelling of your eyelids
  • pus or liquid draining out of your eye

Contact your GP as soon as possible if you think that you may have developed a corneal ulcer. Left untreated, a corneal ulcer could pose a risk to your sight.

Treatment for corneal ulcers includes antibiotics to treat the underlying infections. In severe cases, a corneal transplant may be necessary.

Ulcers
An ulcer is a sore break in the skin or on the inside lining of the body.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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