Ectropion

Overview

Ectropion is the medical term used to describe an eyelid that is turned outward. Eversion, on the other hand, refers to the state of the eyelid being outward-facing. When someone has ectropion, the inner surface of their eyelid can become irritated. While ectropion can affect either the upper or lower eyelid, it is more commonly seen in the lower eyelid.

Ectropion is more frequently observed in older adults and typically affects only the lower eyelid. This condition is categorized into two main groups: congenital (present from birth) and acquired (develops over time). The congenital form is a less frequent occurrence, whereas there are four subtypes of acquired ectropion:

• Involutional: This is the most common type and is associated with the natural aging process, where the muscles and ligaments around the eyelid become lax or loose.
• Paralytic: Paralytic ectropion is linked to facial nerve injuries that can cause the eyelid to turn outward.
• Cicatricial: Cicatricial ectropion is related to scarring that affects the eyelid’s normal position.
• Mechanical: Mechanical ectropion is connected to issues with the weight of the eyelid, leading to an outward rotation.

To alleviate the symptoms of ectropion, individuals may find relief through the use of artificial tears and lubricating ointments. However, surgical intervention is often necessary to fully correct the condition.

Symptoms

Blinking naturally involves your eyelids distributing tears evenly to keep your eyes moist and lubricated, with tears typically flowing through small inner-eyelid openings called puncta for drainage. In cases of ectropion, a condition in which the lower eyelid turns outward, this normal tear drainage process is disrupted. Consequently, individuals with ectropion can experience a range of symptoms, including:

• Excessive tearing: Due to impaired drainage, your tears may accumulate and continuously spill over your eyelids, causing watery eyes.
• Increased dryness: Ectropion can result in a sensation of dryness, grittiness, and sandiness in your eyes as they lack sufficient lubrication.
• Eye irritation: Stagnant tears or dryness can irritate your eyes, resulting in a burning sensation and redness in both your eyelids and the white part of your eyes.
• Light sensitivity: The accumulation of tears or dryness may irritate the surface of your cornea, making your eyes more sensitive to light.

Consult your doctor for persistent watery eyes, irritation, or drooping eyelids. If you have ectropion and encounter rapidly worsening eye redness, increased light sensitivity, or declining vision, seek immediate care as these may indicate cornea exposure or ulcers that can harm your vision.

Causes

Ectropion can arise from various factors, including:

• Eyelid growths: Both benign and cancerous growths on the eyelid can force the eyelid to turn outward, leading to ectropion.
• Age-related muscle weakening: As you grow older, the muscles beneath your eyes may weaken, and tendons can stretch, losing their ability to keep your eyelid firmly against your eye. This weakening can result in eyelid drooping.
• Facial paralysis: Conditions like Bell’s palsy and specific types of tumors can cause paralysis of facial nerves and muscles. If the eyelid muscles are affected by facial paralysis, it can lead to ectropion.
• Genetic disorders: Although rare, congenital ectropion, present from birth, can be associated with genetic disorders like Down syndrome.
• Scars or prior surgeries: Skin that has been damaged due to burns, trauma (such as a dog bite), or previous eyelid surgeries (like blepharoplasty) can alter the natural position of your eyelid, potentially causing ectropion. This risk is higher when a significant amount of eyelid skin has been removed during surgery.

Risk factors

Ectropion risk factors include:

• Advancing age.
• Presence of eyelid-affecting skin conditions.
• Regular use of contact lenses.
• Frequent rubbing or pulling of the eyelids.
• Facial nerve palsy or paralysis.
• Extended usage of certain types of eye drops.
• Previous eyelid injuries or surgeries.