Entropion vs Ectropion: Understanding Eyelid Malpositions

What Are Eyelid Malpositions?

The eyelids are designed to rest in close apposition to the eyeball, distributing the tear film evenly and protecting the cornea. When an eyelid turns inward or outward from its normal alignment, it is called a malposition. The two most common malpositions are entropion (inward turning) and ectropion (outward turning). Both predominantly affect the lower eyelid and become more common with age.

Entropion: The Inward-Turning Eyelid

In entropion, the eyelid margin rotates inward, causing the lashes to rub against the cornea and conjunctiva. This produces a scratchy or foreign-body sensation, tearing, redness, and irritation. If left untreated, chronic corneal abrasion from the misdirected lashes can lead to corneal scarring, thinning, and even infection. The most common form is involutional entropion, caused by age-related laxity of the eyelid's retractor muscles and supporting structures.

Ectropion: The Outward-Turning Eyelid

Ectropion occurs when the lower eyelid pulls away from the eyeball and turns outward. This exposes the inner conjunctival surface, causing chronic tearing (because the tear drainage punctum is no longer in contact with the tear lake), redness, and irritation. Over time, the exposed conjunctiva can become thickened and keratinised. Involutional ectropion from age-related tissue laxity is the most frequent variety.

Comparing Symptoms

• Entropion: Scratching sensation, foreign-body feeling, corneal irritation, reflex tearing, red eye
• Ectropion: Watery eye from poor tear drainage, exposed conjunctiva, chronic conjunctivitis, skin irritation from constant wetness

Causes Beyond Aging

While involutional (age-related) changes are the most common cause of both conditions, other aetiologies include cicatricial scarring from trauma, surgery, or inflammatory disease; paralytic causes (such as facial nerve palsy causing ectropion); and mechanical factors such as eyelid tumours that distort lid position. Identifying the specific cause is important because it determines the surgical technique.

Treatment

Both entropion and ectropion are treated surgically. Lubricating eye drops and taping can provide temporary relief, but they do not correct the underlying structural problem. Surgical repair addresses the specific anatomical defect: tightening lax tendons, repositioning retractor muscles, or releasing scar tissue, depending on the cause. The procedures are typically performed under local anaesthesia on an outpatient basis, with a relatively short recovery period. When performed by an experienced oculoplastic surgeon, surgical correction provides a durable result and significant relief from symptoms.