What Is Ectropion?

Ectropion is a condition in which the eyelid margin turns outward, exposing the inner conjunctival surface. The lower punctum (tear drainage opening) moves away from the eye, preventing tears from entering the nasolacrimal system. Paradoxically, this causes both tearing (epiphora) and dryness at the same time.

The lower eyelid is most frequently affected. Upper-lid ectropion is rare and usually results from facial nerve palsy or cicatricial processes.

Types of Ectropion

Involutional (age-related) ectropion

This is the most common form. With aging, the structures that support the lower lid -- the tarsal plate, canthal tendons, and lid retractors -- lose tone. The eyelid gradually falls away from the globe under the effect of gravity.

Paralytic ectropion

Caused by facial nerve (CN VII) palsy, most often Bell palsy. Loss of orbicularis muscle tone allows the lid to sag outward. Corneal protection is particularly critical in this type because the patient cannot fully close the eye.

Cicatricial (scarring) ectropion

Scar tissue on the outer skin surface of the eyelid pulls the margin outward. Common causes include burns, trauma, dermatological conditions, radiation therapy, and prior eyelid surgery.

Mechanical ectropion

A mass (tumor, cyst) or significant edema near the lid physically pushes the margin away from the globe. Treating the underlying cause may resolve the ectropion.

Symptoms

• Persistent tearing (epiphora)
• Dryness, burning, and stinging of the eye
• Visible outward turning of the lid margin
• Redness and thickening of the exposed conjunctiva
• Skin irritation around the eye from chronic tearing
• Mucous discharge due to conjunctival exposure
• Foreign-body sensation
• Light sensitivity

Surgical Treatment

Definitive correction of ectropion is surgical. The technique is chosen based on the type and severity of the condition.

Lateral tarsal strip

The most widely used procedure for involutional ectropion. The tarsal plate is tightened at the outer lid corner and re-attached to the lateral orbital rim. This restores lid tone and normal position. The procedure is performed under local anesthesia.

Medial canthal tightening

Applied when the ectropion involves the medial (inner) corner. The medial canthal tendon is reinforced so that the punctum returns to its correct position against the globe, restoring tear drainage.

Skin graft or flap

In cicatricial ectropion, releasing the scar tissue may leave a skin deficit. A graft (from the upper lid, retroauricular area, or another donor site) or a local skin flap is used to provide adequate tissue coverage.

Paralytic ectropion management

In cases caused by facial nerve palsy, corneal protection takes priority alongside lid repositioning. Lateral tarsal strip, gold or platinum weight implantation in the upper lid, and temporalis muscle transfer may be combined as needed.

Recovery