Ectropion of the Eyelids

What is an ectropion?

An ectropion is an abnormal outward turning of the margin of the eyelid (where the eyelashes are). This usually refers to the LOWER eyelid. Occasionally it can be seen in the upper eyelid.

What causes an ectropion?

In most cases, an ectropion is seen in the older adult and is due to aging of the tissues of the eyelid that support and hold it in place. These supporting structures include the tendons at the inner and outer corner of the eyelids (medial and lateral canthal tendons), and the internal muscles of the eyelid (retractors). Stretching or detachment of these supporting structures results in the eyelid either turning outward (ectropion) or inward (entropion –see separate information sheet).

Less commonly, an ectropion may develop from scarring of the outer skin of the eyelid from previous trauma or surgery, or from the weight of an eyelid tumour or lump. Very rarely, a child may develop an ectropion early in life due to maldevelopment of certain eyelid structures.

How do I know I have an ectropion?

An ectropion usually causes one or more of the following symptoms:

• Watery eye
• Excess mucous/sticky discharge in the eye
• Irritated eye
• Red eye, or reddened lower eyelid margin

Your ophthalmologist will diagnose the presence and cause of your ectropion with a thorough examination of your eyelids and eyes.

What complications can an ectropion cause?

An ectropion will not spontaneously correct itself. In many cases, it will continue to worsen, and may cause complications of the eye itself. These include exposure and drying of the cornea (the clear window of the eye in front of the iris), which can then lead to sight-threatening infections or scarring.

What treatment is available for ectropion?

1.Surgical treatment

Ectropion of the lower eyelids is best managed with surgery. This can be performed as a day case and under local anaesthetic. It usually involves tightening and reattachment of the supporting tendons and retractor muscles, via incisions made in the outer and/or inner corners of the eyelids, and the internal aspect of the eyelid. If the ectropion is due to external scarring, then skin grafts or other grafts may be required.
The aim of surgery is to restore the normal position of the eyelid margin with a good cosmetic result, and to achieve a comfortable eye.

2.Non-surgical treatment

In situations where surgery is not possible (for example, if the patient is not medically fit for surgery) or not desired by the patient, there are some non-surgical methods. These include the use of cautery or radiofrequency to reposition the eyelid. However, these measures are often temporary, and the recurrence rate of ectropion is higher than with surgery.

What are the risks of ectropion surgery?

This surgery is confined to the eyelid tissues, and does not involve the eye itself.

The risks of any anaesthesia used during surgery will be discussed with you by your anaesthetist.

The risks of surgery include (but are not limited to):

• Over-correction
• Under-correction
• Asymmetry of eyelid position (left and right sides look slightly different in position or contour)
• Infection
• Suture granuloma (tender lump at outer corner of eyelid which forms in relation to the sutures used, and which may require further surgery to remove)
• Tenderness at the outer corner of the eyelid (which may last a few weeks to months)
• Recurrence of ectropion and need for further surgery

What to expect after ectropion surgery

Click here for information on Eyelid Surgery.

After surgery, all patients will have bruising and swelling of the lower eyelids which may extend into the cheek or lower face/neck. This usually recovers over 1-2 weeks.
The eyelid often feels and looks tight, and can take up to 6 weeks to soften and settle into its final position, as healing progresses.
There may be tenderness in the outer corner of the eyelid, which can last weeks but usually settles. This is due to the internal sutures used to tighten the outer eyelid.
The eye may feel gritty, irritated or watery in the first few days after surgery, but this usually settles.

You will be reviewed at 1-2 weeks, and 3 months after surgery, to assess the results.