ConditionEyes & vision
Ectropion: When the Eyelid Turns Outward
Ectropion is a condition in which the eyelid, almost always the lower lid, sags or turns outward, away from the eye. The pink inner lining (conjunctiva) is exposed and tears no longer drain properly. Signs include watery eyes, redness, irritation and a dry, gritty feeling. It is most often caused by age-related lid laxity, and is more common in older men. Lubricating drops ease symptoms, and a short operation usually corrects it.
Also called: Eyelid eversion, outward-turning eyelid, everted eyelid
At a glance
- What it is
- An eyelid, usually the lower one, that droops or turns outward.
- Main cause
- Stretching of the lid tendons and muscles with age.
- Signs
- Watery eye, red exposed inner lid, grittiness, crusting, irritation.
- Who gets it
- Mainly adults over 60, more often men.
- Treatment
- Lubricating drops and ointment, then surgery to tighten the lid, which works in most cases.
When to get help
See a doctor within a day or two
- A painful red eye with light sensitivity or blurred vision, which can mean a corneal ulcer from exposure
- Eyelid that cannot close after sudden facial weakness (possible facial nerve palsy or stroke: call 911 if other stroke signs are present)
- Thick discharge with swelling of the lid or face
Book a routine appointment
- A lower lid that sags or turns outward, with watering or irritation
- A red, crusty lid edge that keeps getting worse
- A lump or scar on the lid that is pulling it away from the eye
Usually safe to manage at home
- Mild watering and dryness from known ectropion while waiting for a surgical opinion, managed with lubricants
What ectropion looks like
In a healthy eye, the lower lid sits snugly against the eyeball, and the small drainage hole at its inner end (the punctum) dips into the tear pool. In ectropion the lid falls forward. You may see:
- a gap between the lower lid and the eye
- the red or pink inner surface of the lid showing
- tears spilling onto the cheek
- a thickened, dry, red lid lining after months of exposure
- crusting on the lashes in the morning
Ectropion can involve the inner corner only (medial), the full lid, or, rarely, the upper lid.
Signs and symptoms of ectropion
- Watery eyes: the punctum no longer touches the tear film, so tears spill over.
- Dryness and grittiness: paradoxically, the exposed eye surface also dries out.
- Redness and irritation of the eye and lid.
- Sensitivity to light and wind.
- Mucus discharge and crusting.
- Skin irritation on the cheek from constant tear wiping, which can pull the lid down further.
Causes and types
| Type | Cause | Clues |
|---|---|---|
| Involutional (age-related) | Lid tendons and muscle stretch with age | Most common, both sides, older adults |
| Paralytic | Facial nerve weakness, such as Bell's palsy, stroke or after surgery | Lid also cannot close; face droops |
| Cicatricial | Scarring or shortage of skin pulls the lid down: burns, sun damage, skin cancer removal, injury, ichthyosis | Tight, scarred or dry skin below the lid |
| Mechanical | A lump, tumor or swelling drags the lid | Visible mass on the lid |
| Congenital | Present at birth, often with other conditions | Rare |
Facial nerve palsy, including Bell's palsy, causes paralytic ectropion together with incomplete lid closure (lagophthalmos), which greatly raises the risk to the cornea.
Why ectropion is more common in men
Involutional ectropion is seen more often in older men than women. The exact reason is not proven. Suggested factors include greater lifetime sun exposure, differences in lid size and tissue weight, and more frequent rubbing or wiping of the eyes. Age is still the biggest factor in both sexes.
Ectropion vs entropion
| Ectropion | Entropion | |
|---|---|---|
| Direction | Lid turns outward | Lid turns inward |
| Main symptom | Watering, exposed red lid | Lashes rub the eye, scratchy pain |
| Risk to the eye | Dryness, exposure damage | Corneal scratches and ulcers |
The two can be caused by the same age-related laxity. See entropion.
How ectropion is diagnosed
An ophthalmologist or eyelid surgeon diagnoses ectropion by examining the lids. Tests include:
- Snap-back test: the lower lid is pulled down and released. A lax lid returns slowly or only after a blink.
- Lid distraction test: how far the lid can be pulled away from the eye (more than about 6 mm is abnormal).
- Checking facial nerve function and looking for scarring, lumps or skin shortage.
- A slit-lamp exam with fluorescein dye to look for damage to the cornea.
Treatment
Protecting the eye
- Artificial tears during the day and a lubricating ointment at night
- Taping the lower lid up at night in some cases
- Wiping tears up and in toward the nose rather than down, which drags the lid outward
- Treating any blepharitis or infection
Surgery
Surgery is the definitive treatment and is usually done as an outpatient procedure under local anesthetic:
- Lateral tarsal strip: the outer corner of the lid is shortened and reattached to the bone, tightening the whole lid. This is the most common operation for involutional ectropion.
- Medial spindle procedure: removes a small diamond of tissue on the inner surface to turn the inner part of the lid back in.
- Skin graft or flap: for cicatricial ectropion, adding skin (often from behind the ear or upper lid) so the lid can return to position.
- Removing the lump for mechanical ectropion.
- Paralytic ectropion: tightening, plus procedures to help closure if facial nerve recovery is not expected.
Expect bruising and swelling for 1 to 2 weeks. Success rates are high, though the lid can loosen again with time.
Complications of untreated ectropion
- chronic conjunctivitis and lid thickening
- dry spots, abrasions and ulcers on the cornea (keratitis)
- scarring that permanently blurs vision, in severe neglected cases
Frequently asked questions
What are the signs of ectropion?
The main signs are a lower eyelid that droops or turns outward, a visible red inner lid lining, watering eyes, redness, grittiness, crusting and light sensitivity. Symptoms are often worse in wind or cold.
What causes ectropion?
Most ectropion is caused by age-related stretching of the eyelid tendons and muscle. Other causes are facial nerve weakness such as Bell's palsy, scarring or skin shortage after burns, injury or skin surgery, lumps on the lid, and, rarely, a condition present from birth.
Can ectropion be fixed without surgery?
Lubricating drops, ointment and night-time taping can relieve symptoms and protect the eye, and ectropion from a temporary facial palsy may improve on its own. Age-related and scarring ectropion do not correct themselves, so surgery is the only lasting fix.
Is ectropion surgery painful?
It is usually done under local anesthetic, so you feel pressure but not pain. Afterward there is bruising, swelling and mild soreness for a week or two, eased by cold compresses and simple pain relief. Most people return to normal activities within about 2 weeks.
Is ectropion the same as cervical ectropion?
No. Cervical ectropion is an unrelated, harmless change on the surface of the cervix in women. It shares the word "ectropion", which means turning outward, but has nothing to do with the eyelid.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: What Is Ectropion?
- American Society of Ophthalmic Plastic and Reconstructive Surgery: Ectropion
- NHS: Ectropion
- MedlinePlus: Ectropion
- Cleveland Clinic: Ectropion