Ectropion is a condition in which the floppy lower eyelid is everted (turned out), thus exposing its inner surface (conjunctiva).
The commonest cause is age-related tissue relaxation, but other causes are:
- Palsy of the 7th cranial nerve (aka Bell’s palsy or Facial nerve palsy)
- Trauma to the eye area
- After eye or facial surgery
- long term excessive sun exposure
- Rarely, tumours of the eye socket
Symptoms and signs
The eyes become dry due to excessive exposure of the conjunctival surface, and this can lead to corneal problems such as superficial keratitis. As the eyelid sags away from the eye, the tear duct can no longer carry the normal daily tear production away ( to inside the nose, for disposal). There is therefore excessive tearing, though this is due, not to overproduction of tears, but to inefficient drainage.
The diagnosis is clinical and obvious. If there is any reason to suspect an underlying problem, appropriate investigations must be done, for instance a skull scan.
Preventing desiccation (dryness) of the eye is paramount, and artificial tears and lubricating ointments can successfully be used. If this proves inadequate, or the patient has a strong preference, surgery may be considered to restore normal anatomy. This should only be done by experienced ophthalmic or plastic surgeons, because of the risk of overcorrection, which can then cause new problems, including damage to the cornea. Sometimes surgery can be delayed or even avoided completely by simply using sticky tape (such as Micropore Tape) to pull the lower lid upwards.
Previously reviewed by Dr A G Hall
Reviewed by Dr Clive Novis, Ophthalmologist, June 2011