What is Ectropion?

Ectropion

Introduction

Under certain circumstances the lower eyelid margin turns outward leaving the eyeball exposed externally; this condition is called ectropion. Ectropion may result due to the normal aging process, but is pathological in most scenarios. It may occur in any age group, but older individuals are prone to develop ectropion. 

Ectropion may cause the ocular surface to be exposed to irritants in the environment. Patients often face troublesome symptoms such as irritation, foreign body sensation, and tearing. It usually affects the lower eyelid, but the upper lid may be affected in some cases.  

What Are The Signs And Symptoms Of Ectropion? ¹

• Excessive tear formation 
• Dryness of affected side
• Burning sensation
• Foreign body sensation 
• Redness
• Increased risk of ocular infections
• Photosensitivity 
• Ocular pain
• Visual problems 

What Are The Causes And Risk Factors Of Ectropion? ²

• Increasing age
• Muscles and tendons lose their elasticity with increasing age
• Laxity of muscles
• Decreased muscle tone has led to lid eversion and an inability to fully close the eye
• Exposure to muscle relaxants
• May prevent the complete closure of the eyelids
• Stroke
• May result in facial muscle paralysis 
• Inability to control muscles movements on the affected side
• Injury over the face resulting in scar formation affecting the lower eyelid
• History of burn
• Burns cause the skin to contract upon healing, leading to ectropion
• Cancerous or benign growths on the lower eyelid 
• The weight of these lesions may pull down the eyelids
• Genetic disorders e.g Down syndrome 
• Significant weight loss 
• Loss of protective fat pads
• Previous surgery on the affected side
• Scar formation may contract the skin and prevent complete closure of eyelids 
• Bell’s palsy
• Repeated eye pulling
• Eye rubbing or pulling and repeated hair plucking or pulling may damage the integrity of the eyelid
• Long Term use of some eye drops
• Floppy eyelid syndrome 

How Is Ectropion Diagnosed?

Ectropion is diagnosed clinically by an ophthalmologist. 

• History
• Onset, duration, and associated symptoms
• Previous history of surgery or trauma?
• History of congenital diseases?
• Examination
• Appearance 
• Degree of laxity
• Visual acuity 
• Corneal and Conjunctival examination

Based on the underlying cause your ophthalmologist may order some laboratory investigations to rule out diseases e.g histological examination of the cancerous growths. 

How Is Ectropion Treated? ³

The treatment of ectropion is directed toward the underlying cause. The definitive management of ectropion is surgery. However, identifying and removing and modifiable causes e.g muscle relaxants will result in improvement of symptoms. 

• Lifestyle management 
• The use of sunglasses would prevent the damage from irritants 
• Avoid pulling or plucking hair
• Avoid self-medications
• Avoid aggressive rubbing of the affected eye
• Medical management
• Artificial tears
• Lubricants and artificial tears prevent the damage from dryness by maintaining a protective film over the conjunctiva and cornea
• Horizontal taping of eyelids
• This may provide temporary relief by applying a tape on lateral canthus
• Steroid injections
• They may help with recovery from Bell’s palsy
• Steroids injections into scar tissue may stretch the scar in scar-related ectropion
• Topical retinoids
• They help to avoid the damage from dryness
• Hyaluronic acid gel
• Surgery

The definitive treatment of ectropion is surgery. It depends on the degree of muscle laxity and the underlying cause. Different surgical approaches may be:

• Horizontal tightening of the lower eyelid
• Lower eyelid retractor disinsertion
• Reapposition of everted punctum
• Skin grafting
• Surgical facelift 
• Fixation with bone plates or bone tunnels

Complications

The surgical options offered by our Ophthalmologists are safe and effective. As with any surgery, there is a small risk of bleeding, infection, or other complication. 

 The timely diagnosis of ectropion and correct treatment are critical. Untreated cases may lead to:

• Corneal ulcers 
• Blindness

Call your Eye Care Specialists at ESA for an evaluation today!

References

1. What Is Eyelid Ectropion? (2021, December 1). WebMD. Retrieved May 12, 2022, from https://www.webmd.com/eye-health/what-is-eyelid-ectropion
2. Pietrangelo, A. (2020, November 10). Ectropion. Healthline. Retrieved May 12, 2022, from https://www.healthline.com/health/ectropion#complications
3. Ing, E. B., MD PhD. (2022, March 11). Ectropion: Background, Pathophysiology, Epidemiology. Medscape. Retrieved May 12, 2022, from https://emedicine.medscape.com/article/1212398-overview

Author

Eye Surgeons Associates Drs. Zuhair H. Peracha, Manal H. Peracha-Riyaz, Eric Zuckerman, Matthew Pieters, and Leila Siblani are dedicated to excellence in eye care and service. We utilize the latest treatment methods and procedures, including routine eye care, cataract surgery, glaucoma treatment, retinal disease management, diabetic eye treatment, and eyelid surgery.