Ectropion is an abnormal eversion (outward turning) of the lid margin away from the globe. This is a condition in which your eyelid — typically the lower lid — turns out. This leaves the inner eyelid surface exposed and prone to irritation. Ectropion is more common in older adults. In severe ectropion, the entire length of the eyelid is turned out. When ectropion is less severe, only one segment of the eyelid sags away from the eye.
The prevalence of involutional lower lid ectropion in elderly patients in Brazil has been estimated at 2.9%. The primary morbidity is associated with corneal/conjunctival exposure. Tearing may also cause significant patient complaints. Ectropion can affect patients of any age but is most commonly seen in older adults.
When you have ectropion, your lower lid pulls away from your eye and tears don't drain into the puncta properly, causing a number of signs and symptoms. These include irritation, excessive tearing, excessive dryness.
Ectropion can have several different causes, including:
• Muscle weakness. As you age, the muscles under your eyes tend to get weaker as the tendons stretch out. These muscles and tendons are responsible for holding your eyelid taut against your eye, so when they relax, the eyelid can begin to droop and turn outward.
• Facial paralysis. When some of the facial nerves and muscles are paralyzed, as with Bell's palsy and some types of tumors, it can affect the eyelid muscles and cause ectropion.
• Previous surgery, radiation or cosmetic procedures. Previous eyelid surgery (blepharoplasty) can cause ectropion to develop later, particularly if too much skin from the eyelid was removed at the time of surgery. Radiation of your eyelid for a cancerous growth can trigger ectropion to develop. Even cosmetic laser skin resurfacing can shrink your eyelid too much, pulling it away from your eye and causing ectropion.
• Congenital ectropion. Rarely, ectropion is present at birth (congenital), when it is usually associated with genetic disorders, such as Down syndrome.
• Drug reaction. Certain medications, such as some drops used to treat glaucoma, may contribute to ectropion.
Artificial tears (a lubricant) may ease dryness and keep the cornea moist. Surgery to tighten the muscles that hold the eyelids in place is very often effective. It may be done as outpatient surgery using medicine to numb the area (local anesthesia). Topical retinoids have been suggested as treatment for ectropion from ichthyosis. Hyaluronic acid gel has been described as a treatment for cicatricial ectropion but has a poor cosmetic result. Lubrication and moisture shields are helpful if significant corneal exposure exists from the ectropion.