Front view of eye showing drooping lower eyelid and ectropion.Ectropion is an eyelid that sags or turns outward. It usually affects one or both lower eyelids. Ectropion leaves the eye too exposed. The eye can become dry, irritated, and even infected. This can lead to serious problems. In some cases it can lead to loss of eyesight.

What causes ectropion?

Congenital ectropion is present from birth. There is not enough skin in the area under the eye. This may happen because of problems with some genes. This most often occurs along with health problems such as:

  • Blepharophimosis syndrome

  • Down syndrome

  • Ichthyosis

Acquired ectropion happens later in life. There are 4 different types:

  • Involutional ectropion. This is the most common type of ectropion. It often results from aging. Over time the collagen and elastic fibers in the eyelid can get weak. This causes the eyelid tissue to become very loose. Gravity can then cause the eyelid to fall open. It is most common in older adults. The other types of ectropion are rare.

  • Cicatricial ectropion. This is a rare type of ectropion. It’s caused when the lower lid contracts abnormally. This is often from scarring. It causes the lid to open outward. This may happen because of an eye infection or eye injury, or problems after eye surgery. An infection called trachoma is a main cause of this kind of ectropion. The infection is caused by bacteria.

  • Paralytic ectropion. This is also a rare type of ectropion. This results from a problem with the facial nerve (seventh cranial nerve). This nerve sends signals to the muscle right under the eye. Problems with the nerve can cause other problems in facial movement. Cranial nerve paralysis may occur as a result of a stroke.

  • Mechanical ectropion. This is another rare type. This happens when a tumor or other mass in the eyelid pulls it down.

Symptoms of ectropion

Symptoms are caused by the front part of the eye (cornea) and lining of the eye (conjunctiva) being exposed. They can include:

  • Too much tearing

  • Dry eyes

  • Itching, burning, or crusting, from chronic conjunctivitis

  • Blurry eyesight, sensitivity to light, and eye pain, from an infection or ulcer of the cornea

  • Inability to fully close the eyelids, especially with paralytic ectropion

Diagnosing ectropion

Your eye doctor will ask about your past health. He or she will give you an eye exam. Tests are not needed to diagnose ectropion.

Treatment for ectropion

You may first use treatments such as:

  • Lubricating eye drops

  • Steroid ointment in the eyes

  • Antibiotics to treat an eye infection

  • Taping the eyelid in to normal position, most often at night

Most people with ectropion will need surgery. The type of surgery used depends on the cause of the ectropion. For example, you may need extra skin removed. Or you may need a donor skin graft to add more skin under your eye. You may need a tumor removed from your eyelid. In most cases, surgery fixes ectropion.

Possible complications of ectropion

Ectropion can cause infection of the cornea that leads to a corneal ulcer. This may cause scarring of the cornea and loss of eyesight.

When to call your healthcare provider

Call your health care provider right away if you have any of these:

  • Eye pain

  • Decreased vision

  • Eye redness that gets worse

  • Sensitivity to light that gets worse

  • Blurry eyesight

  • Fluid coming from your eye