Eye diseases: ectropion

By Cristiano Antonino On May 4, 2023

Ectropion is a condition in which the eyelid margin is turned outwards causing symptoms related to exposure of the ocular surface

The definitive treatment is surgical, however proper medical management can improve symptoms and delay surgery.

In most cases the lower eyelid is involved, however, eversion of the upper eyelid can occur in the so-called Floppy eyelid syndrome.

What are the causes of ectropion

There are different types of ectropion:

Senile, i.e. caused by increased horizontal laxity of the lower eyelid.
Cicatricial, i.e. secondary to inflammatory processes of the eyelid that cause thinning of the anterior lamella between the skin and orbicularis muscle.
Paralytic, i.e. caused by a decrease in the tone of the orbicularis muscle that supports the lower eyelid.
Mechanical, which may occur if a mass displaces the lower eyelid margin.
Congenital and may be associated with other congenital malformations of the periocular region.

Several factors predispose to the development of this condition, in particular advancing age that causes loss of tissue elasticity, inflammatory skin conditions involving the eyelids, mechanical rubbing of the periocular region, trauma and previous eyelid surgery may result in this condition.

What are the symptoms of ectropion?

The outward rotation of the eyelid margin, which is peculiar to this condition, involves the tear dots (the oval openings from which the tear ducts originate), which shrink over time and accumulate keratin precisely because they are exposed to the outside and become keratinised.

The consequence of this alteration of the tear ducts is epiphora, i.e. the overflow of tears outside the eye. In this situation, the conjunctiva (the membrane covering the eyeball and the inside of the eyelids) and the cornea lose their normal lubrication and protection.

This promotes secondary inflammation, a thickening of the inner part of the eyelid (the tarsus) that further worsens the ectropion and the development of a keratopathy, a disease that in extreme cases can cause ulceration and perforation of the cornea.

Initially asymptomatic, in more advanced stages patients will therefore experience tearing, irritation and foreign body sensation, red eye and mucous discharge.

How to diagnose ectropion?

In the presence of the described symptoms associated with ocular discomfort, it is necessary to undergo a complete eye examination to assess the presence of this condition.

The ophthalmologist will assess several aspects to define the cause of ectropion and set the correct therapeutic approach.

It evaluates the facial architecture for any malpositions or malformations, the effectiveness of the facial nerve action, the degree of eyelid laxity and the presence of any chronic inflammatory pathologies, the position of the tear duct and the state of the ocular surface to highlight epithelial changes of the cornea secondary to exposure.

Treatments

The definitive treatment is surgical, the operation is performed under local anaesthesia and often aims at increasing the horizontal tension of the lower eyelid by means of a lateral tarsal strip or similar procedure.

Medical management uses lubrication of the ocular surface and horizontal ‘taping’ of the lower eyelid, again with the aim of increasing its tension and reducing epiphora.

However, it must be remembered that medical management can be temporarily effective and improve symptoms pending definitive surgical treatment.

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