When the lower eyelid is turned out away from the eyeball and the inner lining of the eyelid is no longer in contact with the eye, it is called ectropion.
There are two opposing sets of eyelid muscles that oppose each other. One muscle system (eyelids retractors) pulls the eyelid away from the eye. The other muscle systems (orbicularis oculi) pull the eyelid towards the eye. If there is an imbalance in these two muscle system then the eyelid can turn in or out. When the muscles pulling the eyelids towards the eye are weaker than the force pulling the eyelid out, the result is ectropion.
Symptoms of Ectropion
Frequent tearing (epiphora) is very common. This is caused by the opening of the tear duct called the puncta is no longer in touch with the eye and its tear film. The tear duct drains the tears from the eye into the nose. The tears are unable to reach the puncta and drain into the nose. Therefore the tears drain from the eye.
Due to the eye not having sufficient tears on its surface, the following may occur:
Foreign body sensation (feels like something is in the eye)
Frequent eye infections
If the inner lining of the eyelid is exposed enough, the air can dry out this mucous membrane leading to thickening, scarring and redness.
Common Causes of Ectropion
As the muscles of the lower eyelid lose their strength and the tendons of the lower eyelid stretch, the eyelid can droop and turn away from the eye. This is the most common form of ectropion.
Cicatricial or Scarring Ectropion
Scarring of the tissues in the lower eyelid can cause the eyelid to turn outward and is called cicatricial ectropion. This can develop from excessive sun damage, burns, trauma, and infections such as Herpes Zoster (“shingles”).
Bell’s palsy, congenital weakness, or tumors can cause paralysis of the muscles around the eye leading to ectropion. Bell’s palsy is usually temporary and resolves over the following weeks to months.
If the ectropion is mild, then using artificial tears and ointment may be adequate.
Surgery is many times required to resolve the condition. The procedure is done as an outpatient under local anesthesia. The eyelid and muscles are tightened to lift the eyelid up. In cicatricial ectropion a skin graft may be necessary in order to lift the eyelid up to its proper position.