Ectropion

Ectropion is the term for outward folding of the lower eyelids. The inner wall of the eyelids helps lubricate the surface of the eye and is very sensitive to drying.

Ectropion exposes the inner wall of the eyelids to outside environment, causing irritation.

This condition is common in elderly, but can also be caused by facial injuries or paralysis. It can be mild (affecting only a part of an eyelid) or severe, involving the whole length of the eyelid.

Ectropion must be treated to prevent eye dryness, tears to the cornea and visual loss. Artificial tears and lubricant ointments temporarily relieve dryness and irritation, but surgery is needed to correct the condition.

Symptoms of Ectropion are varied, but generally are associated with sensitive and watery eyes.

Blinking lubricates the eyes by distributing tears evenly throughout the eye surface. The excess tears drain into tiny holes (called puncta) in the inner part of the eyelids.

Ectropion pulls the lower eyelid from the eye’s surface, so each blink does not put enough tears to the eyes. It also distorts the pathway of tears and so cannot drain into the puncta.

Thus, the person suffers from:

• Watery or teary eyes due to pooling of tears over the eyes.
• Dryness of the eye caused by insufficient lubrication, causing the eyes to feel dry, gritty and sandy.
• Redness of the whites of the eyes with burning sensation.
• Sensitivity to light, caused by too little tears protecting the eye surface.

It is important for you to see a doctor immediately, especially if your eyes are always watery or irritated, or if your eyelids seem to sag or drop.

If left untreated, ectropion can cause exposure of cornea that can result in reduction in vision.

If you already have ectropion, seek emergency care if you experience:

• Rapid progression of redness in your eye
• Sensitivity to light
• Problems or reduction in vision

Ectropion can be caused by the following:

• The weakness of the muscles in the face, which can cause the tendons holding the eyelid to sag resulting to ectropion. Muscles generally become weak as we age, which explains why it is more common in elderly.
• Paralysis of the facial muscles, which can be caused by conditions like Bell’s palsy or tumors that affect the nerves innervating the face.
• Injuries or surgeries on the face can also cause ectropion. The scars caused by these conditions can stretch the skin as they heal, which may affect the resting position of the eyelid and cause ectropion. Even procedures like eyelid surgery (blepharoplasty) can cause ectropion, especially if lots of skin were removed.
• Growths in the eyelid, like tumors, skin tags or warts, can make the eyelid turn outward
• Some genetic disorders such as Down’s syndrome and Harlequin-type ichthyosis can cause ectropion

The doctor can easily diagnose ectropion after a physical examination and eye examination.

Your doctor may request you to close your eyes or may pull the eyelids to determine muscle tone and tightness.

If scars, growths or previous surgeries cause ectropion, the doctor will examine them too.

For the treatment of ectropion's mild cases, your doctor may prescribe regular use of artificial tears or lubricate ointment. You have to apply them properly to ease eye dryness and redness. The only treatment for ectropion is surgery, which can be simple or complicated depending on severity.

The surgeon may simply remove a small portion of the outer edge of the lower eyelid, and stitch the remaining skin together. This causes the eyelid to tighten and rest properly on the eye. This is appropriate for ectoprion caused by weakened muscles or ligaments due to aging.

If ectropion is caused by scars from surgery or injuries, the surgeon may apply a skin graft to support the lower eyelid. This skin grafting can be done up to two times, which is needed for severe ectropion caused by paralysis or extensive scarring. The skin graft is usually harvested from your upper eyelid or behind your ear.

Surgery for ectropion is done with local anesthetic, and you will be lightly sedated so you will be more comfortable throughout the procedure. This is usually done on an outpatient basis, so you can have surgery and go home on the same day.

Here are some important things to do after surgery:

• You need to wear an eye patch for around 24 hours.
• The doctor may prescribe an antibiotic and steroid ointment that you need to apply on your eye several times a day. These medications are applied for one week.
• You must apply cold compresses periodically to reduce bruising and swelling

Take note that you will experience swelling and bruising on and around your eye after surgery, which should gradually disappear and fade in around two weeks.

Your eye may feel tight right after surgery, but it will ‘loosen’ up and you will become more comfortable in few days.

Lifestyle modifications are necessary in order to cope with ectropion.

You can relieve eye dryness and irritation caused by ectropion through these tips:

• Use eye lubricants like artificial tears and eye ointments regularly. These lubricants help keep your cornea lubricated and prevent damage that can result in loss of vision. At night, apply eye ointment and wear a moisture shield to prevent your eyes from drying while you sleep.
• You need to wipe your eyes in a certain manner, carefully starting from the outer eye and in toward the nose. This can prevent stretching of the muscles and tendons of the eyelids that worsen ectropion.

There are several risks and complications associated with ectropion.

You are more likely to have ectropion if you are:

• Aged 60 and above. Muscles tend to weaken during aging, increasing risk of ectropion of the eyelids
• Have had eye or facial surgeries
• History of skin cancer, burns or facial injuries

Ectropion makes your eyes less lubricated and prone to dryness, causing the cornea to sustain tears.

If not treated, tears in the cornea can cause loss of vision.