ectropion

Ectropion is a condition in which the lower eyelid turns outward away from the globe, exposing the palpebral conjunctiva. It most commonly involves the lower lid and can lead to tearing, irritation, dry eye, and exposure-related corneal problems.

Classification typically includes involutional (age-related), cicatricial (from scarring), paralytic (due to facial nerve or muscle weakness), mechanical (from a mass or edema), and congenital forms. Each type reflects a different underlying mechanism affecting eyelid position and function.

Causes and risk factors vary by type. Involutional ectropion results from progressive eyelid laxity and can pull the lid outward. Cicatricial ectropion arises from scarring after burns, dermatitis, or chronic conjunctival inflammation. Paralytic ectropion occurs with facial nerve palsy or other neuromuscular impairment. Mechanical ectropion can be caused by eyelid edema or lesions that pull the lid away from the globe. Age, chronic ocular surface disease, and previous eyelid surgeries may contribute.

Symptoms commonly include persistent tearing (epiphora), irritation or a burning sensation, a gritty feeling, redness, and exposure-related dryness or conjunctival inflammation. There may be reduced blinking efficiency and, in severe cases, exposure keratopathy or corneal ulcers.

Diagnosis is clinical, based on assessment of eyelid position, eyelid-lid and lid-globe relations, tear film, and the ocular surface. Examination of corneal staining with fluorescein helps gauge exposure damage. Additional testing targets underlying causes, such as nerve function in paralytic cases.

Treatment depends on cause and severity. Conservative measures include artificial tears, lubricating ointments, and eyelid taping or moisture protection. Mild involutional ectropion may respond to lateral canthal tightening (lateral tarsal strip) or canthopexy. Cicatricial ectropion often needs scar release and reconstructive lid procedures, sometimes with grafts. Paralytic ectropion may require temporary tarsorrhaphy to protect the cornea, with definitive lid procedures after nerve recovery. Mechanical ectropion is treated by addressing the mass. The goal is to restore lid apposition and protect the ocular surface. Prognosis varies with the underlying cause and the success of corrective surgery, but many patients achieve symptom relief with appropriate management.