Eyelid Ectropion

4 min read

An eyelid ectropion occurs most commonly in the lower eyelid. A person’s lower eyelid will become droopy and it will extend outward. Because the eyelid is not in the correct position, the eyeball is not as protected as it should be. This causes eye exposure. An upper eyelid ectropion is very uncommon and may be related to sleep apnea.

Symptoms Of Eyelid Ectropion

The majority of symptoms that patients experience from an eyelid ectropion are due to the fact that when the patient blinks or tries to close their eyes, the eyelids do not close properly. Therefore, parts of the eye itself are exposed and they become dry and irritated.

Because of the exposure, symptoms of eyelid ectropion include tearing, eye irritation, eye redness, and in some cases eye discharge. Because a patient may develop severe dry eye due to having a long standing ectropion, their vision can even become blurry over time. 

Risk Factors For Eyelid Ectropion

An ectropion can happen for many different reasons. One of the most common reasons is getting older. 

A patient can also develop an eyelid ectropion as a result of eyelid disease. For example, if a patient has an eyelid tumor or eyelid mass in their lower eyelid, this can physically cause that eyelid to become heavier and more subject to the forces of gravity. This mechanical force then pulls the eyelid down causing it to become droopy and rotate outwards.

Trauma or eyelid injury can also cause an eyelid ectropion. While most people think of trauma as a big event, even small repeated events over a long period of time can cause an eyelid ectropion. An example of this would be a person who has a habit of constantly rubbing their eyes. Another example is a patient who constantly pulls their eyelid down to insert contact lenses. 

In less common cases, certain eye drops can cause eyelid ectropion when they are being used for a long time. This is seen with the chronic use of drops like dorzolamide and brimonidine, which are commonly used to treat glaucoma. In some patients, they may develop an allergy or inflammatory reaction to these drops and that can cause inflammation in the eyelid as well. This inflammation can cause the eyelid to droop. Although eye drops for glaucoma are meant to go inside the eye and not onto the eyelid, many patients will have some drops that also touch their eyelid. If you think you have an eyelid problem because of your glaucoma drops, you should talk to your ophthalmologist or glaucoma specialist. It is not a good idea to discontinue any medical eye drops without first speaking to your ophthalmologist. 

There are also reports of other topical treatments to the eyelid area that can cause an ectropion. In one case report, authors described treatment of a eyelid xanthelasma (accumulation of lipid) that caused an eyelid ectropion.

 

Treating Eyelid Ectropion

The most definitive treatment for an eyelid ectropion is surgical correction. The surgery to correct an eyelid ectropion is usually done by an oculoplastics specialist. An oculoplastics specialist is an eye surgeon who has completed medical school, a four year residency in ophthalmology, and then additional years of surgical training in oculoplastics. 

 

Sources:

Orbit, Eyelids, and Lacrimal System, Section 7. Basic and Clinical Science Course. San Francisco: American Academy of Ophthalmology; 2009.

Bedran EG, Pereira MV, Bernardes TF. Ectropion. Semin Ophthalmol. 2010 May;25(3):59-65. doi: 10.3109/08820538.2010.488570. PMID: 20590414.

https://pubmed.ncbi.nlm.nih.gov/20590414/

Salloum G, Crawford JJ, Dryden S, Meador AG, Wesley RE, Klippenstein K. Lower Eyelid Ectropion Secondary to Over-the-Counter Treatment of Xanthelasma. Ophthalmic Plast Reconstr Surg. 2022 Jan-Feb 01;38(1):e25-e28. doi: 10.1097/IOP.0000000000002070. PMID: 34812179.

https://pubmed.ncbi.nlm.nih.gov/34812179/

Vallabhanath P, Carter SR. Ectropion and entropion. Curr Opin Ophthalmol. 2000 Oct;11(5):345-51. doi: 10.1097/00055735-200010000-00010. PMID: 11148701.

https://pubmed.ncbi.nlm.nih.gov/11148701/

https://eyewiki.org/Ectropion

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