What is ectropion?
Ectropion is a condition where the lower eyelid droops or turns away from the eye itself. The eyelid can appear as if it is turned โinside outโ, where the delicate, pink inner lining called the conjunctiva is exposed. The lower lid not touching the eye can create symptoms that can be mild or severe and may even cause loss of vision. With ectropion, the lower eyelid is loose and floppy, and you may not be able to close your eye. This can cause eye irritation, dry eyes, redness, tearing, crusting, and eventually permanent eye damage with decreased vision. Ectropion can be diagnosed by physical examination and treatments vary depending on how much the drooping eyelid bothers you. Conservative treatment like ointments and taping the eye closed at night may improve symptoms. Sometimes, surgery is needed to improve symptoms and to help restore a more natural look of the eyelid.
What are the symptoms of ectropion?
As the eyelid sags and turns inside out, you can lose the ability to close your eye. This leads to burning, dry eye, tearing and visible asymmetry. Patients usually dislike the bright pink inner lining of the conjunctiva they can see while looking in the mirror. Tears may collect within the everted eyelid, or leak onto the cheek. This is because the normal tear drainage system needs the eyelid to be tight against the globe of the eye to work well. Pooled tears can spill out from a drooping eyelid leading to persistent tearing called โepiphoraโ. Patients who constantly need to wipe away tears can experience skin irritation and complain of the inability to wear make-up. At the same time, the eye experiences dryness, a sensation there is something in the eye (foreign body sensation), or a burning sensation because the tears are not able to moisturize and lubricate the eye. Some patients may also experience blurred vision due to decreased layer of tears across the globe of the eye. This sensation of eye dryness causes increased tear production causing the eye to tear more. Severe eye irritation can lead to inflammation and corneal (outer surface of the eye) scratches. Repeat corneal trauma can result in ulcerations, infections and eventually, decreased vision.
What causes ectropion?
There are multiple causes of ectropion.
Age. This is the main reason that patients will have ectropion. As we age, we know that everything tends to sag. The lower eyelids are no different. The lower eyelid is supported on each side by support (canthal) tendons similar to a hammock. These canthal tendons that hold the eyelid against the eye will relax with age and can fall away from the globe creating a sagging, loose eyelid. Middle third of the face is also important in lower eyelid support. Moreover with age, there is sagging of the cheeks of the midface that pulls down on the lower eyelid which further contributes to eyelid eversion and stretching of the canthal tendons.ย
Facial paralysis. Lack of muscle in the eyelid can prevent the eyelid from closing. Anything that damages the facial nerve such as a tumor, surgery or penetrating injury, can cause weakness or paralysis of the eyelid muscles. Bellโs palsy is a condition of unknown origin that can cause temporary or permanent paralysis of facial nerves that close the eyelid.ย
Prior surgery. Patients who underwent prior eyelid surgery for lesion removal and after a lower eyelid skin reduction (blepharoplasty) can develop lower eyelid drooping and ectropion. Aggressive laser and chemical peels of the eyelid areas can pull down on the lower lid as well.
Trauma. Repeat trauma to the eyelid can loosen the eyelid and cause ectropion. The history of repeat pulling on the eyelid for placing contact lenses can weaken the canthal tendons.ย
Eyelid Lesions. Growths and tumour scan โweigh downโ the eyelid causing its premature stretching and eversion.
Congenital. Rarely the eyelid can be drooping and ectropion present at birth.
How is ectropion diagnosed?
You may notice your eye feeling drier and the pink conjunctiva showing. This will lead many patients to see their doctor.ย A routing examination including a history and physical can be used to diagnose ectropion. The history of the symptoms listed above can direct the physical exam. The drooping of the eyelid and exposure of the conjunctiva will show ectropion. The doctor may perform a โsnap testโ where they will pull on your lower eyelid and see how quickly or if the eyelid returns to the globe. A slow or incomplete return of the eyelid to the eye shows ectropion. The doctor having you close your eyes tightly will give an idea of the tone and proper functioning of the eyelids. Photographs of the eyelids in open, wide open, and closed position will be taken to monitor the eyelid position and are required by most insurance companies.
What is the treatment for ectropion?
Mild ectropion can be treated medically. However, these treatments will not reverse the droopiness of the eyelid away from the eye. Eye irritation can be treated with increased lubrication of the eyelid including over the counter natural tear drops or ophthalmic ointments. Patients with more severe ectropion or facial paralysis may need to tape the eye shut at night to avoid eye injury during sleep. Eyelid stretching exercises may be recommended by your doctor to try to help close the eye.ย
Surgery is only treatment that can be used to tighten the eyelid. Ectropion surgery will depend on the cause and location of the ectropion. Loose tendons can be tightened and repositioned to restore normal eyelid shape and function (lateral canthoplasty and canthopexy). If tendons cannot be tightened, another tendon can be borrowed from a different location in the body to lengthen the tendon before tightening (tendon sling transfers). Age-related correction may need to lift the middle third of the face that sagged due to aging if it is contributing to the problem (midface lift). If scar tissue from prior injury or surgery is contributing to ectropion, grafting of either skin from the inner lining of the cheeks may be necessary to restore proper eyelid function. After surgery, the eyelid will feel and look tighter to the eye and symptoms should improve or resolve completely. Dr Araslanova can guide you through both medical and surgical options depending on the severity of the ectropion.