Ectropion: Symptoms, Types, Causes and Treatment

Ectropion is a common eyelid condition that can dramatically impact eye health and comfort. Whether you’re a patient, caregiver, or simply curious about its nuances, understanding ectropion’s symptoms, types, causes, and treatment options is key to effective management and improved quality of life. This article offers a comprehensive, evidence-based guide based on the latest research to help you navigate this complex condition.

Symptoms of Ectropion

When the eyelid turns outward—no longer hugging the eye’s surface—every blink can become uncomfortable. Recognizing the symptoms early is crucial for prompt treatment and preventing complications such as infection or vision issues.

Symptom	Description	Severity/Impact	Source(s)
Epiphora	Excessive tearing due to poor tear drainage	Common, can impair vision	2, 4
Irritation	Redness, burning, or gritty sensation	Mild to severe	2, 4
Corneal Exposure	Eye surface dries out, risk of damage	Moderate to severe	2, 4
Pain/Discomfort	Aching or soreness in/around affected eyelid	Variable	4
Ulceration	Sores on the cornea or conjunctiva	Severe, can threaten sight	4
Keratinization	Thickening/drying of eye surface tissues	Chronic cases	4
Lagophthalmos	Incomplete eyelid closure, exposure risk	Can worsen dryness	4

Table 1: Key Symptoms

Epiphora (Excessive Tearing)

One of the hallmark symptoms of ectropion is epiphora—constant tearing. This occurs because the eyelid no longer properly channels tears into the tear duct, causing them to spill over the cheek. Epiphora can blur vision and lead to skin irritation below the eye, making daily life uncomfortable 2, 4.

Ocular Irritation and Redness

With the inner eye exposed, patients often experience persistent irritation, redness, and a gritty feeling. The exposed conjunctiva and cornea are more susceptible to environmental irritants, leading to chronic discomfort 2, 4.

Corneal Exposure and Ulceration

Failure of the eyelid to protect and lubricate the eye can result in corneal exposure, which, if left untreated, may progress to painful ulceration or even infection. In severe cases, this can pose a risk to vision 4.

Pain and Lagophthalmos

Pain varies by individual and ectropion severity. Some experience mild soreness, while others find the discomfort significant enough to interfere with sleep or daily activities. Lagophthalmos (incomplete closure of the eyelid) further exposes the eye, compounding symptoms 4.

Types of Ectropion

Ectropion isn’t a one-size-fits-all condition. It encompasses several distinct types, each defined by its underlying mechanism and patient population. Understanding the type is essential for selecting the right treatment and predicting outcomes.

Type	Defining Feature	Typical Patient/Context	Source(s)
Congenital	Present at birth, often with other defects	Rare, infants	1, 2, 4
Involutional	Age-related relaxation of eyelid structures	Older adults	1, 2, 4, 5
Paralytic	Nerve (CN VII) palsy, muscle weakness	All ages, facial paralysis	2, 4
Cicatricial	Scarring or contracture shortens eyelid	After trauma, burns, surgery	1, 2, 4, 7, 8, 11
Mechanical	Tumor or mass pulls lid outward	Tumor/inflammation	1, 2, 4

Table 2: Ectropion Types

Congenital Ectropion

Congenital ectropion is rare and typically appears alongside other eye or facial malformations, such as euryblepharon or ptosis. These cases often require specialized pediatric management 1, 2, 4.

Involutional Ectropion

This is the most common type, especially in older adults. It results from the gradual laxity of the eyelid tendons and supporting structures due to aging, leading to the outward turning of the lower eyelid. Gender differences are noted, with involutional ectropion being more common in males, potentially linked to anatomical variations in the tarsal plate 5.

Paralytic Ectropion

Paralytic ectropion arises from facial nerve (cranial nerve VII) paralysis, such as Bell’s palsy or after stroke or surgery. The loss of muscle tone prevents the eyelid from maintaining its normal position, resulting in eversion 2, 4.

Cicatricial Ectropion

This type is caused by scarring or contracture of the skin and tissues of the eyelid. Common culprits include trauma, burns, dermatological diseases, prior surgery, or chronic inflammation. The scarring shortens the anterior eyelid, pulling it outward 1, 2, 4, 7, 8, 11.

Mechanical Ectropion

Mechanical ectropion occurs when a mass—such as a tumor, cyst, or swelling—physically pushes or pulls the eyelid away from the eye. Inflammation or poorly fitted spectacles can also create enough traction to cause eversion 1, 2, 4.

Causes of Ectropion

Ectropion can have myriad causes, ranging from the natural aging process to trauma and underlying medical conditions. Identifying the root cause is fundamental to crafting an effective treatment plan.

Cause	Mechanism/Description	Examples	Source(s)
Age-related	Tissue laxity, tendon weakening	Elderly, involutional	1, 2, 4, 5
Scarring	Skin contraction pulls lid outward	Burns, surgery, trauma	1, 2, 4, 7, 8, 10, 11
Nerve Palsy	Muscle weakness from CN VII paralysis	Bell’s palsy, stroke	2, 4
Tumors/Masses	Physical displacement of eyelid	Tumors, cysts	1, 2, 4, 9
Inflammation	Chronic inflammation causes traction	Dermatitis, allergies	1, 2, 4, 10
Congenital	Developmental abnormalities	Genetic syndromes	1, 2, 4
Previous Surgery	Post-surgical changes, excessive skin removal	Blepharoplasty	1, 2, 10, 11
Miscellaneous	Eyelid rubbing, contact lens use, etc.	Habits, local trauma	2

Table 3: Major Causes of Ectropion

Age-Related Tissue Changes

Aging is the predominant factor behind involutional ectropion. Over time, the eyelid’s supporting structures (like the canthal tendons and tarsal plate) weaken and become lax, causing the eyelid to sag and evert. Studies also show that males typically have larger tarsal plates, correlating with a higher risk of ectropion in this group 5.

Scarring and Skin Disorders

Cicatricial ectropion stems from anything that scars or contracts the eyelid skin—burns, trauma, skin tumors, allergic reactions, chronic skin conditions, or even complications from aesthetic surgeries like blepharoplasty. The resulting tissue shortening pulls the eyelid away from the eye 1, 2, 4, 7, 8, 10, 11.

Neuromuscular Causes

When the facial nerve is damaged—by injury, stroke, tumors, or Bell’s palsy—the orbicularis oculi muscle loses tone, leading to paralytic ectropion. This loss of muscular support is especially problematic because it can affect both eyelid closure and tear drainage 2, 4.

Tumors, Masses, and Mechanical Traction

Mechanical ectropion is less common but can be caused by anything that exerts a pulling force on the eyelid, including tumors, cysts, or even herniated orbital fat. Inflammatory swelling or poorly fitted glasses may also contribute 1, 2, 4, 9.

Other Contributing Factors

• Chronic rubbing of the eyelids or habitual pulling can stretch tissues and trigger ectropion 2.
• Long-term use of contact lenses or chronic eye allergies may also predispose individuals 2.
• Congenital causes are rare and often associated with other syndromic findings 1, 2, 4.

Treatment of Ectropion

Treating ectropion aims to restore eyelid function, relieve symptoms, and prevent complications. Options span conservative management, minimally invasive procedures, and surgical correction, tailored to the cause and severity.

Treatment	Indication/Usage	Main Advantages	Source(s)
Lubrication	All types (symptomatic relief)	Simple, non-invasive	2, 4
Massage/Taping	Early, mild, or post-surgical	May resolve mild cases	10
Hyaluronic Acid	Cicatricial ectropion, surgery unfit	Quick, aesthetic benefit	8, 11
Surgical Repair	Most moderate/severe cases	Definitive correction	1, 2, 6, 9, 10, 11
Skin Grafting	Cicatricial (scar) type	Restores skin deficit	7, 9, 10, 11
Canthopexy/Tarsal Procedures	Involutional, mechanical	Tightens/realigns lid	6, 9, 10

Table 4: Treatment Options

Conservative Management

For mild cases, especially early post-surgical ectropion, conservative measures may suffice:

• Lubricating eye drops/ointments help maintain moisture and comfort 2, 4.
• Eyelid massage and taping can sometimes realign the eyelid if started early, especially after blepharoplasty 10.
• Treat underlying inflammation to reduce mechanical traction if dermatitis or allergies are present 2.

Minimally Invasive Treatments

• Hyaluronic acid filler injections have emerged as a promising option for cicatricial ectropion, acting as a tissue expander to stretch contracted eyelid skin. This approach is especially valuable for patients who cannot undergo surgery, offering immediate correction with good safety and aesthetic outcomes, though recurrences are more common than with surgery 8, 11.
• Other injectables and non-surgical methods are being researched but are less established 11.

Surgical Correction

Most cases, especially moderate to severe or recurrent ectropion, require surgery:

• Lid-tightening procedures (lateral tarsal strip, canthopexy) are mainstays for involutional and mechanical ectropion, restoring horizontal support 6, 9, 10.
• Skin grafts or local flaps are used to address skin deficiency, especially in cicatricial ectropion 7, 9, 10, 11.
• Medial or lateral canthal tendon repair may be indicated if tendon laxity is significant 6, 9.
• Complex reconstructive procedures may be needed in cases of tumor, extensive scarring, or prior failed repairs 9.

Postoperative and Multimodal Approaches

• Recurrence is a recognized risk, particularly in challenging cicatricial or reconstructive cases. Multiple procedures or staged operations may be necessary 9, 11.
• Individualized, carefully planned surgical strategy is crucial for optimal results 9.

Conclusion

Ectropion is a multifaceted eyelid disorder that, while common, requires careful evaluation and individualized management. Here’s a summary of what we covered:

• Ectropion presents with symptoms like tearing (epiphora), irritation, and risk of corneal exposure and ulceration.
• There are several types of ectropion: congenital, involutional (age-related), paralytic (nerve-related), cicatricial (scarring), and mechanical (mass effect).
• Key causes include aging, scarring, facial nerve palsy, tumors, inflammation, and previous surgeries.
• Treatment ranges from conservative (lubrication, massage) to minimally invasive (hyaluronic acid), and definitive surgical correction tailored to the underlying cause and severity.
• A thorough evaluation and personalized treatment plan are essential to restore function, comfort, and appearance.

If you or someone you know experiences symptoms suggestive of ectropion, early consultation with an eye care professional is advised to prevent complications and ensure the best possible outcome.