Ectropion is the eversion or outward turning of the eyelid, most commonly affecting the lower eyelid but sometimes involving both lids. This malposition exposes the palpebral conjunctiva, potentially impairing normal ocular surface protection and lacrimal drainage.

• If the lacrimal puncta are everted, tear drainage is compromised, leading to epiphora (excessive tearing).

• Ectropion may develop gradually with aging (involutional ectropion), or result from trauma, scarring, or facial nerve paralysis (cicatricial or paralytic ectropion).

Pathophysiology

Ectropion occurs when the structural support of the eyelid is insufficient to maintain normal lid-apposition to the globe:

• Involutional (age-related): Weakening of the orbicularis oculi muscle, canthal tendons, and tarsal plate laxity leads to lid laxity and outward turning.

• Paralytic (facial nerve palsy): Loss of orbicularis oculi tone prevents lid closure and promotes eversion.

• Cicatricial (scarring): Contracture of skin, conjunctiva, or scar tissue pulls the eyelid outward.

• Mechanical: Tumors or mass lesions exert traction on the eyelid.

Consequences include exposure keratopathy, chronic conjunctivitis, and tear film instability.

Examination Technique

Inspection

• Observe the eyelid in primary gaze for eversion and palpebral conjunctival exposure.

• Note epiphora, redness, or signs of chronic irritation.

Palpation

• Gently assess lid laxity and canthal tendon tension.

• Evaluate for orbicularis oculi weakness or scarring.

Functional Assessment

• Check tear drainage by inspecting the position of lacrimal puncta.

• Assess ocular surface for keratitis, punctate epithelial erosions, or conjunctival inflammation.

Clinical Features

Differential Diagnosis

Pediatric considerations

• Rare; may occur secondary to congenital eyelid malformations or birth trauma.

• Early recognition prevents corneal exposure and visual complications.

Geriatric considerations

• Most common in older adults due to age-related tissue laxity.

• Chronic exposure can lead to corneal ulceration and secondary infections.

Limitations

• Mild involutional ectropion may be asymptomatic.

• Distinguishing between temporary lid laxity and true ectropion requires careful examination.

Patient counseling

• Explain that ectropion is a structural eyelid problem that can cause tearing, irritation, or corneal damage.

• Highlight the importance of ocular surface protection, such as lubricating eye drops or ointments.

• Discuss treatment options: temporary measures (taping, moisture protection) or surgical correction for persistent or symptomatic cases.

• Address underlying causes, especially in trauma or facial nerve paralysis.

Conclusion

Ectropion is a malposition of the eyelid that can compromise ocular surface integrity and tear drainage. Early detection, proper assessment, and timely management—especially surgical correction in symptomatic cases—help prevent chronic irritation, keratopathy, and vision complications.

References

1. Kersten RC, Kulwin DR. Eyelid Malpositions: Ectropion and Entropion. N Engl J Med. 2020;382:2298–2307.

2. American Academy of Ophthalmology. Basic and Clinical Science Course (BCSC): External Disease and Cornea. 2021–2022.

3. Jordan DR. Surgical correction of ectropion and entropion. Ophthalmology Clinics of North America. 2005;18(4):477–490.

4. Shields JA, Shields CL. Eyelid, Conjunctival, and Orbital Tumors. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2016.