Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 30, 2016

Ectropion is a condition marked by the eyelid, usually the lower lid, sagging away from the eye. This is not considered a life-threatening ailment but can cause damage over time and is uncomfortable. 


Definition & Facts

Ectropion is the turning of the eyelid away from the eye. It most commonly affects the lower lid, but it can occur in the upper lid as well. The curling exposes the membrane of the eye to the air. It is this exposure that causes the damage to the eye. While ectropion can be caused by trauma, it most often occurs due to the aging process.

Symptoms & Complaints

The most prominent symptom of ectropion is the visible sagging or turning of the eyelid. When the eyelid begins to curl away from the eye, the inner part of the eyelid becomes visible and has a reddish color. The eyelid will sag more with time, and that process will leave the eye exposed and cause tears to not drain properly.

The exposure can cause mild symptoms to appear and, at first, they may be indistinguishable from allergy symptoms. Symptoms like red or itchy eyes can appear relatively early and may be accompanied by dryness.

Chronic dryness can cause damage to the eye that also causes sensitivity to light. Due to the dryness caused by the eyeball's exposure, a person may also experience excessive tears. A patient may also note that their eyes burn or feel dirty or gritty.

Those who suffer from ectropion might also notice that they have recurring conjunctivitis or pink eye. Pain in the eyes may occur in some cases. Some patients also complain of loss of visual acuity caused by either the dryness or the excessive tears. Symptoms can also occur in the eyelid as well as the eye. The lids may have a burning sensation and can turn red. 


Most often ectropion is caused by the aging process. As a person gets older their skin loses elasticity or the muscle tissue simply grows weaker and when this happens around the eyes, it can cause the eyelid to droop. This is the most common cause of the condition and most patients with the condition are over the age of 60.

Aging, however, is not the only possible cause. Facial paralysis can be a cause of the condition. Bell's palsy can cause the kind of muscle weakness and relaxing of tendons that can cause the eyelid to fall away from the eye. An injury or burn can contribute to ectropion much in the same way paralysis can: by damaging the skin elasticity or weakening the muscles.

Any time the integrity of the skin or muscles around the eye is damaged, including from a previous eye surgery, there is a risk of developing ectropion. In cases where a lot of skin has been removed from the eye area, the chance of developing ectropion increases.

If a patient has suffered from previous growths or cancer on their eyelid, those growths can cause the eyelid to sag. If a patient pulls their eyelid away from their eye often, such as when using contact lenses, that can also cause the muscles and skin to loosen. In very rare cases a person can be born with ectropion.

Diagnosis & Tests

Diagnosing ectropion can be done during a normal physical examination or eye examination. The doctor will check around the eyes to check for the outward, physical symptoms of the condition. They can check the skin and muscles around the eyes to see if there is any weakening or sagging. They can test for elasticity by pulling on the skin and test muscle strength by asking the patient to forcefully close their eyes. During this process, they can also check for signs of palsy or facial paralysis.

Diagnosing ectropion can be as much about ruling out alternate causes for symptoms as it is looking for symptoms. The doctor will need to rule out allergies or other eye maladies that can cause redness and irritation. They will also check for signs of growths or tumors around the eye area.

A close visual examination can reveal if the lid is beginning to curl away from the eye. The doctor may also examine the area around the eyes to check any symptoms that may have been caused by a prior surgery or eye trauma.

Treatment & Therapy

The treatment of ectropion varies based on the initial cause of the condition. For temporary treatment or to treat very mild cases, treatment is focused on keeping the eye moist. Eye drops or artificial tears can be used to help fight the dryness the condition causes. In cases where facial paralysis caused the ectropion, a specially formed weight can be used on the eyelid to help weigh it down. The weights are applied to the eyelid by the patient during the day and removed at night.

When scar tissue is the cause, the eye may be treated with scar tissue stretching or a skin graft. This therapy will help relax the tissue around the eye so that it can close properly.

The most common treatment for ectropion is surgery and it is typically the only way to treat the condition long-term. Surgery for ectropion is simple surgery that can be performed with a local anesthetic. The type of surgery can vary slightly based on the underlying cause of the condition but is always performed with the purpose of allowing the eye to close properly. This may mean that scar tissue needs to be removed and new skin grafted on or it may involve removing part of the lower eyelid in order to tighten it.

Prevention & Prophylaxis

In most cases, there is no way to prevent ectropion as it is either due to an injury or it occurs as part of the natural aging process. The best course of action is to catch the condition early and begin treatment right away if it appears.

However, there are ways to reduce the risk slightly. It is best to avoid or limit actions that can add to the loosening or sagging of the skin around the eyes. Eyedrops should be put in without stretching the eyelid and the eyes should be wiped without dragging excessively on the skin around the eyes.