Ectropion is an outward turning of the eyelid margin. Ectropion can cause dryness of the eyes, excessive tearing, red eyes, and increased sensitivity to light and wind. It may occur unilaterally or bilaterally and is almost always in the lower eyelid. Acquired causes of ectropion include: involutional (due to aging changes), paralytic (due to seventh cranial nerve palsy), cicatricial (due to scarring), inflammatory, or mechanical.
Involutional ectropion is the most common form of ectropion. The etiology of involutional ectropion is similar to that of involutional entropion. Progressive laxity of the supportive structures of the eyelid is present in both conditions. In ectropion, however, normal or decrease orbicularis muscle (eyelid muscle) tone results in the eyelid turning out. The ectropion may just involve the medial portion of the lid or it may involve the entire lid.
Temporary or permanent seventh cranial nerve palsy (due to surgery or a Bell’s palsy) often results in paralytic ectropion of the lower eyelid. The orbicularis muscle loses its tone and the eyelid falls outward. Poor blinking and eyelid closure leads to chronic eye irritation.
Any type of scarring process of the eyelid or facial skin may result in eversion of the eyelid. It may occur following chemical or thermal burns to the face, trauma, or previous eyelid surgery. Dermatologic conditions such as rosacea, atopic dermatitis, eczema, and ichthyosis may also cause cicatricial ectropion.
Bulky tumors of the eyelid may weigh down the lower eyelid resulting in eversion of the lid. Poorly fit or heavy spectacles may also pull a lax or loose eyelid outward.
The Treatment of Ectropion
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Ectropion treatment, for the most part, is surgical. The only form of ectropion that may be amenable to temporizing measures is the paralytic form secondary to seventh cranial nerve palsies. In these cases, the use of lubricating eye drops and ointment combined with taping the eyelids closed at night may be successful in keeping the eye comfortable for a brief time in anticipation of recovery of seventh nerve function (Bell’s palsy).
Surgery is generally performed with local anesthesia as an outpatient. The surgery involves tightening the lower eyelid and turning the eyelid margin back into its normal position. If a cicatricial process is present, the skin disease should be treated first. If the eyelid is still turned out once the skin is quiet and the dermatitis has resolved, a full-thickness skin graft or local skin-muscle (myocutaneous) flap may be required. Skin may be taken from the upper eyelid(s), in front of or behind the ear, or just above the clavicle if a skin graft is required.