Ectropion is a condition in which your eyelid — typically the lower lid — turns out, leaving the inner eyelid surface exposed and prone to irritation. Ectropion occurs mainly in older people. Ectropion also affects men more often than women. In severe ectropion, the entire length of the eyelid is turned out. When ectropion is less severe, only one segment of the eyelid sags away from the eye.

Normally when you blink, your eyelids distribute tears evenly across your eyes, keeping them lubricated. These tears drain into the little openings on the inner part of your eyelids (puncta). When you have ectropion and your lower lid is pulling away from your eye, the tears don't drain into the puncta properly, causing a number of signs and symptoms:

• Irritation. Stagnant tears or dryness can irritate your eyes, causing a burning sensation and redness in your eyelids and in the whites of your eyes.
• Excessive tearing. Without proper drainage, your tears may pool and constantly flow over your eyelids. Many people with ectropion complain of watery or weepy eyes.
• Excessive dryness. Ectropion can cause the eyes to feel dry, gritty and sandy.

When to seek medical advice
If you begin noticing that your eyes are constantly watering or irritated, or your eyelid seems to be sagging or drooping, make an appointment to see your doctor for an evaluation.

If you know that you have ectropion, be alert for symptoms of cornea exposure or ulcers, including rapidly increasing redness, pain, light sensitivity or decreasing vision. If you experience any of these vision-threatening signs and symptoms, seek immediate care in an emergency room.

Ectropion can have several different causes, including:

• Muscle weakness. As you age, the muscles under your eyes tend to get weaker as the tendons stretch out. These muscles and tendons are responsible for holding your eyelid taut against your eye, so when they relax, the eyelid can begin to droop and turn outward.
• Facial paralysis. When some of the facial nerves and muscles are paralyzed, as with Bell's palsy and some types of tumors, it can affect the eyelid muscles and cause ectropion.
• Scars or skin problems. Scarred skin from facial burns or trauma, such as a dog bite or lacerations, can affect the way that the eyelid rests against the eye. Chronically irritated or inflamed skin (dermatitis), or previous skin cancer in the facial area, also can cause ectropion.
• Eyelid growths. Benign or cancerous growths on your eyelid can cause the lid to turn outward.
• Previous surgery, radiation or cosmetic procedures. Previous eyelid surgery (blepharoplasty) can cause ectropion to develop later, particularly if too much skin from the eyelid was removed at the time of surgery. Radiation of your eyelid for a cancerous growth can trigger ectropion to develop. Even cosmetic laser skin resurfacing can shrink your eyelid too much, pulling it away from your eye and causing ectropion.
• Rapid weight loss. Sometimes, losing weight very quickly can cause ectropion.
• Congenital ectropion. Rarely, ectropion is present at birth (congenital), when it is usually associated with genetic disorders, such as Down syndrome.

Certain factors increase your risk of developing ectropion:

• Age. The most common cause of ectropion is weakening muscle tissue associated with aging. The older you are, the greater your chances of developing the condition.
• Previous eye surgeries. People who have had eyelid surgery (blepharoplasty) are at higher risk of developing ectropion later.
• Previous cancer, burns or trauma. If you've had spots of skin cancer on your face, facial burns or trauma, you're at higher risk of developing ectropion.

The most serious complication associated with ectropion is irritation and damage of the cornea. Because ectropion leaves your cornea irritated and exposed, it is more susceptible to wear (corneal abrasions) and ulcers, which can cause permanent loss of vision. Lubricating eyedrops and ointments can help to protect your cornea and prevent damage until your ectropion is corrected.

When you go to see your doctor, you should be ready to discuss the following:

• Your medical history, including regular medications
• Any history of other eye problems
• Any previous eye surgeries
• What your symptoms are and how long you've been experiencing them

You may wish to bring a photograph of yourself before your ectropion was noticeable so that your doctor can observe the difference in your eyelid appearance. If it helps, you might also consider bringing along a list of your symptoms, such as watery eyes or redness, and approximately when each one started.

Once at the doctor's office, you can expect detailed questions about your symptoms, a physical examination and an eye exam.

Usually, ectropion can be diagnosed with a routine eye exam and physical examination. Your doctor may pull on your eyelids during the exam, or ask you to close your eyes forcefully, in order to assess your eyelid's muscle tone and tightness.

If your ectropion is caused by a scar, tumor or previous surgery, your doctor will examine the surrounding tissue as well. Understanding how other conditions cause ectropion is important in choosing the correct treatment or surgical technique.

Eyedrops and ointments can be used to manage symptoms and protect your cornea until a permanent treatment is done. Most cases of ectropion require surgery.

Scar tissue stretching
This treatment can be considered if your ectropion is caused by a developing scar that's tightening or pulling on your skin. Massaging the scar tissue, injecting it with steroids or doing both may help to modify the scar and relieve the ectropion. However, this is not usually effective.

Surgery
There are several different surgical techniques for ectropion, depending on the cause and the condition of the tissue surrounding your eyelid. Before the surgery, you'll receive a local anesthetic to numb your eye and the area around it, and you'll be lightly sedated using oral or intravenous (IV) medication to make you more comfortable.

If your ectropion is caused by muscle and ligament relaxation due to aging, your surgeon will likely remove a small part of your lower eyelid, which tightens the tendons and muscles of the lid. You'll have a few stitches on the outside corner of your eye, or just below your lower eyelid. In general, this procedure is relatively simple and will be the only surgery you need.

If you have scar tissue from an injury or previous surgery, the surgeon may need to use a skin graft, taken from your upper eyelid or behind your ear, to help support the lower lid. If you have facial paralysis or significant scarring, the outcome of surgery is less predictable, and it's likely that more than one procedure will be necessary before your ectropion is completely resolved.

Following your surgery, your doctor may require you to wear an eye patch for 24 hours, and then to use an antibiotic and steroid ointment on your eye several times a day for one week. You may also use cold compresses periodically to decrease bruising and swelling, as well as acetaminophen (Tylenol, others) for pain. Avoid drugs containing aspirin, because they tend to increase bleeding.

At first your eyelid might feel tight, but as you heal it will become more comfortable. Most people say that their ectropion symptoms are relieved immediately after surgery. You will get your stitches removed about a week after your surgery, and you can expect the swelling and bruising to fade in about two weeks.

These lifestyle tips will relieve your discomfort until you have surgery:

• Use eye lubricants. To help protect against vision-threatening cornea damage, use artificial tears and eye ointments to keep your cornea lubricated. Using an eye ointment and a moisture shield, which you wear over your eye, seals in moisture and is particularly useful overnight.
• Wipe your eyes carefully. Constantly wiping watery eyes can make your under-eye muscles and tendons stretch even further, making ectropion worse. If you must wipe your eye, use an up-and-in motion, wiping from the outer eye up and in toward the nose.
• Use skin tape. To temporarily tighten your lower lid and relieve some ectropion symptoms, you can use skin tape on the sides of your eyes. Ask your doctor to demonstrate the correct use and position of skin tape before you try it.