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Ectropion (Eyelid Turning Outward): Causes and Managmemt

Ectropion means that the lower eyelid is “rolled out” away from the eye, or is sagging away from the eye. Analogy: Imagine the lower eyelid as a tennis net. If the tennis net gets loose, it can flop in or out. Similarly, when the lower eyelid tendon gets loose over time due to aging (or other causes), the eyelid can turn in (entropion) or out (ectropion).

The sagging lower eyelid leaves the eye exposed and dry. If ectropion is not treated, the condition can lead to chronic tearing, eye irritation, redness, pain, a gritty feeling, crusting of the eyelid, mucous discharge, and breakdown of the cornea due to exposure.

What Causes Ectropion?
Generally the condition is the result of tissue relaxation associated with aging (involutional ectropion). Other types of ectropion are paralytic and cicatricial. Paralytic ectropion results from paralysis of the facial nerve or muscle weakness from prior surgeries or trauma. The eyelid is unable to close and flops out. Cicatricial ectropion results from tightness or scarring of the eyelid skin, pulling the eyelid outward. Common causes of cicatricial ectropion include chronic sunlight exposure, previous surgeries or trauma, and skin cancer

The wet, inner, conjunctival surface is exposed and visible. Normally, the upper and lower eyelids close tightly, protecting the eye from damage and preventing tear evaporation. If the edge of one eyelid turns outward, the two eyelids cannot meet properly and tears are not spread evenly over the eye. Symptoms may include excessive tearing, chronic irritation, redness, pain, a gritty feeling, crusting of the eyelid and mucous discharge.

The treatment is typically surgery. Type of surgery can depend on the type of ectropion (involutional or age-related, cicatricial or scarring, paralytic, congenital). The classical surgical technique is the tarsal strip method and canthoplasty. Dr Taban also uses an alternative, minimally invasive approach to tighten the lower eyelid, which provides better eyelid contour with hidden scars. Most patients experience immediate resolution of the problem once surgery is completed with little, if any, post-operative discomfort. After your eyelid heals, your eye will feel comfortable and be protected from corneal scarring, infection, and loss of vision. Cicatricial ectropion requires addition of skin to the lower eyelid (skin graft). Dr. Taban avoids the use of skin graft and uses a skin flap from the upper eyelid (“switch flap” technique) to provide a better tissue and color match, so that the added skin will best match surrounding skin and blend in.

Who Should Perform Ectropion Surgery?
When choosing a surgeon to perform ectropion and entropion eyelid surgery, look for a cosmetic and reconstructive facial surgeon who specializes in the eyelids, orbit, and tear drain system. Your surgeon’s membership in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) indicates he or she is not only a board certified ophthalmologist who knows the anatomy and structure of the eyelids and orbit, but also has had extensive training in ophthalmic plastic reconstructive and cosmetic surgery.