Out turning eyelid (ectropion)
Ectropion means that all, or part, of the lower eyelid is sagging away from the eye and the eyelashes are turning outwards. By far the commonest cause is age related eyelid tissue laxity, the muscle and eyelid skin become slack over time. Approximately 1 in every 14 people aged between 60-69 years will develop an ectropion and this figure increases to 1 in every 6 people once over the age of 80 years old. Less common causes are eyelid lumps and bumps weighing the eyelid down, facial paralysis (weakness) such as Bell's palsy or tight lower lid skin pulling the eyelid away from the eye.
Whatever the cause the symptoms of ectropion can include:
- tearing (epiphora).
- mucous discharge.
- crusting and occasionally infection.
- Irritation often resulting in eye rubbing which may further weaken the eyelid tissues and worsen the situation.
- Occasionally the eyes may not be able to close properly due to the lower lid ectropion, leading to drying and even infection of the cornea (front window of the eye). Any damage to the cornea can affect eyesight.
Ocular lubricants (artificial tear gel or ointment), and occasionally antibiotics, can be useful in the short term but the treatment is usually an operation to tighten the lower eyelid and the results are generally very good. The surgery is easier and has a better outcome if the ectropion is dealt with quite early, rather than being left for months or years. In long standing ectropion chronic changes occur with the soft inner lining of the eyelid becoming rough, the eyelid edge "blunting" and there can also be skin changes on the outside.
There are many different procedures for surgically correcting an ectropion depending on the extent of the problem and whether there are any secondary changes in the eyelid tissues. The majority of cases can be successfully treated under local anaesthetic as an out-patient. Occasionally a more severe ectropion requires a longer oculoplastic operation, sometimes with a skin graft, and this may be better undertaken using day case sedation or a general anaesthetic.