Skip to main content

Health condition · Clinically reviewed

Ectropion, why the lid turns out - and how oculoplastic surgery restores it.

More than a watery eye. Left alone, an outward-turned eyelid can quietly damage the cornea. A tailored surgical plan almost always fixes it.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against RCOphth, BOPSS and peer-reviewed oculoplastic sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK oculoplastic practice including lateral tarsal strip, skin grafting and facial-nerve rehabilitation.

Key facts

Ectropion at a glance.

The essentials, in plain English - what it is, why it matters, and how a UK oculoplastic surgeon usually puts it right.

  • What it is

    An eyelid malposition where the lid margin rotates outward, exposing pink conjunctiva and lifting the tear-drainage punctum away from the eye.

  • Most common type

    Involutional (age-related) ectropion, driven by horizontal lid laxity, orbicularis atrophy and tarsal disinsertion.

  • Other causes

    Cicatricial (scarring), paralytic (facial-nerve palsy), mechanical (lid mass), congenital and severe chronic dermatitis.

  • Main symptom

    Watery, irritated, sore eye - epiphora from a mispositioned punctum and exposure of the ocular surface.

  • Why it matters

    Chronic corneal exposure risks keratopathy, ulceration, scarring and permanent vision loss if left untreated.

  • Definitive treatment

    Oculoplastic surgery tailored to the cause - most often a lateral tarsal strip, with skin grafts or lid loading where needed.

Why this guide matters

A watery eye isn’t always minor.

Ectropion is common in later life and easy to dismiss. These three points shape how oculoplastic surgeons think about it.

  • The cause guides the operation

    Involutional, cicatricial, paralytic and mechanical ectropion all need different repairs - a single technique cannot fix all four.

  • Lubrication buys time, not a cure

    Drops and ointments protect the cornea while surgery is planned, but they rarely settle significant ectropion long term.

  • Early surgery protects vision

    Fixing lid position before the cornea breaks down is faster, simpler and safer than dealing with a scarred eye later.

How the diagnosis is made

From watery eye to a tailored plan.

What a UK GP, ophthalmologist or oculoplastic surgeon will normally do, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and underlying cause

    Age, previous lid trauma, burns, surgery, radiotherapy, facial palsy, skin disease or a visible lid mass all point to a specific ectropion type.

  2. 02

    Assessing

    Lid position and punctum check

    A close look at how far the lid margin has rotated outward and whether the tear-drainage punctum has lifted off the ocular surface.

  3. 03

    Assessing

    Orbicularis and blink assessment

    Testing eyelid closure and blink strength to identify facial-nerve weakness (paralytic ectropion) and the risk of exposure.

  4. 04

    Confirming

    Snap-back and distraction tests

    Two quick bedside tests of horizontal lid laxity - a slow snap-back or wide distraction confirms an involutional component.

  5. 05

    Confirming

    Corneal exposure and slit lamp

    Visual acuity, fluorescein staining and slit-lamp review to grade exposure keratopathy and rule out ulceration.

  6. 06

    Preparing

    Clinical photography

    Standardised photographs document lid position, laxity and any scarring - useful for planning surgery and monitoring change.

  7. 07

    Preparing

    Oculoplastic referral

    A specialist oculoplastic assessment sets the surgical plan, particularly for cicatricial, paralytic or recurrent ectropion.

Typical timeline: a first visit to a surgical plan in weeks, not months.

Symptoms

What ectropion actually looks like.

The classic combination of a rolled-out lid margin, a watery eye and a persistently sore ocular surface - plus the features that mean urgent review.

  • Outward-turned lid margin

    The lower eyelid rolls away from the eye, exposing the pink inner conjunctival surface.

  • Watery eye (epiphora)

    The tear-drainage punctum lifts off the ocular surface, so tears spill over the lid instead of draining.

  • Redness and irritation

    Exposed conjunctiva becomes chronically inflamed, dry and gritty.

  • Dry, sore ocular surface

    Poor lid closure allows evaporative dry eye and a persistent foreign-body sensation.

  • Scarring or tethered skin

    A tight or puckered lower-lid skin band suggests cicatricial ectropion from burns, surgery or radiotherapy.

  • Facial-nerve weakness

    A drooping brow, weak blink and flattened nasolabial fold point to paralytic ectropion from Bell’s palsy, stroke or tumour.

  • Visible lid mass

    A chalazion, papilloma or tumour dragging the lid downward causes mechanical ectropion.

  • Red flag - corneal exposure

    Blurred vision, severe pain, photophobia or a cloudy cornea needs same-day ophthalmology review.

Treatment

How ectropion is treated in the UK.

Lubrication protects the eye while a tailored oculoplastic operation - most often a lateral tarsal strip - restores the lid to the ocular surface.

  • Ocular lubrication

    Preservative-free artificial tears through the day, ointment or gel at night, and moisture chamber goggles or lid taping for severe exposure.

  • Treat the underlying cause

    Topical steroid or tacrolimus for eczematous skin, scar-directed therapy for cicatricial disease, and rehabilitation of any facial-nerve palsy.

  • Botulinum toxin (selective)

    Chemodenervation of the levator can protect the cornea in paralytic disease while waiting for definitive surgery - specialist use only.

  • Lateral tarsal strip (LTS)

    The workhorse operation for involutional ectropion - tightens the lower lid horizontally at the lateral canthus. Often combined with a tarsoconjunctival diamond excision.

  • Medial canthal tendon repair

    Medial ectropion and punctal ectropion often need a medial canthal tendon plication or medial spindle procedure alongside a strip.

  • Skin graft or Z-plasty

    For cicatricial ectropion - scar release plus a full-thickness skin graft (from the upper lid or behind the ear) or a Z-plasty replaces the missing skin.

  • Lid loading and suspension

    Paralytic ectropion often needs an upper-lid gold or platinum weight, plus a lower-lid suspension sling using fascia lata or synthetic material.

  • Mass excision

    Mechanical ectropion is corrected by removing the underlying chalazion, papilloma or tumour, with lid reconstruction where needed.

After surgery

Most ectropion repairs are day-case procedures under local anaesthetic. You go home with a short course of antibiotic and lubricant drops, a follow-up appointment at one to two weeks, and clear advice to avoid rubbing the eye. Recurrence is uncommon after a well-chosen operation, and results are usually stable for years.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your ophthalmologist or oculoplastic surgeon knows your eye and history and can tell you which parts apply to you. If in doubt, get seen.

  • Royal College of Ophthalmologists (RCOphth). Clinical guidance on eyelid malpositions and oculoplastic surgery.

  • British Oculoplastic Surgery Society (BOPSS). Patient information on ectropion, entropion and lid surgery.

  • NICE Clinical Knowledge Summaries (CKS). Facial nerve palsy - eye care and referral.

  • American Academy of Ophthalmology. Basic and Clinical Science Course - Orbit, Eyelids and Lacrimal System.

Red flags

When ectropion needs urgent attention.

Most ectropion can be worked up through a routine ophthalmology clinic. These are the situations that can’t wait.

  • Corneal ulceration

    A red, painful, photophobic eye with a cloudy cornea after long-standing ectropion needs same-day ophthalmology assessment.

  • Sudden facial-nerve palsy

    New drooping of the face, forehead or mouth with a poor blink is an emergency - Bell’s palsy, stroke and Ramsay Hunt need urgent review.

  • Growing lid mass

    A firm, irregular or ulcerating lump distorting the lid margin can be a basal or squamous cell cancer and needs urgent biopsy.

  • Rapidly worsening scarring

    Progressive tightening of lower-lid skin after burns, surgery or radiotherapy risks corneal exposure and needs early oculoplastic review.

  • Vision loss or diplopia

    Any drop in vision, double vision or a fixed pupil alongside ectropion suggests a deeper orbital or neurological problem.

  • Recurrent ectropion after surgery

    Ectropion returning within weeks of a repair usually needs a re-look with an oculoplastic surgeon rather than another round of drops.

  • Chronic dermatitis flare

    A severe eczema, ichthyosis or contact dermatitis flare around the eye can pull the lid outward and needs combined dermatology and eye care.

  • Post-radiotherapy change

    Late tissue changes years after radiotherapy can produce cicatricial ectropion - flag any new lid malposition to the oncology team.

  • Congenital lid abnormality

    Ectropion in a newborn (blepharophimosis, ichthyosis, Down syndrome) always needs specialist paediatric ophthalmology input.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - keeping the eye lubricated, protecting it overnight, looking after the lid skin and knowing when to step up.

A quiet reminder

Lubrication buys time. Surgery ends the problem.

Drops and ointments are a bridge to definitive treatment - not a long-term substitute for a well-planned repair.

  1. 01 Protect

    Lubricate generously

    Preservative-free tears through the day and ointment at night are the single most useful thing you can do while waiting for surgery.

  2. 02 Overnight

    Consider taping or a chamber

    Selective lid taping or moisture chamber goggles at night reduce evaporative exposure when the lid will not close.

  3. 03 Skin

    Look after the lower-lid skin

    Gentle emollients, sun protection and treating any eczema stop scar tissue and tightness from worsening.

  4. 04 Escalate

    Don’t wait for corneal damage

    If lubrication is not enough, an oculoplastic opinion for a lateral tarsal strip or skin graft is the definitive step.

Frequently asked

Everything we get asked about ectropion.

Quick answers on causes, corneal risk, lateral tarsal strip, skin grafts and lid loading.

  • What is ectropion?

    Ectropion is an eyelid malposition where the lid margin (usually the lower lid) rotates outward, exposing the pink conjunctival surface. The commonest cause is age-related laxity, but scarring, facial-nerve palsy, lid masses, chronic dermatitis and rare congenital conditions can all cause it.

  • Why does ectropion make my eye water?

    The tear-drainage punctum sits on the inner corner of the lower lid and normally rests against the eye. In ectropion it lifts off the surface, so tears cannot drain into the nose and instead spill over the lid - producing the constant watering (epiphora) most patients notice first.

  • Is ectropion dangerous?

    It can be. Long-standing exposure of the cornea from poor lid closure can cause dry eye, keratopathy, corneal ulceration, scarring and permanent vision loss. This is why oculoplastic surgeons treat significant ectropion actively rather than watching it drift on.

  • What is a lateral tarsal strip?

    The lateral tarsal strip is the standard operation for involutional (age-related) ectropion. Through a small incision at the outer corner of the eye, the surgeon shortens and refixes the lower lid to the bone of the lateral orbital rim, restoring its normal contact with the eye. It is typically a day-case procedure under local anaesthetic.

  • What if my ectropion is caused by scarring?

    Cicatricial ectropion needs more than a tightening procedure. The scar tissue is released and the missing lower-lid skin replaced with a full-thickness skin graft (usually from the upper lid, behind the ear or the inner arm) or rearranged with a Z-plasty. This is specialist oculoplastic work.

  • What about ectropion from facial-nerve palsy?

    Paralytic ectropion needs eye protection first (lubricants, taping, moisture chambers, sometimes botulinum toxin) and then surgery that addresses both the paralysed upper lid (a gold or platinum weight) and the loose lower lid (a canthal tightening plus a suspension sling). It is managed within a facial-palsy MDT.

Related content

Keep reading.

Pulse Healthcare concierge

Send us your enquiry

A concierge service for UK private healthcare. We match you with the best vetted clinics and consultants in our network - they then contact you directly.

So we can match you to the right clinician close to you.

We reply to every enquiry within 24 hours (Mon–Fri). Confidential - your details are never shared outside our vetted consultant network.