Ectropion: what it is, symptoms, causes and treatment

The NHS describes ectropion as a condition in which the lower eyelid droops or sags away from the eye and turns outwards. It mainly affects the lower eyelid and can happen in one or both eyelids at the same time. It is more common in older people.

The Leeds Teaching Hospitals leaflet explains that left untreated, the drooping eyelid can affect tear drainage, and the eye can become sore, red, irritated, water excessively, feel dry and gritty and be at increased risk of infection such as conjunctivitis.

The NHS lists the main symptoms below. It adds that ectropion also means you are more likely to get infections like conjunctivitis.

• A drooping and sagging lower eyelid.

• A sore, irritated and red eye and eyelid (redness may be harder to see on brown or black skin).

• Difficulty closing your eye.

• Watery eyes.

• Dry and gritty feeling eyes.

The NHS says to see a GP if you think you have ectropion. It says to ask for an urgent GP appointment or get help from NHS 111 if you have very red eyes (in one or both eyes), pain in your eyes, changes in your vision, sensitivity to light, or a headache and you feel sick or are vomiting.

Leeds Teaching Hospitals says that after an operation you should contact the hospital if your vision deteriorates, you have severe pain not relieved by painkillers, you develop a sticky green or yellow discharge, you have new floaters or you injure your eye.

The NHS says ectropion is usually caused by ageing, as the muscles around the eye become weaker. Less commonly it can be caused by the following.

• Using eye drops continuously for a long time.

• Nerve problems or conditions that cause facial paralysis, like Bell's palsy.

• A lump, cyst or tumour on the eyelid.

• Damage to the skin around the eye because of an injury, burn or scarring from previous surgery.

The NHS says a GP can diagnose ectropion by examining your eye, and may refer you to an eye specialist (ophthalmologist) for further assessment. The specialist will consider what is causing it, because treatment depends on the symptoms and the cause.

The NHS says treatment depends on what symptoms you have and what is causing ectropion. If your symptoms are mild, you may not need treatment. If you cannot shut your eye properly, treatment may include the following.

The NHS also advises avoiding wiping or rubbing your eyes too much, as this can make ectropion worse. If you need to wipe your eyes, dab them gently and carefully with a clean tissue.

Leeds Teaching Hospitals says to expect an increased watering of the eye with blood-stained tears, soreness, blurred vision from the ointment and sensitivity to light after the operation. You are advised not to rub or apply pressure to the eye, to avoid strenuous exercise, gardening and heavy lifting for two weeks, not to wear eye make-up for two weeks, not to swim for two weeks (and wear goggles for the first month) and not to drive if your vision is affected. It suggests planning up to a week off work if your job involves heavy lifting.

Bruising can take 2 to 3 weeks to subside completely and swelling as long as 3 to 4 weeks. Risks include recurrence, under-correction or over-correction, bleeding, infection and scarring. Loss of sight because of surgery is very unlikely. Many people have other problems causing a watery or irritated eye, such as dry eye or tear duct problems, so correcting the lid position may not remove all symptoms. The leaflet says the lateral tarsal procedure has a very high chance of success, but as many as 15% of people get a tender spot at the outer corner of the eyelid.

Ectropion is often mentioned together with entropion, but they are opposites, and the risks to the eye differ.

On the NHS, a GP examines the eye and may refer you to an ophthalmology or oculoplastic (eyelid surgery) clinic. Waiting times for surgery vary by area.

Some people choose to see a private eye surgeon for faster access to surgery. The operation is the same in either setting. Ask what type of repair is planned and why, what recovery involves and who will see you if you have problems after discharge.