What Is Eyelid Ectropion?

Medically Reviewed by Whitney Seltman, OD on February 12, 2024
3 min read

Eyelid ectropion occurs when the muscles around your eyelid weaken, causing the eyelid to turn outward and pull away from your eye. This condition is also called flipped eyelids or inverted eyelids. It leaves the delicate surface of the inner eye exposed to pollutants, dust, and other irritants.

Ectropion typically affects the lower eyelid. In severe cases, the entire lower eyelid is turned out. In mild cases, ectropion appears in one small segment of the eyelid. Older adults are more prone to developing this condition. 

You may develop ectropion as a result of:

Weakening eyelids: As your body ages, the tendons and muscles under your eyes lose elasticity and can't hold the eyelid tight. 

Paralysis: Some facial tumors or conditions like Bell's palsy paralyze or weaken your eyelid muscles. 

Trauma: If you've had surgery or had skin removed, it can affect the eyelid's position against your eye.

Genetics: Certain conditions, like Down syndrome, are associated with ectropion, although this is rare.

Ectropion symptoms include: 

  • Dryness, or a feeling that you have sand or grit in your eyes
  • Irritation, like burning or stinging that causes the inside of your eyelids to turn red
  • Light sensitivity from dryness
  • Red, watery eyes from tears that don't drain properly; ectropion pulls the lower lid away from your eye, preventing tear drainage

The following factors can increase your risk of developing eyelid ectropion:

  • Aging
  • Eyelid surgery
  • Skin diseases that affect your eyelid
  • Repeat eyelid pulling or rubbing
  • Using a specific type of eye drops

The most common complication of ectropion is corneal infection. If your cornea gets scarred, light can't pass through it. This can damage your vision and requires emergency treatment. 

If you notice a change in the shape of your lower eyelid, constant irritation and watery eyes, and light sensitivity, it's time to see an eye doctor. They will use a bright light and a magnification device known as a slit lamp to examine your eyelids. 

Your provider will also check your: 

  • Eyelid laxity, or lower eyelid sagging
  • Facial shape and architecture
  • Corneal surface 
  • Facial nerves 

Mild cases of eyelid ectropion are first treated with artificial tears and steroid ointments. If there is an infection, antibiotics will be prescribed.

Your doctor may also suggest a nightly routine of using a small piece of medical tape to hold your eyelid in place.

Eyelid ectropion tends to get worse over time. The majority of people will need surgery. 

The type of surgery you have depends on the underlying cause. If your condition is due to aging, your surgeon may shorten and tighten your lower eyelid. If you've experienced eye trauma, you may require a graft to lengthen the eyelid skin. Other people may need to have a tumor or growth removed. 

Ectropion surgery is usually an outpatient procedure. You'll be lightly sedated and will have to wear an eye patch for a few days to protect your eyes. Your provider may prescribe an antibiotic ointment to help the area heal. 

You may experience minor bruising or swelling after the procedure. This typically disappears after a week or two. 

After surgery, be sure to follow your doctor's instructions to reduce the risk of infection or a corneal ulcer. If you experience any of these symptoms, seek medical care immediately: 

  • Severe eye pain or soreness
  • Red eyes and discharge 
  • Swollen eyelids 
  • Increasing sensitivity to light

After your eyelid heals, your eyes will feel more comfortable and you won't have to worry about infection or vision loss. 

Ectropion surgery is considered both safe and effective. However, the condition may return, requiring a second surgery.