Ectropion is an outward turning of the eyelid margin, almost always the lower lid, so the inner surface is exposed and tears do not drain normally. It is most often caused by age-related lid laxity, and less often by facial nerve palsy, scarring or a lid mass.
Key symptoms
- Watery eye with tears spilling down the cheek
- Red, irritated, gritty eye
- Crusting and discharge
- Visible sagging, outward-turned lower lid
What you find on exam
- Lower lid margin turned out, red exposed conjunctiva
- Snap-back and lid distraction tests show laxity
- Facial nerve function and lid closure
- Skin scars, sun damage or lid masses
- Corneal surface for dryness from exposure
Tests
- Clinical diagnosis
- Slit lamp with fluorescein for exposure damage to the cornea
- Biopsy of any suspicious lid lesion
Treatment basics
- Lubricating drops and ointment to protect the cornea
- Tape the lid closed at night if closure is poor
- Wipe tears upward and inward, not downward
- Surgical lid tightening (lateral tarsal strip) is the definitive fix
- Treat the cause: facial palsy care, scar release or skin graft
Red flags
- Corneal ulcer or vision loss from exposure
- Acute facial nerve palsy with incomplete eye closure
- Lid mass, bleeding or ulcerated lesion (possible cancer)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.