AKT · Ophthalmology/Lids & surface

Ectropion

Out-turning of the eyelid margin (commonly involutional/age-related)

Overview

Outward turning of the (usually lower) eyelid margin away from the globe, most often involutional (age-related lid laxity). Exposes the palpebral conjunctiva, causing watering (epiphora), exposure keratopathy and irritation.

Recognise

Lower lid margin turned outward; visible exposed red palpebral conjunctiva
Watering eye (epiphora — the punctum no longer contacts the tear lake) and chronic irritation
Exposure keratopathy: gritty, dry, inferior corneal staining

Red flags

Corneal exposure with pain/visual loss → keratitis risk; facial-nerve palsy causing paralytic ectropion needs corneal protection

Differentials & how to tell them apart

Entropionlid turns INWARD with lashes abrading the cornea — opposite direction

Facial nerve palsyparalytic ectropion + incomplete blink/lagophthalmos — protect the cornea

Floppy eyelid syndromeeasily everted upper lids, often with OSA

Investigations

Clinical. Identify cause (involutional, cicatricial, paralytic — e.g. VII palsy, mechanical).

Management

Lubricants for comfort/corneal protection; surgical lid-tightening if significant

1Ocular lubricants and ointment to protect the cornea; tape the lid at night if exposure.Gate: Refer same-day if corneal exposure threatens sight; treat an underlying VII palsy and protect the cornea
2Symptomatic/persistent → oculoplastic surgery (horizontal lid tightening, e.g. lateral tarsal strip).

Ocular lubricants — protect the exposed cornea while awaiting surgery

Lubricating ointment + taping at night — for exposure, especially paralytic ectropion

Key points

Out = ectropion (epiphora, exposure). In = entropion (lashes scratch the cornea).

Monitor & prognosis

Corneal integrity; surgical outcome.

Good with surgery.

Source: College of Optometrists CMG; RCOphth