Ectropion
👁️ Ectropion
🔍 Definition
Ectropion is a condition in which the eyelid (usually lower) turns outward, away from the eyeball. This leads to exposure of the conjunctiva, poor tear drainage, and dry, irritated eyes.
🧬 Types of Ectropion
| Type | Cause | Notes |
|---|---|---|
| Involutional | Age-related laxity of eyelid and canthal tendons | Most common type in elderly |
| Paralytic | Facial nerve (CN VII) palsy | Eyelid loses tone and sags |
| Cicatricial | Scar contraction pulls lid outward | Burns, trauma, or surgery |
| Mechanical | Tumor or mass pushes the lid outward | Rare |
| Congenital | Rare malformation | Seen at birth |
🧠 Etiology (Causes)
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Aging – weakens orbicularis oculi muscle and ligaments
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Facial nerve palsy (Bell's palsy)
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Skin conditions – eczema, ichthyosis
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Previous eyelid surgery
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Burns / trauma / radiation
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Mass effect from tumors or cysts
👀 Clinical Features
| Symptom / Sign | Description |
|---|---|
| Tearing (epiphora) | Tears don't drain properly into the punctum |
| Dryness & irritation | From exposed conjunctiva |
| Redness (conjunctival injection) | Due to chronic exposure |
| Photophobia | Light sensitivity from ocular surface dryness |
| Mucous discharge | In chronic exposure or secondary infection |
| Keratitis / corneal ulcer | From long-term dryness or exposure keratopathy |
| Visible eversion | Lower lid droops away from the eyeball |
🩺 Diagnosis
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Clinical examination – observe lid eversion
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Snap-back & distraction tests – evaluate lid laxity
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Check Bell’s palsy signs – especially in paralytic type
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Tear breakup time / Schirmer’s test – assess dry eye
💊 Treatment
🔹 Conservative (temporary or mild cases)
| Treatment | Purpose |
|---|---|
| Lubricating drops & ointments | Relieve dryness, protect cornea |
| Moisture chamber goggles | Reduce evaporation overnight |
| Taping eyelid | Temporary protection |
| Antibiotics | If there is conjunctivitis or keratitis |
🔹 Surgical (definitive)
| Procedure | Indication |
|---|---|
| Lateral tarsal strip | Involutional ectropion |
| Medial spindle procedure | Punctal eversion |
| Skin grafting or Z-plasty | Cicatricial ectropion |
| Canthoplasty or canthopexy | Reconstruct lid support |
| Gold weight implantation (upper lid) | For paralytic ectropion + lagophthalmos |
🔧 Surgery aims to tighten the eyelid, reposition the punctum, and correct eversion.
⚠️ Complications
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Chronic conjunctivitis
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Exposure keratitis
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Corneal ulceration
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Permanent visual impairment (in severe cases)
📋 Quick Comparison: Entropion vs Ectropion
| Feature | Entropion | Ectropion |
|---|---|---|
| Lid position | Inward (lashes rub cornea) | Outward (lid sags away) |
| Main problem | Corneal irritation | Exposure & poor tear drainage |
| Common age group | Elderly | Elderly |
| Common symptom | Irritation, tearing | Dryness, tearing, redness |
| Treatment | Surgical lid repositioning | Surgical lid tightening |
🧠 Mnemonic: "Ectro = Exit" → Lid exits outward.
Would you like:
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A visual diagram of the different lid malpositions?
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A case scenario for clinical application?
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Or a quick revision flashcard?
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