Ectropion is when your lower eyelid turns or sags outward, away from your eye, exposing the surface of your inner eyelid.
This condition can cause eye dryness, excessive tearing, and irritation. Ectropion may be due to several factors, including facial paralysis and injury. The most common cause is muscle weakness or slipping due to aging.
If you have symptoms of ectropion, you should seek medical attention. Without treatment, ectropion can lead to serious problems with your cornea, and can even cause blindness.
Eye lubricants can help ease symptoms, but surgery is usually necessary to achieve full correction. Most people who have the surgery experience a positive outcome.
Ectropion is usually associated with aging. It can happen as the tissues and muscles of the eyelids become weaker as you get older.
Less common causes of ectropion include:
Normally when you blink, your eyelids distribute tears evenly across your eyes, keeping the surfaces of the eyes lubricated. These tears drain into small openings on the inner part of your eyelids (puncta).
If you have ectropion, your lower lid pulls away from your eye and tears don't drain properly into the puncta. The resulting signs and symptoms can include:
Examine the bony architecture of the lower orbital rim and midface position. Patients with hypoplastic midface, also known as hemi proptosis, will have an inferior orbital rim located posteriorly relative to the globe.
Facial nerve palsy:
Inspect the face and test facial muscle strength to assess for paralysis.
To test for horizontal laxity, place a thumb beneath the lateral canthus and push the eyelid laterally and superiorly. If the lid margin does not roll back into position, suspect a cicatricial component. In involutional cases, the ectropion typically disappears with this maneuver. The eyelid distraction test is done by pulling the lid away from the globe. Normal lid distraction is between 2-3 mm. If it is more than 5mm, there is substantial laxity. In cases of cicatricial ectropion, the eyelid malposition will often become accentuated by asking the patient to look upwards and to open his or her mouth at the same time; the maneuver places the anterior lamella on maximum stretch.
Examine the eyelid margin under magnification to look for signs of chronic blepharitis, palpebral conjunctival hypertrophy and keratinization, conjunctival scarring, and to rule out suspicious changes such as loss of lashes (madarosis), ulceration, or infiltration.
Assess the position of the lower punctum which may rotate away with medial laxity and no longer make contact with the ocular surface and tear lake.
Examine the cornea for epithelial changes secondary to exposure.
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