Ectropion Causes, Symptoms, Risk Factors, And Treatment Process

Ectropion, the outward turning of the lower eyelid, poses discomfort and vision concerns. This blog explores its causes, symptoms, and treatment approaches. Ectropion necessitates attention due to its potential complications, whether brought on by ageing, facial nerve damage, or other factors. Individuals can navigate this condition by understanding its underlying triggers and available remedies, from conservative measures to surgical interventions, with informed choices and an improved quality of life.

What is ectropion?

How common is ectropion?

What are the causes of ectropion?

• Age-related changes are the most common cause, where the muscles and tendons around the eye weaken over time, causing the eyelid to droop and turn outward. This form is known as involutional ectropion and predominantly affects older adults.
• Paralytic ectropion can result from facial paralysis, such as Bell's palsy, which impairs the muscle control required to maintain eyelid position. In such cases, the nerve damage prevents the eyelid from functioning normally, contributing to its outward turn.
• Scarring or previous surgical interventions on the eyelids can also lead to ectropion. Conditions like burns, trauma, or the aftereffects of surgical procedures may cause the eyelid to contract abnormally. Known as cicatricial ectropion , this condition can forcibly pull the eyelid outward.
• Eyelid growths or tumours, whether benign or malignant, can mechanically distort the eyelid's natural position by creating outward pressure, resulting in mechanical ectropion .
• In rare instances, ectropion can be congenital , present at birth, typically due to developmental issues, and possibly associated with genetic disorders like Down syndrome.

Symptoms of Ectropion

• Excessive Tearing: The eyelid malposition disrupts normal tear drainage, causing tears to overflow and constant eye-watering.
• Dryness and Irritation: With the inner eyelid exposed, there's increased vulnerability to environmental elements, making the eye prone to dryness and irritation. This can produce a gritty sensation as if something is in the eye.
• Chronic Conjunctivitis: The exposure and subsequent dryness can lead to recurrent conjunctivitis, characterised by eye redness, burning sensations, and discharge.
• Corneal Damage: Long-term exposure can lead to more severe issues like corneal abrasions or ulcers, risking permanent damage to vision if these conditions progress untreated.
• Vision Loss: In severe cases, continuous exposure and lack of proper lubrication can lead to deterioration in vision, potentially leading to partial or total vision loss.

Risk Factors of Ectropion

• Age : Muscle tissue naturally weakens as individuals age, particularly around the eyes. This age-related degeneration is the most prevalent cause of ectropion, as the muscles holding the eyelid snugly against the eye begin to relax.
• Previous Eye Surgeries : Individuals who have undergone surgeries on their eyelids are at an increased risk of developing ectropion. These surgical procedures can sometimes interfere with the natural position and function of the eyelids, leading to their outward turning.
• Previous Burns, Trauma, or Cancer : Those who have experienced burns, significant facial injuries, or have had cancerous lesions removed from their face are more susceptible to ectropion. These conditions can cause scarring and other changes in the skin's elasticity and structure, which can, in turn, affect the positioning of the eyelids.

Diagnosis of Ectropion

• Slit Lamp Examination: A slit lamp, which provides a magnified, three-dimensional view of the eye structures, is used to examine the extent to which the eyelid has turned outward. This instrument allows the doctor to observe the eyelid's detailed anatomy and assess the ectropion's severity.
• Physical Assessment of Eyelid Function: The doctor will evaluate the strength and functionality of the muscles around the eyelids. This includes checking for any laxity in the eyelid, which is a common cause of ectropion. The eyelids' ability to close entirely and their reflexes are also tested.
• Facial Nerve Function: Since facial nerve paralysis can cause ectropion, it is crucial to assess facial nerve function. This helps diagnose cases of paralytic ectropion, where the nerve that controls eyelid movement is impaired.
• Evaluation of Eyelid Skin and Surrounding Tissues: The doctor will check for any signs of scarring, previous surgical alterations, or abnormalities in the eyelid's skin that might contribute to ectropion. This includes looking for growths, tumours, or inflammatory conditions that could affect the eyelid's position.
• Corneal Assessment: Since ectropion can expose the cornea to damage, a thorough examination is performed to check for any signs of irritation, abrasion, or infection that might have resulted from the eyelid's abnormal position.
• Review of Medical History: The patient’s overall health, previous eye conditions, surgeries, and any history of facial trauma are reviewed to identify potential contributing factors to the development of ectropion.

Treatment of Ectropion

Initial Management:

• Lubrication : Patients often use artificial tears or ointments to moisten the eye and reduce irritation. This is especially helpful for mild cases and is typically the first approach to managing symptoms.
• Protective Measures : For night-time protection, the eye may need to be taped shut or covered with a moisture shield to prevent further exposure and damage.

Surgical Treatment:

• Minor surgery: This procedure may require ectropion due to ageing-related muscle relaxation to tighten the lower eyelid. This can help the eyelid rest appropriately against the eye.
• Complex Surgery: More complicated procedures might be required in cases where scar tissue, injury, or prior surgeries are the root causes of ectropion. These could include skin grafts from other body parts to support the ey elid.
• Additional Procedures : In severe cases, especially those involving facial paralysis or extensive scarring, multiple surgeries might be necessary to correct the ectropion fully.

Post-Surgical Care:

• P atients typically need to use antibiotic and steroid ointments on the eye for a week.
• Cold compresses can help reduce bruising and swelling post-surgery.
• The recovery might involve temporary swelling and bruising around the eye, with stitches usually removed about a week after the surgery.
• Ongoing use of eye lubricants may be recommended to manage symptoms related to tear instability or deficiency.