Normally when you blink, your eyelids distribute tears evenly across your eyes, keeping them lubricated. These tears drain into the little openings on the inner part of your eyelids (puncta). When you have ectropion, your lower lid pulls away from your eye and tears don't drain into the puncta properly, causing a number of signs and symptoms:
- Irritation. Stagnant tears or dryness can irritate your eyes, causing a burning sensation and redness in your eyelids and the whites of your eyes. The stagnant tears and dryness can also irritate the surface of the cornea, making you sensitive to light.
- Excessive tearing. Without proper drainage, your tears may pool and constantly flow over your eyelids. Many people with ectropion complain of watery or weepy eyes.
- Excessive dryness. Ectropion can cause your eyes to feel dry, gritty and sandy.
When to see a doctor
If you begin noticing that your eyes are constantly watering or irritated, or your eyelid seems to be sagging or drooping, make an appointment to see your doctor for an evaluation.
If you know that you have ectropion, be alert for symptoms of cornea exposure or ulcers, including rapidly increasing redness, pain, light sensitivity or decreasing vision. If you experience any of these vision-threatening signs and symptoms, seek immediate care in an ophthalmologist's office or an emergency room.
Ectropion can have several different causes, including:
- Muscle weakness. As you age, the muscles under your eyes tend to get weaker as the tendons stretch out. These muscles and tendons are responsible for holding your eyelid taut against your eye, so when they relax, the eyelid can begin to droop and turn outward.
- Facial paralysis. When some of the facial nerves and muscles are paralyzed, as with Bell's palsy and some types of tumors, it can affect the eyelid muscles and cause ectropion.
- Scars or skin problems. Scarred skin from facial burns or trauma, such as a dog bite or lacerations, can affect the way that the eyelid rests against the eye.
- Eyelid growths. Benign or cancerous growths on your eyelid can cause the lid to turn outward.
- Previous surgery, radiation or cosmetic procedures. Previous eyelid surgery (blepharoplasty) can cause ectropion to develop later, particularly if too much skin from the eyelid was removed at the time of surgery. Radiation of your eyelid for a cancerous growth can trigger ectropion to develop. Even cosmetic laser skin resurfacing can shrink your eyelid too much, pulling it away from your eye and causing ectropion.
- Congenital ectropion. Rarely, ectropion is present at birth (congenital), when it is usually associated with genetic disorders, such as Down syndrome.
- Drug reaction. Certain medications, such as some drops used to treat glaucoma, may contribute to ectropion.
Certain factors increase your risk of developing ectropion:
- Age. The most common cause of ectropion is weakening muscle tissue associated with aging. The older you are, the greater your chances of developing the condition.
- Previous eye surgeries. People who have had eyelid surgery (blepharoplasty) are at higher risk of developing ectropion later.
- Previous cancer, burns or trauma. If you've had spots of skin cancer on your face, facial burns or trauma, you're at higher risk of developing ectropion.
The most serious complications associated with ectropion are irritation and damage of the cornea. Because ectropion leaves your cornea irritated and exposed, it's more susceptible to drying. This can lead to corneal abrasions and ulcers, which in turn can cause permanent loss of vision. Lubricating eyedrops and ointments can help to protect your cornea and prevent damage until your ectropion is corrected.