Ectropion (Eyelid Eversion)

Ectropion refers to outward eversion of the eyelid margin, most commonly affecting the lower eyelid. The eyelid margin loses contact with the globe, exposing palpebral conjunctiva, and disrupts the punctal apposition needed for tear drainage, leading to chronic epiphora, irritation, and exposure of the cornea. Four main types exist by etiology: involutional (age-related laxity of canthal tendons and orbicularis weakness, by far the most common), paralytic (facial nerve palsy with orbicularis weakness, e.g., Bell's palsy), cicatricial (vertical shortening of anterior lamella from burns, trauma, surgery, sun damage, or chronic dermatitis), and congenital (rare, often with chromosomal anomalies).

Clinical features include lower lid eversion with exposed bulbar conjunctiva, chronic tearing (epiphora) due to dysfunctional lacrimal pump and punctal eversion, conjunctival hyperemia and keratinization, exposure keratopathy with punctate keratitis, corneal scarring or ulceration in advanced cases, and skin maceration from chronic tearing. Snap-back test (delayed return of pulled lower lid) and distraction test (lid pulled >6 mm from globe) demonstrate horizontal laxity.

Treatment is etiology-specific. Lubrication, ocular ointment, and taping may be temporizing measures. Surgical correction options include lateral tarsal strip with horizontal lid tightening for involutional ectropion, medial spindle resection or medial canthal tendon plication for medial ectropion, full-thickness skin grafting from upper lid or supraclavicular area for cicatricial ectropion, and gold/platinum upper lid weight implant or temporary tarsorrhaphy for paralytic ectropion. Treatment of underlying facial nerve palsy and addressing skin disease is essential.