Ectropion

The disorder known as ectropion causes your eyelid to turn outward. This exposes the sensitive inner eyelid surface, making it vulnerable to discomfort.

Ectropion often only affects the lower eyelid and is more prevalent in elderly persons. The whole length of the eyelid is turned out in acute ectropion. Just one portion of the eyelid sags away from the eye with less acute ectropion.

Ectropion symptoms can be relieved using artificial tears and lubricating creams. Nonetheless, surgery is frequently required to entirely treat the disease.

Ectropion: Causes

The following are the important causes of developing ectropion −

• Muscular lassitude. The tendons and muscles around your eyes tend to sag as you become older. Your eyelid is held taut against your eye by these muscles and tendons. Your eyelids may start to droop if they start to deteriorate.

• Paralysis of the face. Bell's palsy and certain tumors are two disorders that can paralyze the nerves and muscles of the face. Ectropion can result from facial paralysis that affects the eyelid muscles.

• Scars or signs of prior surgery. The way your eyelid rests on your eye might be affected by skin that has been burned or otherwise injured, as from a dog bite. Ectropion can result following previous eyelid surgery (blepharoplasty), especially if a significant quantity of skin was taken from the eyelid during the procedure.

• Eyelid enlargements. The eyelid might turn outward due to benign or malignant growth.

• Genetic conditions. Ectropion is infrequently seen at birth (congenital). When it is, genetic abnormalities like Down syndrome are frequently linked to it.

Ectropion: Symptoms

By properly distributing tears over your eyes when you blink, your eyelids typically keep the surfaces of your eyes lubricated. Your eyelids' inner portion has little apertures where these tears might exit (puncta).

Ectropion causes your lower lid to slide away from your eye, which prevents tears from properly draining into the puncta. The following list of symptoms and indicators might result −

• Moist eyes (excessive tearing). Your tears may accumulate and continuously pour over your eyelids if there is improper drainage.

Excessive dryness. Your eyes may feel dry, gritty, and sandy as a result of ectropion.

• Irritation. Your eyes might get irritated by stagnant tears or dryness, which can make them feel burning and cause their whites and lids to become red.

• Light sensitivity. Dry eyes or stagnant tears can irritate the cornea's surface, making you more sensitive to light.

When to Visit a Doctor?

If your eyelids appear to be drooping or sagging, or if your eyes are frequently moist or inflamed, consult a doctor.

If you have ectropion and suffer any of the following symptoms −

• Your eyes' redness rises quickly

• Responsiveness to light

• Reduced vision

These are indications of ulcers or corneal exposure, which can impair your eyesight.

Ectropion: Risk Factors

Several factors play an important role in the development of ectropion which includes −

• Age. Age-related muscle tissue deterioration is the most frequent cause of ectropion.

• Prior eye operations. Individuals who have undergone eyelid surgery are more likely to eventually develop ectropion.

• Disease, burns, or trauma in the past. You run an increased chance of getting ectropion if you've experienced burns, facial injuries, or skin cancer patches on your face.

Ectropion: Diagnosis

The diagnosis of the ectropion is mainly done based on history and some of the tests may be required for confirmation and to rule out the underlying causes.

Ectropion of the lower eyelid results in an unnatural posture for the lower eyelid. During an inspection, the lower eyelid edge may seem low and the lower cornea may be seen. The inferior corneal limbus is typically 1 to 2 mm above the lower eyelid. The lower eyelid may appear to be turned outward as a result of ectropion. In severe instances, the tarsal conjunctiva may be seen and show symptoms of chronic conjunctivitis, including keratinization. The cornea may be dry with punctate epithelial erosions and potential ulceration in severe situations resulting in exposure keratopathy. The eye may also be injected. Lax eyelids would usually be seen as well.

By pushing the lower lid outward and down to determine how far, one can determine whether the lower eyelid is distractible. A snap-back test is carried out by drawing the lid outward and down, and then timing how long it takes for the lid to snap back against the ocular surface. In severe circumstances, blinking the eyelids may be necessary to reposition them. To rule out further explanations like cicatricial alterations, such as chronic skin changes, or a tumor, one would also extensively inspect the periorbital area during an examination. As the etiology of the offended ectropic eyelid may also be causing ectropion of the contralateral eyelid, it is therefore crucial to examine that eyelid.

Ectropion: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

Conservative Treatment

Your doctor could suggest artificial tears and creams to relieve the symptoms of moderate ectropion. Ectropion is typically totally corrected by surgery.

Surgical Treatment

Surgical treatment may be required in severe cases. Your surgical procedure will rely on the health of the tissue around your eyelid and the underlying reason for your ectropion −

Ectropion is brought on by aging-related muscle and ligament relaxation. Your lower eyelid's outer margin will probably have a minor portion removed by the surgeon. The tendons and muscles of the lid will be strengthened during the healing process, causing the lid to sit correctly on the eye. The process is often rather straightforward.

Scar tissue from an accident or previous surgery is the cause of ectropion. To support the lower lid, your surgeon might need to utilize a skin graft from your upper eyelid or from behind your ear.

You'll be given a topical anesthetic to numb your eyelid and the region around it before surgery. Depending on the treatment you're having and whether it takes place in an outpatient surgical clinic, you can be given oral or intravenous medicine to make you more comfortable.

Ectropion: Prevention

Individuals who weep and have early punctal ectropion or incipient ectropion may be advised to gently wipe their eyelids up and in (away from the nose) to prevent medial ectropion from getting worse. Digital massage can assist lengthen the scar after trauma or lid surgery that results in cicatricial ectropion.

Conclusion

An interprofessional team that includes the pharmacist and nurse can handle ectropion most effectively. Intensive eye lubrication with artificial tears, gels, and creams is usually the first step in treatment. There is no immediate need to safeguard the eyelid if the ocular surface is secured. The cornea, on the other hand, can rapidly decompensate if the ocular surface is weakened, as in the case of a patient with facial palsy, and scarring of the cornea can form, resulting in vision loss that cannot be reversed.

Ectropion is frequently treated surgically, however, the outcomes are rarely great. Two primary postoperative problems that still have a significant negative impact on quality of life are dry eyes and poor cosmetics.