Ectropion is a condition where the eyelid, most often the lower eyelid, turns outward away from the eyeball instead of sitting gently against it. Because the eyelid no longer touches the eye properly, the surface of the eye is exposed. This exposure prevents normal spreading and drainage of tears, causing either excessive tearing (because tears spill over) or dryness (because the eye cannot stay properly lubricated), sometimes both. The eyelid’s job is to protect and keep the eye moist; when it’s pulled away, the eye tissues can become irritated, red, infected, or injured. Ectropion is the opposite of entropion, where the eyelid turns inward. Simple tasks like blinking no longer fully protect the front of the eye, and the tear drainage system (including the punctum) can be distorted, which adds to symptoms like tearing or inflammation. Early recognition matters because untreated ectropion can damage the cornea and reduce vision. Consultant360 NCBI ScienceDirect
Ectropion is when the eyelid, most often the lower one, turns outward away from the eye. This makes the inner eyelid surface exposed, leading to drying, irritation, tearing, redness, and sometimes infection. If untreated, the exposed eye can develop injury to the cornea (exposure keratopathy) and vision problems. Ectropion happens because of weakness, scarring, nerve problems, or aging that disrupts the normal support and tension of the eyelid. This article explains in simple English what ectropion is, its types and causes, many ways to help (non-drug and drug), supplements that support eye/skin health, regenerative and experimental approaches, surgeries, prevention, diet advice, when to see a doctor, and frequently asked questions—all written for readability and search visibility. Sources are cited so readers can trust and further explore the evidence. NCBI Cleveland Clinic ScienceDirect
The basic mechanism behind ectropion is a failure of the eyelid to remain snug against the globe. This can happen because the eyelid tissues become loose, scarred, paralyzed, pulled, or mechanically pushed away. When the eyelid doesn’t close or appose correctly, the normal tear film breaks down, and the exposed conjunctiva or cornea can dry, leading to inflammation, infection risk, and discomfort. Reflex tearing may develop because the eye senses dryness and overproduces tears, but those tears do not drain properly because the punctum (tear opening) is no longer in the right position, so the tears spill over the cheek instead of going through the drainage system. Consultant360 eyerounds.org
Types of Ectropion
Ectropion is divided into major types based on why the eyelid is turned outward. There are five commonly recognized types: involutional, paralytic, cicatricial, mechanical, and congenital. Each type has a different cause and needs a different way of thinking about diagnosis and treatment. Consultant360EyeWikiActas Dermo-Sifiliográficas
1. Involutional Ectropion: This is the most common kind. It happens because of aging. As people get older, the tissues and ligaments that hold the eyelid tight become loose. The eyelid stretches horizontally and may sag due to weakness of support structures like the canthal tendons, retractors, and skin elasticity. The lower eyelid slowly drifts outward and may not cause strong symptoms at first, but over time it leads to exposure and tearing. Involutional ectropion can include “tarsal” changes if deeper support structures have detached, meaning repair usually needs tightening horizontally and reattaching those deeper layers. Consultant360
2. Paralytic Ectropion: This type happens when the nerve that controls the muscles around the eyelid (especially facial nerve—seventh cranial nerve) is weak or paralyzed. When the orbicularis oculi muscle loses tone, the eyelid cannot be held snugly against the eye. Facial nerve palsy can be due to stroke, Bell’s palsy, tumors, surgery, or trauma. The severity of ectropion depends on how much paralysis there is and how well the eye’s protective reflexes (like Bell’s phenomenon) are preserved. Loss of corneal sensation makes the outcome worse because the eye cannot feel injury as well. Consultant360
3. Cicatricial Ectropion: This form is caused by scarring or shrinkage of the front layers of the eyelid (the anterior lamella, which includes skin and muscle). Burns, chemical injuries, surgery, chronic skin diseases (like dermatitis or lupus), trauma, or even aggressive skin treatments can cause the skin to shorten. When that front layer is tightened by scar tissue, it physically pulls the eyelid away from the eye. The eyelid may be tight vertically, and tears may spill over because the drainage system becomes distorted. Ento KeyActas Dermo-Sifiliográficas
4. Mechanical Ectropion: This happens when something pushes the eyelid outward. A mass like a tumor, severe swelling, large chalazion, or heavy dermatochalasis (excess eyelid skin) can push or weigh the eyelid away from the eye. Sometimes overfilling or edema in the tissues also creates a mechanical vector that everts the lid. Fixing the underlying mass or swelling is the first step. ScienceDirecteyerounds.org
5. Congenital Ectropion: Rarely, babies are born with ectropion. It is usually part of a syndrome (like Down syndrome or blepharophimosis) or due to developmental problems where the eyelid structures are abnormal. The eyelid may be everted from birth and sometimes responds to gentle stretching, lubrication, or in more severe cases requires surgical repair. Consultant360
Sometimes combinations occur: for example, scar tissue in an older person (involutional plus cicatricial) or paralysis with skin tightening, so careful examination is needed to identify all contributing types. eyerounds.org
Causes of Ectropion
Aging (Involutional laxity): Natural loosening of eyelid tissues with age leads to horizontal laxity and detachment of support structures, making the eyelid sag and evert. Consultant360
Facial nerve palsy: Paralysis or weakness of the orbicularis muscle from Bell’s palsy, stroke, or surgery leads to loss of eyelid tone and outward turning. Consultant360
Prior eyelid surgery or trauma: Surgical scars or injury can pull the eyelid margin outward (cicatricial mechanism) or damage supportive structures. Ento Key
Chemical burns: Burns on eyelid skin result in scar formation and contraction which shortens the anterior lamella. Actas Dermo-Sifiliográficas
Thermal injury: Heat injuries promote scar medialization or tightness of skin, leading to cicatricial ectropion. Actas Dermo-Sifiliográficas
Chronic inflammatory skin disease: Conditions like chronic dermatitis, lupus, or lichen planus can cause skin changes and scarring around the lid margin, pulling it outward. Ento Key
Tumors or masses (orbital or eyelid): Growths behind or on the eyelid push it out mechanically, or distort its normal position. ScienceDirecteyerounds.org
Edema or severe swelling: Inflammation or fluid buildup can mechanically evert the lid if the tissues become bulky. ScienceDirect
Overcorrection from eyelid tightening surgery: Too much tightening in previous surgeries may alter eyelid tension and produce malposition including ectropion. NCBI
Dermatochalasis: Excess loose eyelid skin can change the weight balance and contribute to mechanical or involutional ectropion. eyerounds.org
Scarring after skin cancer removal: Excision of cancers near the lid margin (e.g., basal cell carcinoma) and consequent reconstruction may tighten or distort the lid. Romanian Journal of Oral Rehabilitation
Parotid surgery or facial surgery: Procedures near the facial nerve or on midface can cause nerve damage or scarring that leads to paralytic or cicatricial ectropion. Romanian Journal of Oral Rehabilitation
Congenital syndromes (Down syndrome, blepharophimosis): Developmental eyelid abnormalities or associated facial differences cause ectropion from birth. Consultant360
Traumatic facial fractures (midface/maxillofacial): Trauma changing bony support or causing soft tissue scarring can lead to ectropion. Romanian Journal of Oral Rehabilitation
Neurogenic disorders beyond facial nerve palsy (e.g., tumors compressing nerve): Space-occupying lesions affecting nerve control of eyelid muscles produce paralysis leading to ectropion. eyerounds.org
Poor wound healing (e.g., in diabetics): Healing problems after surgery or injury can create irregular scarring and lid malposition. (Inference based on known increased cicatricial risk with poor wound healing; supported generally by surgical scar literature such as in ectropion reconstruction references). Consultant360
Radiation therapy to eyelid/adjacent skin: Radiation can cause fibrosis and skin tightening over time, contributing to cicatricial ectropion. Ento Key
Infection causing skin breakdown or scarring: Severe or chronic infections around the eyelid can damage skin and cause contraction or distortion. Ento Key
Neuromuscular diseases affecting eyelid tone: Conditions that weaken muscles (beyond isolated facial nerve palsy) may reduce eyelid support and contribute to malposition; examples include myasthenia gravis with variable muscle control. (General inference from understanding of eyelid muscle role in position). eyerounds.org
Mechanical pressure from prolonged use of devices or chronic rubbing: Constant external forces (e.g., from ill-fitting goggles or habitual lid pulling) over time may gradually change eyelid position in susceptible individuals. (Clinical extrapolation from mechanical ectropion principles). ScienceDirect
Symptoms of Ectropion
Tearing (Epiphora): Even though the eyelid is turned out, the eye may water excessively because tears cannot drain correctly. The tear duct opening (punctum) may be pulled away or everted, so tears spill over the cheek. Consultant360NCBI
Dryness and irritation: Because the eyelid no longer spreads tears properly, the surface of the eye becomes dry, leading to a constant scratchy sensation. Consultant360AAO Journal
Redness of the eye: Exposure leads to inflammation of the conjunctiva (the white part) and sometimes the cornea, making the eye look red. Consultant360eyerounds.org
Foreign body sensation: Patients feel like something is in the eye—this is usually due to the drying and irregular tear film rather than a real object. AAO JournalAjo
Blurry vision: Tear film problems and exposure can cause fluctuations in vision, especially if the cornea begins to dry or develop superficial damage. American Academy of Ophthalmology
Light sensitivity (photophobia): Exposed and irritated corneal nerves can make the eye more sensitive to bright light. American Academy of Ophthalmology
Mucous or pus discharge: Chronic irritation may cause a mucoid or even purulent discharge if secondary infection develops. Consultant360
Eyelid redness or inflammation: The turned-out eyelid edge can itself become irritated, inflamed, or thickened from constant exposure and tearing. Consultant360
Sticking of eyelids in the morning: Tearing mixed with mucous may glue eyelids partially shut after sleep. Consultant360
Corneal damage (exposure keratopathy): If the cornea remains exposed, it can develop epithelial breakdown, ulcers, or infections, leading to pain and further vision problems. American Academy of Ophthalmology
Punctal eversion or distortion: The tear drainage opening may be turned outward or not aligned, visible on exam, contributing to tearing. Consultant360
Thickened or hyperemic conjunctiva: Chronic exposure causes the conjunctiva to swell, become red, and sometimes feel gritty. Consultant360
Soreness or aching around the eye: Persistent dryness and inflammation often manifest as aching discomfort. AAO Journal
Eyeball exposure symptoms (feeling of wind or draft): Patients may feel their eye is exposed to air currents more than normal, worsening dryness. eyerounds.org
Secondary infection signs: Increased redness, discharge, and pain can signal bacterial infection from increased exposure; risk rises if corneal epithelium is damaged. Consultant360
Diagnostic Tests for Ectropion
Diagnosis mostly comes from careful clinical examination, but a variety of tests help determine type, severity, underlying cause, and whether complications are present. The tests fall into the five categories the user asked for: Physical Exam, Manual Tests, Lab/Pathological, Electrodiagnostic, and Imaging. Each is described below.
A. Physical Examination (basic observational and functional assessments)
Inspection of eyelid position and margin: The clinician visually looks to see if the eyelid is turned outward, if the punctum is visible or everted, and if the eyelid touches the globe. The extent of eversion and any associated eyelid swelling or skin changes are noted. Consultant360
Assessment of tearing and tear lake: Observing tear overflow on the cheek or pooling in the lower eyelid helps understand if epiphora is from malposition versus overproduction. NCBI
Corneal examination with fluorescein stain: Fluorescein dye highlights areas of corneal dryness, abrasions, or early ulceration from exposure. It shows how well the eye surface is protected. Consultant360
Slit-lamp examination: A detailed magnified look at eyelid margin, conjunctiva, cornea, tear film, and punctum to assess damage, inflammation, and exact lid anatomy. Consultant360
Tear film quality (tear breakup time): Measuring how long the tear film stays intact; low time indicates unstable tear film (common with exposure and dryness). Consultant360Ajo
Schirmer test: Measures total tear production by placing a paper strip under the lower eyelid and seeing how much wets in 5 minutes; helpful to separate dry eye from overflow tearing. Consultant360
Evaluation of punctal position and function: Looking at whether the punctum is everted, stenosed, or malpositioned, since this affects drainage. Consultant360
Assessment of corneal sensation and Bell’s phenomenon: In paralytic cases, testing how the eye moves when the patient attempts to close (the reflex upward movement) helps gauge risk to the cornea. Loss of corneal sensation worsens prognosis. Consultant360
B. Manual Structural Tests (specialized physical maneuvers)
Distraction test: The examiner gently pulls the lower eyelid away from the globe; if the distance exceeds about 10 mm, there is significant horizontal laxity indicating involutional ectropion. Consultant360
Snap-back test: The lower lid is pulled downward and away, held, and then released to see how fast it returns. Delayed return shows laxity. Consultant360
Medial canthal laxity test: Pulling the lid laterally at the inner corner measures laxity of medial support; excessive displacement means laxity. Consultant360
Lateral canthal laxity test: Pulling the lid medially at the outer corner checks the lateral support; again, excessive displacement is abnormal. Consultant360
Eyelid eversion check: Physically everting the eyelid to see underlying tissues, look for scarring, and assess how easily it can be repositioned. This helps determine if the lid is fixed or flexible. eyerounds.org
C. Laboratory and Pathological Tests
Skin biopsy of eyelid if cicatricial cause is unclear: Sampling eyelid skin in suspected autoimmune or chronic inflammatory disorders (like lupus or lichen planus) can show fibrosis, inflammation, or other patterns that explain cicatricial ectropion. Ento Key
Microbial culture or swab: If infection is suspected (e.g., mucopurulent discharge, chronic eyelid inflammation), culturing conjunctival or skin discharge identifies bacteria or fungi contributing to scarring or secondary infection. Ento Key
Autoimmune screening: For patients with chronic skin disease causing cicatricial changes, blood tests for autoimmune markers (like ANA, anti-dsDNA, or others depending on suspicion) help diagnose underlying systemic disease. (General clinical practice in inflammatory eyelid disorders). Ento Key
Thyroid function tests: While classic ectropion is not directly caused by thyroid disease, the overall facial and eyelid tissue changes (and coexisting eyelid malpositions) may prompt evaluation especially when multiple eyelid abnormalities are present. (Inference from overlapping orbitopathy screening practices.) eyerounds.org
Neurologic workup for facial nerve dysfunction: Blood sugar, Lyme disease panels, or other relevant labs when evaluating the cause of facial nerve palsy as a source of paralytic ectropion, since underlying systemic illness may contribute. (Standard neuro-ophthalmic approach.) eyerounds.org
D. Electrodiagnostic Tests
Facial nerve electromyography (EMG) and nerve conduction studies: These tests measure the function of the facial nerve and orbicularis oculi muscle, helping distinguish paralysis severity, chronicity, and potential for recovery in paralytic ectropion. eyerounds.org
Blink reflex testing: A specialized neurophysiologic test that assesses the reflex pathway of eyelid closure; altered responses can support diagnosis of nerve-related eyelid dysfunction. eyerounds.org
E. Imaging Tests
Orbital and eyelid CT scan: Helps detect masses, bony abnormalities, or anatomical causes pushing the eyelid outward (mechanical ectropion) and evaluates soft tissue structures. eyerounds.org
Orbital MRI: Provides better soft tissue contrast to evaluate tumors, nerve compression, inflammation, or chronic changes in surrounding tissues that might cause paralytic or mechanical ectropion. eyerounds.org
External photography with measurement: Standardized photos with measurement tools (e.g., millimeter rulers) help document the degree of ectropion, follow progression, and plan surgery. (Common clinical practice in oculoplastic evaluation.) eyerounds.org
Dacryocystography or tear drainage imaging: If tearing is severe and drainage malfunction is suspected along with ectropion, imaging the tear system can help rule out anatomic blockage or punctal malposition contributing to symptoms. Consultant360
Ultrasound of eyelid/orbit: Bedside ultrasound can help identify soft tissue masses, edema, or other swelling that may be mechanically affecting lid position. ScienceDirect
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: August 03, 2025.
