Ectropion
Treatment

When the conjunctival surface of the eyelid turns outward the lid loses its protective function. Tears may pool or run down the cheek and blinking no longer cleanses the cornea. Ectropion can be congenital or develop with age and is commonly treated by oculoplastic surgery.

Ectropion can arise at different ages for several reasons:

• Age-related laxity: Loss of collagen and relaxation of eyelid tendons with aging can pull the lid outward.
• Eyelid masses: Tumors or cysts can weigh the lid down and cause it to evert.
• Facial palsy: Paralysis of the facial nerve muscles can leave the lid unsupported and predispose to ectropion.
• Trauma and burns: Scarring from injuries or infections can contract the skin and evert the lid margin.
• Congenital causes: Some infants are born with underdeveloped eyelid support tissues causing congenital ectropion.

Regular tear distribution is essential for corneal health. When the lid turns outward this balance is disturbed, which can lead to:

• Insufficient tear distribution: The tear film cannot cover the cornea properly causing dryness and burning.
• Corneal damage: An exposed cornea is prone to abrasions, infection and permanent visual loss if untreated.
• Epiphora (tearing): Excess tearing onto the cheek causes irritation and may be socially distressing.
• Aesthetic concerns: An outward-turned eyelid produces a noticeable cosmetic defect in a visible part of the face.

Although the cosmetic effect may be visible, the primary concern is corneal exposure and infection. Timely surgical repair is recommended to protect the ocular surface and prevent chronic dryness or ulceration.

Temporary measures can be used before surgery to protect the ocular surface. These measures do not cure the condition but help limit corneal damage:

• Artificial tears and ointments: Keep the surface lubricated and relieve dry areas.
• Antibiotic drops: Reduce the risk of infection at the lid margin.
• Night protective bandages: Help keep the eye closed during sleep and protect the cornea.
• Temporary taping: Gently apposes the lid margin to improve tear distribution temporarily.

Definitive treatment of ectropion involves surgical tightening and repositioning of eyelid tissues. Under local anaesthesia, the procedure usually takes about 30–45 minutes and includes the following steps:

1. Detailed examination: Identify the source of laxity and remove masses if necessary.
2. Local anaesthesia and marking: Plan the incision sites on the lid margin.
3. Lateral tarsal strip or wedge resection: Shorten lax tissues to reposition the lid margin inward and upward.
4. Muscle and ligament reinforcement: Reposition retractors and secure the lid to the orbital rim or tarsal plate as indicated.
5. Dressing and medication: Apply prescribed drops and a protective dressing over the lid.

Patients are usually discharged the same day. A tailored surgical technique restores lid position and provides lasting protection for the corneal surface.