Ectropion

Definition/diagnostic criteria Ectropion is an eye condition characterised by the outward turning (eversion) of the eyelid, typically affecting the lower lid. This exposes the inner eyelid and globe, leading to symptoms such as irritation, tearing and redness. The diagnosis is primarily clinical, based on observation of the eyelid position and evaluation of symptoms.

Epidemiology Ectropion predominantly affects older adults, with a higher prevalence in those aged over 60 years. It is more common in males than females. The condition may be associated with aging changes, facial palsy, scarring or previous surgeries.

Diagnosis
Clinical features: The presentation includes visible eversion of the lower eyelid, conjunctival hyperaemia, tearing and discomfort. Chronic cases may present with keratinisation of the exposed conjunctiva and corneal irritation.

Investigations: Diagnosis is usually clinical. However, specific investigations might be required in atypical cases or to assess underlying causes:

• Slit-lamp examination: To evaluate the extent of eyelid malposition and assess ocular surface health.
• Tear film assessment: Schirmer’s test or tear break-up time to evaluate tear film stability and quantity.
• Facial nerve function tests: Particularly if facial palsy is suspected.
• Imaging: Rarely required, but can be useful in cases with suspected orbital or periorbital pathology.

Treatment The approach to treatment varies based on the severity and underlying cause:

• Conservative management: Includes lubricating eye drops and ointments to manage exposure symptoms.
• Temporary measures: Taping the eyelid or botulinum toxin injections in cases of facial nerve palsy.
• Surgical intervention: Indicated in symptomatic cases or where conservative management fails. Procedures include:
  • Lateral tarsal strip surgery – for involutional ectropion.
  • Medial canthal tendon tightening – for medial ectropion.
  • Skin grafting or local flaps – in cases of cicatricial ectropion.

Referral to an ophthalmologist is recommended for patients requiring surgical management or when the diagnosis is uncertain.

Prognosis The prognosis for ectropion is generally good, especially when treated appropriately. Surgical correction is often successful in restoring normal eyelid position and function. However, patients with underlying conditions, such as facial nerve palsy, may have a more variable outcome.