Ectropion is very often caused by the aging process. The connective (supporting) tissue of the eyelid becomes weak. This causes the lid to turn out so that the inside of the lower lid is no longer against the eyeball. It can also be caused by:

• A defect that occurs before birth (for example, in children with Down syndrome)
• Facial muscle weakness
• Scar tissue from burns or injuries

Symptoms include:

• Dry, painful eyes
• Excess tearing of the eye (epiphora)
• Eyelid turns outward (downward)
• Long-term (chronic) conjunctivitis
• Keratitis
• Redness of the lid and white part of the eye

If you have ectropion, you will most likely have excess tearing. This happens because the eye gets dry, then makes more tears. The excess tears can't get into the tear drainage duct. Therefore, they build up inside the lower lid and then spill over the edge of the lid onto the cheek.

The health care provider will make a diagnosis by doing an exam of the eyes and eyelids. Special tests are not needed most of the time.

Artificial tears (a lubricant) may ease dryness and keep the cornea moist. Ointment may be helpful when the eye can't close all of the way, such as when you are asleep. Surgery is very often effective. When ectropion is related to aging or paralysis, the surgeon can tighten the muscles that hold the eyelids in place. If the condition is due to scarring of the skin, a skin graft or laser treatment may be used. The surgery is most often done in the office or at an outpatient surgery center. A medicine is used to numb the area (local anesthesia) before the surgery.

The outcome is very often good with treatment.

Corneal dryness and irritation may lead to:

• Corneal abrasions
• Corneal ulcers
• Eye infections

Corneal ulcers can cause vision loss.

Contact your provider if you have symptoms of ectropion.

If you have ectropion, get emergency medical help if you have:

• Vision that is getting worse
• Pain
• Sensitivity to light
• Eye redness that is getting worse quickly

Most cases cannot be prevented. You may want to use artificial tears or ointments to prevent injury to the cornea, especially if you are waiting for a more permanent treatment.

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Maamari RN, Couch SM. Ectropion. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 12.6.

Nicoli F, Orfaniotis G, Ciudad P, et al. Correction of cicatricial ectropion using non-ablative fractional laser resurfacing. Lasers Med Sci. 2019;34(1):79-84. PMID: 30056585 pubmed.ncbi.nlm.nih.gov/30056585/.

Olitsky SE, Marsh JM. Abnormalities of the lids. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 642.

Stein HA, Stein RM, Freeman MI, Stein RL. Common eye disorders. In: Stein HA, Stein RM, Freeman MI, Stein RL, eds. The Ophthalmic Assistant. 11th ed. Philadelphia, PA: Elsevier; 2023:chap 23.

Updated by: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.