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Ectropion types, reasons and treatments

Ectropion is an out-turning eyelid. It is a condition when the eyelid turns outwards, so that the edge of the eyelid, usually the lower one, is no longer in contact with the surface of the eye.  As a result, it can cause watering of the eye, and the eyelid can become irritated and inflamed. Ectropion is a lot more common in older people.  There is a natural form that can occur in babies, but that is relatively rare.
Ectropion can be very mild and almost undetectable.  This type is often called punctual ectropion, where just the opening of the tear duct is not opposed to the eye. Instead, the slit opening faces upwards, and so it does not catch the tears, and the patient experiences a watering eye, but there is no redness or particular irritation.
Punctal ectropion can be cured by quite simple surgical treatment done as a day case under local anaesthetic where I turn the eyelid inwards either using a little bit of cautery or removing a small amount of tissue and then putting in a stitch.
However before I do that, I do have to assess the patient and make sure that the tear duct is functioning well and there is not an associated obstruction of the lacrimal system.  I also have to check that there is not any laxity to the lower lid, which would necessitate me doing a little bit more surgery such as tightening the cap at the same time.
A more severe ectropion than punctual ectropion is a medial third ectropion, where the lower lid towards the nose just begins to sag outwards, and about a third of the lid can look a little bit red on the inside tarsal conjunctiva, and there is a gap between the lid and the eyeball that is visible.  These patients get irritation and watering.
Gradually ectropion, if it is not treated, will get worse and will turn outwards and the whole of the lid will be red, and that is called a complete ectropion.
Lower eyelid sag is a form of ectropion where the lid is falling away from the eye, but it is due to mainly lower lid laxity so most of the time the eyelid looks and is is in touch with the eye, but if it is pulled away gently from the eye it is very slow to return to its normal position because there is some weakness associated.  This can occur because of old age, congenitally or with facial palsy.
Although I have mentioned surgery for ectropion a lot of the symptoms of ectropion, particularly its irritation and redness, can be dealt with by medical treatment with lubricant drops and ointment.
It is vital to treat the ectropion inflammation first before doing any surgery.
Lastly, there is a type of ectropion, which is because of an allergic reaction called contact dermatitis, where the eye drops that you are using fall onto the skin and there are redness and tightening of the skin, which pulls the lid outwards.  This is reversible by stopping the eye drop. Then a different drop can be substituted for which you are not allergic.  Most commonly the preservative used causes the allergy, and I am pleased that now many eyes drops, particularly anti-glaucoma drops, do not have preservatives in them. This will help prevent this unpleasant side effect, albeit rare, of contact dermatitis ectropion.
If you think you have ectropion because the appearance of the lid looks as if though it’s falling away from the eye or sagging down, or if your uncle or grandfather has this, but they do not know about it, arrange for them to be assessed by me here at Clinica London at consultation.  In my next blog, I will tell you what happens at the ectropion consultation.

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