Ectropion

The eyelids play a crucial role in protecting the eyes. They act as natural barriers that shield against external debris, regulate the amount of light entering the eye, and help distribute the tear film evenly across the ocular surface to maintain moisture and clear vision. When the eyelid position becomes abnormal—such as with entropion or ectropion—these protective mechanisms are disrupted, leading to discomfort and potentially more serious ocular complications. Understanding the causes and treatment options of eyelid malposition is essential for early detection and proper management.

What Is Ectropion?

Ectropion refers to a condition in which the eyelid margin—most commonly the lower eyelid—turns outward, exposing the inner eyelid surface (the conjunctiva). This prevents the eyelid from resting properly against the eye, disrupting normal tear drainage and leading to dryness, excessive tearing, ocular irritation, and redness. In more severe cases, the cornea may become exposed and vulnerable to injury.

Causes of Ectropion

Involutional (Age-Related) Ectropion

The most common type. Age-related weakening and laxity of the eyelid muscles and supporting ligaments cause the eyelid to lose stability and rotate outward. Gravity may further contribute to the condition.

Paralytic Ectropion

This type results from dysfunction or paralysis of the facial nerve (cranial nerve VII), which controls eyelid closure. Facial nerve palsy may result from Bell's palsy, stroke, tumors, or trauma, leading to weakness of the orbicularis oculi muscle and outward turning of the eyelid.

Cicatricial Ectropion

Caused by scarring and contraction of the eyelid skin and muscle (the anterior lamella). It may be the result of burns, trauma, dermatologic conditions, or previous ocular surgeries. Scar contraction pulls the eyelid outward.

Different types of ectropion require treatment tailored to the underlying cause. For example, involutional ectropion typically involves tightening the lax eyelid tissues, whereas cicatricial ectropion may require skin grafting to release the pulling force of the scar.

Symptoms of Ectropion

The primary symptoms of ectropion arise from outward rotation of the eyelid, leading to ocular surface exposure and impaired tear drainage:

・Excessive tearing (epiphora), because the everted eyelid prevents tears from entering the lacrimal drainage opening
・Dryness, foreign-body sensation, or burning due to increased tear evaporation from ocular exposure
・Redness and irritation of the eye and eyelid
・Blurred vision, especially when the cornea becomes dry or damaged
・Sensitivity to light and wind
・Incomplete eyelid closure
・Chronic conjunctivitis or keratitis

If these symptoms occur, prompt medical evaluation is recommended to prevent worsening of the condition and further complications.

Ideal Candidates for Ectropion Repair Surgery

Individuals with ectropion-related dry eye symptoms that significantly affect daily quality of life
Patients with corneal exposure caused by ectropion, leading to epithelial defects or inflammation
Individuals whose lower eyelid laxity from aging results in incomplete eyelid closure and frequent tearing or discomfort
Patients experiencing corneal damage or decreased vision due to ectropion

Primary Treatment Methods

Surgery for ectropion aims to restore the eyelid to its proper position in contact with the ocular surface, thereby improving tear drainage and protecting the corneal surface.

Lateral Tarsal Strip Procedure

This is the most common surgical method for treating involutional (age-related) ectropion. The procedure shortens the lateral portion of the lower eyelid and reattaches it to the lateral canthal tendon, thereby tightening and repositioning the lower eyelid.

Horizontal Eyelid Tightening (Wedge Resection)

A small full-thickness segment of the eyelid is excised, and the edges are sutured together to tighten the eyelid and restore proper positioning.

Skin Grafting

Used for the treatment of cicatricial ectropion. When scarring or previous surgery results in insufficient eyelid skin, an autologous skin graft is placed in the lower eyelid to increase the length of the skin and muscle. In some cases, a midface lift may also be performed to provide additional support to the lower eyelid.

Lateral Canthal Fixation

The lateral canthal tendon is secured to the periosteum at the lateral orbital rim without the need for a lateral canthotomy.

Tarsorrhaphy

A portion or the entirety of the upper and lower eyelids is sutured together to reduce corneal exposure, commonly used in cases of paralytic ectropion. The procedure may be temporary or permanent, depending on the patient's condition and treatment goals.

Surgical Procedure Overview

01Preoperative Instructions

One Week Before Surgery:

・Discontinue anticoagulant medications (such as aspirin). Please confirm with your prescribing physician whether temporary discontinuation is appropriate.
・Stop taking all nutritional supplements (such as fish oil, ginkgo, ginseng, and vitamin E).
・Avoid smoking and alcohol from one week before surgery until one month after the procedure.

On the Day of Surgery:

・Please arrive with a clean face and no makeup; remove any eyelash extensions.
・Do not wear any accessories or metal items. If you have piercings, please remove them in advance.
・If you are nearsighted, you may wear contact lenses to the clinic, but they must be removed before surgery. Please bring a storage case, eyeglasses, or sunglasses for use afterward.

02Preoperative Surgical Planning

The surgeon will determine the appropriate surgical approach and assess the degree of eyelid fixation required based on your individual condition.

03Anesthesia

・Local anesthesia does not require fasting, and you may eat and drink as usual.
・General anesthesia requires fasting for approximately 8 hours. Please avoid all food and drinks, including water and chewing gum.
・Please do not drive or ride a motorcycle yourself after the procedure.

04Postoperative Care

・Cold and Warm Compresses: Apply cold compresses during the first 72 hours after surgery to help reduce swelling and bruising, and keep your head elevated as much as possible. Warm compresses may be started after 72 hours to promote circulation and healing.
・Wound Care and Dressing Changes: Keep the incision area clean and dry after returning home, and change dressings as instructed. If skin sutures are present, they are typically removed around 6–10 days postoperatively, depending on wound condition.
・How to Change Dressings: Clean the wound twice daily using sterile cotton swabs dipped in normal saline, dry the area, and then apply the prescribed ointment. When performing cold or warm compresses, place a piece of gauze over the wound to reduce the risk of infection.
・Medication and Eye Hygiene: Use the prescribed eye drops or ointment as directed to prevent infection and support healing.
・Eye Use and Daily Habits: Avoid prolonged use of mobile phones, computers, or looking down for extended periods. Allow your eyes sufficient rest to facilitate recovery.
・Diet and Medications:

- You may take the prescribed pain relievers as needed to ease postoperative discomfort.
- Avoid irritants such as smoking, alcohol, tea, coffee, spicy foods, and dietary supplements (including vitamin E, lingzhi, and traditional herbal medicine).
- A light diet is recommended, along with adequate hydration and increased intake of protein and vitamin C to support wound healing.

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