An ectropion is the term used to describe an outward sweep of the eyelid, which usually affects the lower eyelid. In this case, the affected eye usually exhibits redness, frequent tearing (tear drainage over the lid margin), and chronic conjunctival and, by extension, corneal irritation. With early therapy, ectropion is reversible and, depending on the causes, does not lead to subsequent damage.
What is an ectropion?
An ectropion is a malposition of the eyelid in which the edge of the eyelid is turned outward. As a result, both the conjunctiva and the cornea are exposed in an ectropion and can dry out easily. This leads to chronic conjunctival irritation (conjunctivitis) with characteristic symptoms such as redness, burning of the eye, and watering of the eye (epiphora). As it progresses, corneal inflammation (keratoconjunctivitis) may develop, with a cloudy cornea, increased sensitivity of the eye to light, and limited vision.
Causes
An ectropion is usually an acquired eyelid malposition, most commonly due to age-related factors (ectropium senile) or scarring (ectropium cicatriceum). In age-related ectropion, the lower eyelid muscles are partially slackened, resulting in a disproportion between the closing and opening muscles and corresponding outward inversion of the eyelid (ectropion). Postoperative scars as well as changes of the eyelid tissue caused by skin diseases can also result in a shortening of the eyelid skin and the eyelid malposition typical for an ectropion. Partial paralysis of the facial muscles (facial paresis) can also lead to an outward turning of the eyelid (paralytic ectropion). Swelling as well as tumors in the area of the eyelid can pull it down mechanically and cause an ectropion. In rare cases, an ectropion is congenital (ectropium congenitum), and the cause is thought to be a genetic disorder of eyelid plate formation.
Symptoms, complaints, and signs
Outward reversion of the eyelid makes the patient’s daily life much more difficult and significantly reduces the quality of life. As a rule, patients suffer from a number of different complaints of the eyes in this case. First and foremost, the eyes become very dry, and they may also be affected by itching. The constant rubbing only intensifies this itching, so that the eyes are often red and in some cases may even water. If the outward sweeping of the eyelid is not treated, many patients suffer from conjunctivitis, which in the worst case can lead to complete blindness. The eyes burn and are extremely reddened, and visual disturbances also occur. The cornea can also become inflamed in the process and also contribute to the various visual complaints. Especially in young people, a loss of vision can lead to severe psychological discomfort or depression. Pain occurs in the eyes themselves, which can spread to the ears or even to the head. Paralysis of the nerves in the face can also occur. The life expectancy of the affected person is usually not reduced by the outward sweeping of the eyelid. In most cases, the condition can also be treated relatively well.
Diagnosis and course
Ectropion is easily diagnosed by the outward sweep of the eyelid edge (in most cases, the lower eyelid). The conjunctiva is exposed by the malposition, and the eyelid droops. During a slit lamp examination, the physician can also determine the extent of possible conjunctivitis as well as keratoconjunctivitis. Depending on the underlying causes, further examinations may be necessary. For example, if an ectropion caused by paralysis is suspected, the corresponding facial nerve should be tested to determine whether it is functioning properly. With early therapy of an ectropion, the eyelid malposition is usually reversible (i.e. curable) and, depending on the causes, does not lead to any consequential damage. Without therapeutic measures, an ectropion can develop conjunctivitis and, in the further course, keratoconjunctivitis with detachment of the cornea and scarring. In the long term, an untreated ectropion can cause reduced vision and blindness.
Complications
The outward sweeping of the eyelid can cause various discomforts and complications. In most cases, this involves increased lacrimation, which can also occur for no particular reason. Furthermore, the eyes are reddened and various inflammations of the eye can occur. These inflammations are usually also associated with a reduction in visual acuity and thus lead to a reduced quality of life. In many patients, discomfort at the eyes can lead to panic attacks or to sweating. It is not uncommon for the eyes to burn and for eye pain to occur. If this pain also occurs at night in the form of pain at rest, this can lead to sleep disturbances or thus to irritability on the part of the patient. In the worst case, outward sweeping of the eyelid without treatment leads to complete blindness of the patient. Treatment of outward sweeping of the eyelid does not usually lead to complications. The symptoms themselves can be treated with the help of creams and ointments. Furthermore, surgical intervention is also usually necessary to surgically correct the discomfort. If tumors are responsible for the outward sweeping of the eyelid, they can also be removed. Life expectancy is not reduced by outward sweeping of the eyelid.
When should you see a doctor?
If noticeable changes in the eye, a doctor should be consulted. In any case, an ectropion requires medical evaluation. Affected persons who notice that the edge of the eyelid is turned outward are therefore best to talk to the ophthalmologist immediately. At the latest, if the eyes redden and possibly also itching and burning of the eyes occur, this should be clarified. It is possible that a chronic conjunctivitis has already developed, which in the further course can cause permanent visual disturbances. If left untreated, ectropion can also cause corneal inflammation. Increased sensitivity to light and severely impaired vision are typical warning signs that must be examined and treated immediately. Ectropion is particularly common in elderly people and patients with a damaged facial nerve. Tumors can also lead to damage of the eyelid. If you belong to these risk groups, it is best to talk to a doctor quickly if you experience the symptoms mentioned above. Congenital ectropion is usually diagnosed and treated immediately after birth.
Treatment and therapy
The treatment measures for an ectropion depend on the causes of the deformity. Eye ointments and drops are used for temporary (transient) ectropion. In most cases, however, it is a permanent, age-related deformity that is treated surgically. The surgical procedure corrects the malpositioned eyelid. For this purpose, the eyelid suspension is shortened (lateral tarsalzungoplasty) and a tightening of the affected eyelid is induced. In most cases of ectropion due to facial nerve palsy, the malpositioning gradually decreases depending on the regression of the palsy. Ointments and drops can be used to keep the conjunctiva and cornea moist. Furthermore, a watch glass bandage may be used at night to protect the cornea, and side shields may be used during the day to help narrow the palpebral fissure. In some cases, a tarsoraphy (suturing of the eyelid in the outer area) is also used for this purpose. If an ectropion is due to a shortening of the eyelid skin by scars, the tissue tension is minimized surgically by moving skin flaps or by skin grafts (Z-plasty). In the case of an ectropion caused by a tumor, it is surgically removed if possible and the malposition is subsequently corrected with the appropriate procedure.
Outlook and prognosis
Ectropion – an outward sweeping of the eyelid – is the opposite of inward sweeping of the eyelids. Again, if treated early, the prognosis is quite good. The longer the ectropion persists, the greater the risks of adverse health effects and sequelae. Chronic conjunctivitis, keratinization of the eyelid margin or hypertrophy are possible. The prognosis improves if the outward sweeping of the eyelid is quickly and promptly corrected surgically. The condition usually does not normalize on its own.Situations in which the triggering factor for the outward return of the eyelid is absent are an exception. Only in this case can the outward return of one or both eyelids improve without surgery. However, this prognosis assumes that the causes of the eyelid malposition are identified and corrected relatively quickly. Most often, ectropion worsens due to a delay in surgery. Those affected permanently wipe away the tears running down their eyes. In doing so, they create what is known as a wiping ectropion. This can lead to progressive eye damage. In extreme cases, the cornea of the eye can be so damaged that blindness is imminent. Since the outwardly rotated eyelid can be easily corrected surgically, there is no reason to take such risks. What is problematic are possible complications that may result from surgery-related scarring.
Prevention
To prevent ectropion, conjunctivitis and inflammation of the lid margin should be treated early. In addition, eye injuries that can lead to scarring should be avoided as much as possible. The risk of ectropion must be taken into account when performing cosmetic procedures on the eye (for drooping eyelids or bags under the eyes). Constant wiping movements during tear troughs should also be avoided, as these promote ectropion.
Aftercare
In cases of outward retraction of the eyelid, the patient usually has no particular options for follow-up care. The affected individual must first seek a full diagnosis and treatment from a physician for this condition to avoid further complications. After successful treatment of the outward sweeping of the eyelid, no further follow-up care is usually necessary. If the outward retraction of the eyelid is treated by an operative or surgical procedure, it is recommended to take care of the eye in any case. As a rule, a bandage is placed around the eye. If medications or eye drops are used to alleviate the outward movement of the eyelid, they should always be applied regularly and correctly. In case of doubt, a doctor should always be consulted in this regard to avoid further complications. A complete healing of the outward sweeping of the eyelid is not always possible, which is why an early diagnosis is very important. As a rule, those affected have to undergo regular examinations even after treatment. The life expectancy of the affected person is not negatively affected or otherwise reduced by this disease.
What you can do yourself
In the case of an ectropion, the affected person has no options for action to cure the deformity. On a day-to-day basis, it is a matter of finding a way for him or her to live well with the condition or to obtain relief when symptoms occur. Since the eyes often dry out and redness of the eyelids occurs, creams and ointments can be used to support the skin. Additionally, eye drops can help. The use of make-up products should be avoided. The organism should be supplied with sufficient fluids to prevent it from drying out. Scratching or rubbing the eyelids should be completely refrained from. Anything that puts additional strain on the eyes or vision should also be refrained from. By wearing accessories or fashionable accents, the patient can distract from or hide the eyelid malposition. For emotional support, it is advisable to communicate with friends, relatives or other patients. Tips and support can be exchanged and fears and worries can be discussed. For mental stabilization, relaxation techniques are often used by patients. In regular training sessions or simple exercise units, they can use yoga or meditation to reduce everyday stress. At the same time, new reserves are built up for the challenges of everyday life.