Ectropion is when the lower eyelid sags and turns outward, away from the eyeball, exposing the pink inner surface of the lid. It is most often caused by age-related slackening of the eyelid tissues and leads to a watery, red, gritty eye. While lubricating drops ease the symptoms, the definitive treatment is a short day-case operation under local anaesthetic to tighten and reposition the eyelid — from £2,400 per eyelid.
What is ectropion?
The lower eyelid normally rests snugly against the eye, spreading tears across the surface and draining them away. In ectropion, the lid margin rolls outward so it no longer touches the eye. The exposed inner lining (conjunctiva) becomes dry, red and sore, and tears spill over the cheek instead of draining properly.
Ectropion almost always affects the lower lid and is usually involutional — the result of the eyelid tendons and muscles stretching with age. Other forms include paralytic (after a facial nerve palsy such as Bell’s palsy), cicatricial (where scarring from skin damage, burns or surgery pulls the lid down), and rare congenital cases. It is closely related to entropion, where the lid turns inward instead.
Symptoms of ectropion
Because the eyelid no longer protects and lubricates the eye, ectropion causes a recognisable set of symptoms:
- A constantly watery eye (tears spilling onto the cheek)
- Redness and soreness of the exposed inner eyelid
- A gritty, burning or sandy sensation
- Crusting of the eyelids and excess mucus
- Dryness despite the watering, as tears no longer coat the eye evenly
Left untreated, prolonged exposure can damage the surface of the cornea, so persistent symptoms should be assessed.
Troubled by a watery, sagging lower lid? An oculoplastic assessment confirms the cause and whether a simple day-case repair will resolve it.
Book an eyelid assessmentCauses & risk factors
Ectropion develops when the lower-eyelid support weakens or is pulled out of position. Common causes and risks include:
- Ageing — stretching of the eyelid tendons and muscles is by far the most common cause
- Facial nerve weakness — such as after a stroke or Bell’s palsy
- Scarring of the eyelid skin — from sun damage, burns, trauma or previous surgery
- Skin cancer or lesions on or near the eyelid
- Previous eyelid or cosmetic surgery that has removed too much skin
How ectropion is diagnosed
Ectropion is diagnosed by a straightforward clinical examination by an oculoplastic surgeon, who also checks the health of the eye surface:
- Eyelid examination — assesses the position and laxity of the lower lid.
- Snap-back test — the lid is gently pulled away from the eye and released to gauge how quickly it returns.
- Lid distraction test — measures how far the lid can be pulled from the eye, indicating tendon laxity.
- Corneal assessment — checks for dryness or surface damage from exposure.
- Skin and scar review — identifies any cicatricial cause that affects the surgical plan.
Treatment options
Mild ectropion can be managed with lubrication, but surgery is the only way to correct the lid position — see our ectropion treatment overview for full detail.
- Lubricating drops and ointment — protect the eye surface and relieve symptoms while you wait for, or decide on, surgery.
- Taping and skin care — a temporary measure for very mild or paralytic cases.
- Lid-tightening surgery — a day-case procedure under local anaesthetic (commonly a lateral tarsal strip) that shortens and re-tensions the eyelid so it sits correctly against the eye.
- Skin graft or flap — used for cicatricial ectropion to replace the skin pulling the lid down. Your oculoplastic surgeon plans the right approach.