👁️Ectropion – When theLid Turns Out

Welcome to thisquick, high-yield deep dive on ectropion,a common but important eyelid condition—especially in older adults. We're hereto clarify what it is, why it happens, how to spot it, and what to do about it.

🔍Definition:

Ectropion is the outward turning of the lower eyelid, causingthe inner surface (conjunctiva) to be exposed. This disrupts normal teardrainage, leaving the eye dry, watery, and irritated.

🧠Causes – 5 MainTypes:

1. Involutional – most common (age-related laxity)
2. Paralytic – e.g., facial nerve palsy
3. Cicatricial – scarring pulls the lid out
4. Mechanical – mass or tumour pushes lid outward
5. Congenital – present at birth (rare)

📌Mnemonic: OLD SICK FACE

Old age, Laceration/trauma,Disease (e.g., skin),

Surgery history, Innervationproblems, Congenital, Known lid laxity

😣Symptoms:

• Watery eyes (epiphora)
• Redness
• Irritation or gritty sensation
• Sensitivity to light
• Dryness due to poor tear film contact
• Exposure keratopathy in severe cases

🔎Clinical Signs:

• Visible sagging of lower eyelid
• Red conjunctiva exposed
• Malpositioned puncta (tear drainage holes)

🩺Diagnosis:

Primarily clinical. Look for:

• Lid laxity
• Puncta displacement
• Fluorescein staining (if corneal damage suspected)
  No imaging is usually required unless a mass is suspected.

🧬Risk Factors:

• Advanced age
• Facial nerve palsy
• History of eyelid surgery or trauma
• Skin disorders, e.g., eczema or dermatitis
• Chronic eye inflammation

💡Pathophysiology:

The eyelid turnsoutward → puncta no longer drain tears → overflow (epiphora) + cornea exposed →dryness & irritation → long-term risk of ulceration.

🔄Differentials toKnow:

• Entropion – inward turning of eyelid
• Trichiasis – inward-growing lashes
• Severe blepharitis
• Paralytic lid malposition (requires separate consideration)

💊Management:

▶️Mild cases:

• Lubricating drops
• Night-time eye ointments
• Eyelid taping (temporary)

▶️Persistent/moderateto severe:

• Surgical correction is definitive (e.g., lateral tarsal strip)
• Aim: restore lid tone and alignment

▶️Paralytic causes:

• Address facial nerve palsy
• Consider gold weight implants or tarsorrhaphy in some cases

📈Prognosis:

• Excellent with surgery – high success, low recurrence
• If left untreated, complications can include:
    • Exposure keratopathy
    • Corneal ulcers/scarring
    • Chronic conjunctivitis
    • Reduced visual acuity

📚Useful Resources

• Revision Notes → https://www.passthemsra.com/topic/ectropion-revision-notes/

• Flashcards → https://www.passthemsra.com/topic/ectropion-flashcards/

• Accordion Q&A→ https://www.passthemsra.com/topic/ectropion-accordion-qa-notes/

• Rapid Quiz → https://www.passthemsra.com/topic/ectropion-rapid-quiz/

• Quiz Link → https://www.passthemsra.com/quizzes/ectropion/

🎯Key MSRA Takeaway:

Ectropion = outward-turning lid, common in older adults, causes epiphora and exposure issues,often treated with surgery. Know thetypes, causes, and complications.

💭Final Thought:

As we age, eyelidstructure changes can impact vision and comfort. Recognising ectropionearly—and knowing when to refer—can prevent serious complications. Stayvigilant, stay prepared.

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