Ectropion

Author: Edsel Ing, MD, FRCSC; Chief Editor: Hampton Roy Sr, MD more...

Updated: Feb 15, 2012

What would you like to print?

Background
Pathophysiology
Epidemiology
Show All

Background

Ectropion is an abnormal eversion (outward turning) of the lid margin away from the globe. Without normal lid globe apposition, corneal exposure, tearing, keratinization of the palpebral conjunctiva, and visual loss may result.

Ectropion usually involves the lower lid and often has a component of horizontal lid laxity.

Treatment is individualized based on the appropriate identification of the etiology.^[1]See the images below.

Medial cicatricial ectropion in a patient with extensive basal cell carcinoma.

Complete (tarsal) paralytic ectropion in a patient with an ipsilateral parotid tumor.

Pathophysiology

The pathophysiology depends on the type of ectropion and is discussed within this article.

Frequency

International

The prevalence of involutional lower lid ectropion in elderly patients in Brazil has been estimated at 2.9%.^[2]

Mortality/Morbidity

The primary morbidity is associated with corneal/conjunctival exposure. Tearing may also cause significant patient complaints.

Race

No racial predilection has been described.

Sex

No sexual predilection has been described.

Age

Ectropion can affect patients of any age but is most commonly seen in older adults.

Proceed to Clinical Presentation

Contributor Information and Disclosures

Author

Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Toronto East General Hospital, Canada

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Ron W Pelton, MD, PhD Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Plastic and Reconstructive Surgery, AO Foundation, and Colorado Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Mark T Duffy, MD, PhD Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Honoraria Speaking and teaching

Lance L Brown, OD, MD Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

Gupta B, Parmar B, Raina J, Chawla JS. Acute idiopathic bilateral lower lid ectropion. Indian J Ophthalmol. Sep 2006;54(3):212-4. [Medline].
Damasceno RW, Osaki MH, Dantas PE, Belfort R Jr. Involutional entropion and ectropion of the lower eyelid: prevalence and associated risk factors in the elderly population. Ophthal Plast Reconstr Surg. Sep-Oct 2011;27(5):317-20. [Medline].
Fezza JP. Nonsurgical treatment of cicatricial ectropion with hyaluronic acid filler. Plast Reconstr Surg. Mar 2008;121(3):1009-14. [Medline].
Schrom T, Habermann A. Temporary ectropion therapy by adhesive taping: a case study. Head Face Med. Jul 21 2008;4:12. [Medline].
Bedran EG, Pereira MV, Bernardes TF. Ectropion. Semin Ophthalmol. May 2010;25(3):59-65. [Medline].
Xue CY, Dai HY, Li L, Wang YC, Yang C, Li JH, et al. Reconstruction of Lower Eyelid Retraction or Ectropion Using a Paranasal Flap. Aesthetic Plast Surg. Jan 25 2012;[Medline].
Osborne SF, Eidsness RB, Carroll SC, Rosser PM. The use of fibrin tissue glue in the repair of cicatricial ectropion of the lower eyelid. Ophthal Plast Reconstr Surg. Nov-Dec 2010;26(6):409-12. [Medline].
Anderson RL, Gordy DD. The tarsal strip procedure. Arch Ophthalmol. Nov 1979;97(11):2192-6. [Medline].
Bashour M, Harvey J. Causes of involutional ectropion and entropion--age-related tarsal changes are the key. Ophthal Plast Reconstr Surg. Mar 2000;16(2):131-41. [Medline].
Ben Simon GJ, Molina M, Schwarcz RM, McCann JD, Goldberg RA. External (subciliary) vs internal (transconjunctival) involutional entropion repair. Am J Ophthalmol. Mar 2005;139(3):482-7. [Medline].
Bergeron CM, Moe KS. The evaluation and treatment of lower eyelid paralysis. Facial Plast Surg. May 2008;24(2):231-41. [Medline].
Caviggioli F, Klinger F, Villani F, Fossati C, Vinci V, Klinger M. Correction of cicatricial ectropion by autologous fat graft. Aesthetic Plast Surg. May 2008;32(3):555-7. [Medline].
Chang L, Olver J. A useful augmented lateral tarsal strip tarsorraphy for paralytic ectropion. Ophthalmology. 2006;113:84-91.
Cook BE Jr, Bartley GB, Pittelkow MR. Ophthalmic abnormalities in patients with cutaneous T-cell lymphoma. Ophthalmology. Jul 1999;106(7):1339-44. [Medline].
Frankfort BJ, Garibaldi DC. Periocular cutaneous toxicity and cicatricial ectropion: a potential class effect of antineoplastic agents that inhibit EGFR signaling. Ophthal Plast Reconstr Surg. Nov-Dec 2007;23(6):496-7. [Medline].
Hedge V, Robinson R, Dean F, Mulvihill HA, Ahluwalia H. Drug-induced ectropion: what is best practice?. Ophthalmology. 2007;114:362-6.
Hintschich C. Correction of entropion and ectropion. Dev Ophthalmol. 2008;41:85-102. [Medline].
Isawumi MA, Adeoti CO, Umar IO, Oluwatimilehin IO, Raji RA. Congenital bilateral eversion of the eyelids. J Pediatr Ophthalmol Strabismus. Nov-Dec 2008;45(6):371-3. [Medline].
Jordan DR, Anderson RL. The lateral tarsal strip revisited. The enhanced tarsal strip. Arch Ophthalmol. Apr 1989;107(4):604-6. [Medline].
Jordan DR, Bawazeer AM, Pelletier CR. Severe congenital ectropion secondary to lamellar ichthyosis. Can J Ophthalmol. Feb 1998;33(1):30-1. [Medline].
Koh S, Hosohata J, Tano Y. Bilateral upper eyelid ectropion associated with blepharospasm. Br J Ophthalmol. Nov 2006;90(11):1437-8. [Medline].
Manku K, Leong JK, Ghabrial R. Cicatricial ectropion: repair with myocutaneous flaps and canthopexy. Clin Experiment Ophthalmol. Sep-Oct 2006;34(7):677-81. [Medline].
Monaco G, Franceschin S, Cacioppo V, Simonetta S, Ratiglia R. Congenital iris ectropion associated with juvenile glaucoma. J Pediatr Ophthalmol Strabismus. Jan-Feb 2009;46(1):35-7. [Medline].
Nowinski TS, Anderson RL. The medial spindle procedure for involutional medial ectropion. Arch Ophthalmol. Nov 1985;103(11):1750-3. [Medline].
Smith B. The "lazy-T" correction of ectropion of the lower punctum. Arch Ophthalmol. Jul 1976;94(7):1149-50. [Medline].
Tse DT, Kronish JW, Buus D. Surgical correction of lower-eyelid tarsal ectropion by reinsertion of the retractors. Arch Ophthalmol. Mar 1991;109(3):427-31. [Medline].
Uthoff D, Gorney M, Teichmann C. Cicatricial ectropion in ichthyosis: a novel approach to treatment. Ophthal Plast Reconstr Surg. Jun 1994;10(2):92-5. [Medline].