What Is Ectropion? Symptoms, Causes and Treatment

Daniel Ezra, 23 October 2026

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Ectropion is an eyelid condition in which the eyelid turns outwards, leaving the inner surface exposed and potentially causing watering, dryness and irritation. While it most commonly develops with age, there are several possible causes, and treatment depends on the underlying reason for the change in eyelid position.

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What Is Ectropion of the Eye?

Ectropion occurs when the eyelid turns away from the surface of the eye rather than resting naturally against it. It most commonly affects the lower eyelid and may occur in one or both eyes.

When the eyelid no longer sits correctly against the eye, its inner surface can become exposed. The altered eyelid position can also interfere with normal tear distribution and drainage, resulting in symptoms such as watery eyes, dryness, redness and irritation.

The severity of ectropion varies. Some people experience relatively mild symptoms, while more pronounced eyelid malposition can leave the surface of the eye inadequately protected.

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What Are the Symptoms of Ectropion?

The symptoms of ectropion are largely related to the eyelid no longer sitting correctly against the eye. Common signs and symptoms include:

  • Excessive tearing or watery eyes.
  • Dryness and irritation.
  • Redness of the eye or exposed inner eyelid.
  • A gritty sensation or feeling that something is in the eye.
  • Increased sensitivity to light.
  • Visible outward turning or drooping of the lower eyelid.

Although they may seem contradictory, dryness and excessive watering can occur at the same time. The altered eyelid position can prevent tears from spreading and draining normally, leaving the eye inadequately lubricated while also causing tears to overflow onto the cheek.

Extreme close-up of an open eye showing a hazel iris, pupil and surrounding lashes and skin.

When Should You Seek Medical Attention?

Persistent watering, irritation or difficulty closing the eye properly should be assessed, particularly if you can see that the eyelid is beginning to turn away from the eye.

Increasing redness or discomfort can also indicate that the exposed surface of the eye is becoming irritated. Severe eye pain, significant sensitivity to light or changes in vision require prompt medical assessment.

What Causes Ectropion?

Ectropion can develop for several reasons. Identifying the underlying cause is important because it influences the most appropriate treatment.

Age-Related Changes

Ageing is one of the most common causes of ectropion. Over time, the muscles, tendons and other supporting tissues around the lower eyelid can weaken and stretch.

As the eyelid becomes increasingly lax, it may begin to sag and turn away from the surface of the eye. This form is known as involutional ectropion.

Scarring and Skin Changes

Scarring or contraction of the skin around the eyelid can pull it outwards. This may occur following an injury, burn, skin condition or previous surgery.

The resulting tension can prevent the eyelid from resting normally against the eye and is known as cicatricial ectropion.

Facial Nerve Paralysis

The facial nerve controls muscles involved in eyelid movement and closure. Weakness or paralysis affecting this nerve can therefore reduce the support needed to maintain normal eyelid position.

This can occur with conditions such as Bell’s palsy and may lead to paralytic ectropion, sometimes alongside difficulty closing the affected eye completely.

Other Causes

Less commonly, ectropion can be caused by a lesion or mass that physically pulls the eyelid away from the eye. This is known as mechanical ectropion.

Rare congenital forms may be present from birth. Ectropion can also develop following eyelid surgery, including blepharoplasty, particularly where structural changes or scarring affect the position of the lower eyelid.

What Are the Different Types of Ectropion?

Ectropion can be classified according to the underlying reason the eyelid has turned outwards.

TypeDescription
Involutional EctropionAge-related ectropion caused by weakening and stretching of the eyelid’s supporting tissues.
Cicatricial EctropionOutward turning caused by scarring or contraction of the skin surrounding the eyelid.
Paralytic Ectropion
Paralytic EctropionEctropion associated with facial nerve weakness or paralysis.
Mechanical EctropionEyelid malposition caused by a lesion or mass pulling the eyelid outwards.
Congenital EctropionA rare form of ectropion that is present from birth.

Ectropion following blepharoplasty is not generally considered a separate formal type. Instead, it may result from structural changes, scarring or other factors affecting the position and support of the lower eyelid.

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How Is Ectropion Diagnosed?

Ectropion can usually be identified through a specialist examination of the eyelids and eyes. Your specialist will assess the position and laxity of the eyelid, how effectively it closes and the condition of the exposed ocular surface.

Your medical history is also important. Previous eyelid surgery, injuries, scarring or facial nerve problems may help establish why the ectropion has developed.

Determining the underlying cause allows treatment to address the specific factors affecting your eyelid rather than the symptoms alone.

Can Ectropion Cause Complications?

When the eyelid turns outwards, the surface of the eye may become more exposed and the normal protective tear film can be disrupted. Over time, this can result in persistent dryness, irritation and inflammation.

In more severe cases, continued exposure can damage the cornea, potentially causing exposure keratopathy or corneal ulceration.

Not every case of ectropion will lead to these complications. However, persistent symptoms or difficulty protecting and closing the eye should be assessed to reduce the risk of ongoing ocular surface damage.

How Is Ectropion Treated?

Treatment depends on the cause and severity of the ectropion, as well as its effect on the surface of the eye. Management may initially focus on protecting the eye and relieving symptoms, while surgery can be used to correct persistent structural eyelid malposition.

Non-Surgical Treatment

Lubricating eye drops and ointments can help relieve dryness and protect the exposed surface of the eye. Additional protective measures may also be recommended where eyelid closure is impaired.

Conservative treatment can be particularly useful for controlling symptoms or protecting the eye while the underlying condition is being assessed. However, when ectropion results from structural changes to the eyelid, these measures generally do not permanently restore its normal position.

Ectropion Surgery

Surgery may be recommended when the eyelid remains turned outwards, symptoms persist, or the ocular surface is inadequately protected.

The procedure is tailored to the underlying cause of the ectropion. Treatment may involve tightening the lower eyelid or using reconstructive techniques where scarring, tissue shortage or other structural changes are contributing to the problem.

For more information about the surgical approaches available, visit our Ectropion Surgery treatment page.

FAQ

Can Ectropion Go Away on Its Own?

Whether ectropion can improve without surgery depends on its cause. Structural ectropion caused by age-related tissue laxity or scarring is unlikely to permanently correct itself.

Temporary or changing eyelid weakness, such as that associated with some facial nerve conditions, may behave differently. A specialist assessment can identify the cause and determine whether conservative management or surgery is appropriate.

Is Ectropion a Serious Eye Condition?

Ectropion is not always serious, particularly when symptoms are mild. However, persistent exposure of the eye can cause dryness and irritation and, in more severe cases, damage to the cornea.

Treatment is therefore aimed not only at improving eyelid position but also at maintaining a healthy and protected ocular surface.

Can Ectropion Affect Both Eyes?

Yes. Ectropion can affect one or both eyes. The pattern may vary depending on the underlying cause, with age-related changes potentially affecting both lower eyelids.

Is Ectropion the Same as Entropion?

No. The two conditions affect eyelid position in opposite directions. With ectropion, the eyelid turns outwards, while with entropion, it turns inwards towards the eye.

Both can cause irritation and affect the ocular surface, but their symptoms and treatment approaches differ. Learn more in our guide to Entropion vs Ectropion.

Can Ectropion Develop After Blepharoplasty?

Yes. Ectropion can occasionally develop following lower eyelid surgery, including blepharoplasty. Changes in eyelid support, tissue position or scarring may cause the lower eyelid to pull away from the eye.

Treatment depends on the underlying problem and its severity. More complex cases may require corrective eyelid surgery to restore the position and function of the lower eyelid.

Learn more about Revision Blepharoplasty and how problems following previous eyelid surgery can be assessed and treated.

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