What are the treatment options for ectropion?

Treatment for Ectropion

Ectropion requires a stepwise approach starting with ocular lubrication for all patients, progressing to surgical correction when conservative measures fail or when corneal damage is present. 1

Initial Conservative Management

All patients with ectropion should receive ocular lubrication as first-line treatment to protect the ocular surface, maintained long-term if lagophthalmos persists. 1

Topical Lubrication Strategy

• Preservative-free artificial tears are strongly recommended, including carboxymethylcellulose 0.5-1%, carmellose sodium, hyaluronic acid, and petrolatum ointment at night 1
• When tear substitutes are used more than four times daily, nonpreserved formulations are generally recommended 2
• Lipid-containing eye drops are particularly effective when meibomian gland dysfunction coexists 1
• Emulsions, gels, and ointments provide longer-lasting effects due to increased viscosity, though they may blur vision 2

Adjunctive Conservative Measures

• Eyelid emollients and massage can improve lagophthalmos and ectropion based on case reports 1
• For temporary paralytic ectropion with unclear prognosis, adhesive taping (such as Steri-Strips) can provide reversible correction until definitive prognosis is established 3
• Humidifying ambient air and using moisture chamber goggles may decrease ocular discomfort 2

Medical Therapy for Moderate-to-Severe Cases

Oral retinoids are recommended as second-line therapy in combination with topical agents for moderate-to-severe ectropion to reduce severity and prevent further worsening. 1

Important Caveats

• Topical retinoids (tazarotene) may be used for ectropion but are contraindicated during pregnancy 2
• Oral retinoids may induce ophthalmic side effects such as dry eyes, requiring careful monitoring 1
• Topical agents may cause irritation in some patients 1

Surgical Intervention Indications

Surgery is indicated when: 1, 4

• Conservative measures fail to provide adequate relief
• Corneal exposure or epiphora persists despite medical management
• Evidence of keratinization of the palpebral conjunctiva is present
• Superficial punctate keratitis or other corneal damage is documented

Surgical Techniques

• Common techniques include horizontal tightening with lateral tarsal strip or Bick procedure, lateral tarsorraphy, inverting sutures, and sub-orbicularis oculi fat lift 5
• For severe, recurrent, or tarsal ectropion (where much of the tarsal conjunctiva is visible with keratinization), superotemporal skin transposition combined with lateral tarsal strip or Bick procedure is effective 5
• Cicatricial ectropion may require full-thickness skin grafts from suitable donor sites 6
• Post-blepharoplasty ectropion should initially be treated conservatively with massage for up to 6 months; if this fails, horizontal lid-shortening procedures address laxity, while vertical shortening requires release and grafting 7

Bilateral Cases

Patients with documented ectropion of both lower eyelids causing ocular symptoms and corneal damage should undergo bilateral ectropion repair. 4

Follow-up Care

Regular ophthalmic examination is recommended, with frequency varying from monthly to once or twice yearly depending on severity. 1

Assessment Components

• Age-appropriate vision assessment 1
• Slit lamp or portable assessment of the ocular surface 1
• Cycloplegic refraction to exclude significant refractive errors 1

Critical Warning

Delaying treatment of bilateral ectropion with documented corneal damage can lead to progressive corneal epithelial breakdown, increased risk of corneal ulceration, and chronic discomfort. 4 Prompt surgical intervention is required when conservative management fails and corneal damage is present. 4