Ectropion and entropion are common maladies of the eyelid margin that can directly affect ocular function and patient comfort; surgical repair is commonly performed.
Ectropion (out-turning of the eyelid) can present with keratoconjunctivopathy, infection, and dermatitis, among other signs and symptoms. Tearing is a common presentation, whether the punctum is everted (resulting in a tear outflow problem) or not (as in reflex tearing from irritation and exposure keratoconjunctivopathy). Combined-mechanism tearing is not unusual in these cases.
Ectropion is classified into the following categories on the basis of etiology:
Congenital ectropion - This is due to a developmental vertical foreshortening of anterior lamellar tissue, resulting in eversion of the lid margin
Cicatricial ectropion - This results from vertical foreshortening caused by acquired scarring or inflammation and may coexist with involutional horizontal lengthening of the lid margin due to chronic vertical traction; treatment in these cases is directed at lengthening the lid vertically with midface lifting or skin grafts or flaps; concomitant repair of any horizontal component is similar to repair of involutional ectropion
Mechanical ectropion - This is due to a mass effect on the eyelid (eg, from a tumor), which pulls the lid margin away from the globe; it is managed through treatment of the underlying causative factor (eg, tumor excision)
Involutional ectropion - This is due to horizontal laxity of the eyelid, leading to stretching of the lid or dehiscence of its attachments at the medial or lateral canthus, with resultant out-turning of the lid margin