Eyelid Ectropion and Entropion: Causes, Symptoms, and Surgical Repair

Are you interested in learning about the difference between an ectropion and entropion? Truth be told, both are conditions that almost always affect the lower eyelids, but can at times affect the upper eyelids too.

In this article, Dr. Paul Johnson highlights the difference between an ectropion and entropion, including causes, symptoms, and surgical repair.

Ectropion vs entropion

The difference between an ectropion and entropion is simple. Ectropion occurs when the eyelid turns outward. This can cause tearing and irritation. On the other hand, entropion occurs when the eyelid turns inward. This can cause pain as the eyelashes rub against the surface of the eye.

These conditions are most commonly seen as we get older. In fact, wear and tear throughout the years leads to a loosening of the support structures of the eyelids. This can then cause the eyelid to turn inward or outward, depending on the strength of the major muscle of the eyelid known as the orbicularis oculi.


Other causes of ectropion and entropion include congenital causes (meaning the patient has the condition at birth) and causes due to scarring (which includes chronic exposure to UV light, trauma, and certain autoimmune conditions).

Ectropion can also be caused by facial palsy, which is commonly referred to as Bell’s Palsy.

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Entropion before and after
Entropion – before (top) and after (bottom)

Diagnosis and treatment options

If you think you might be suffering from one of these conditions, it’s best to seek the care of your trusted eye care professional. This individual can help diagnose the problem and may refer you to an oculoplastic surgeon for surgical treatment.

Surgical repair is the only permanent treatment option for both ectropion and entropion. For cases due to aging, these procedures can usually be performed in the office. However, for more complicated cases, like those mentioned earlier, the procedure may involve the use of graphs and is best performed under anesthesia.

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Ectropion and entropion surgical repair

Next, let’s talk about ectropion and entropion repair. As mentioned earlier, these procedures can usually be performed in your doctor’s office as a same-day procedure.

First, a numbing injection, similar to what you might receive at the dentist, is performed on the affected eyelid. Next, an incision is made at the outer corner of the eye which will allow the surgeon to tighten the lower eyelid by shortening it and placing dissolvable stitches. Keep in mind, additional stitches may be placed at the center or inner part of the eyelid as needed.

After the procedure, the patient may experience some soreness in the outer corner of the eye for a few days. This can usually be controlled with over the counter pain medications, such as acetaminophen.

Unfortunately, patients undergoing repair are usually out of commission the day of the procedure and the day after. After that, they can return to normal life but should avoid exercise and heavy lifting for about a week.

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Ectropion before and after
Ectropion – before (top) and after (bottom)

Risks and complications

It’s important to keep in mind that the area surgically repaired will bruise and swell. Fortunately, his can be covered with sunglasses and makeup.

Risks of surgery include bleeding and infection, which is similar to anytime you have surgery on the body. Also, there is a 1 in 10,000 chance the patient could lose vision from the surgery. Honestly, it’s probably riskier crossing the street but we do it.

Finally, there is about a 5% chance that the patient may need a revision down the road. However, the vast majority of patients who undergo these treatments report greatly improved quality of life after having them done.

RELATED: Treatment Options For Excessive Tearing (Including Surgery)


In the end, ectropion and entropion is something I commonly see in my office and is often a fact of life. Fortunately, surgical outcomes are fantastic (both functionally and cosmetically). If you have any further questions about these eyelid conditions, comment below or make an appointment with your local eye care professional today!

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Dr. Paul Johnson is a board-certified ophthalmologist with subspecialty training in cosmetic and reconstructive oculoplastic surgery. He performs facial rejuvenation procedures including upper and lower eyelid blepharoplasty (eyelid lift/contouring), brow lifts, Botox injections, soft tissue fillers (Radiesse/Juvederm/Restylane), and chemical peels with meticulous attention to detail. Dr. Johnson is also skilled in reconstructive oculoplastics including ptosis repair, excision, and reconstruction of eyelid skin cancer, orbital decompression surgery, repair of orbital fractures, eye socket reconstruction, management of facial nerve paralysis (Bell’s palsy), blocked tear duct repair (dacryocystorhinostomy), ectropion and entropion repair, management of thyroid eye disease, enucleation and evisceration surgery, and the repair of orbital, eyelid, and tear duct trauma. He attended Johns Hopkins University and Jefferson Medical College. He completed his ophthalmology residency at the prestigious New York Eye & Ear Infirmary, and his oculoplastics fellowship at the top-rated Wills Eye Institute. He has authored multiple publications and has been actively involved in teaching future ophthalmologists at both New York Eye & Ear and Wills Eye Institute.