Ectropion Surgery: When You Need It, How It Works and Recovery
Ectropion surgery returns a lower eyelid that has turned outward back against the eye. The method depends on the cause, such as tightening a lid that has loosened with age or releasing a scar. Most cases use local anesthesia, stitches come out in about 7–14 days, and surgery is considered when symptoms disrupt daily life or threaten the cornea.
By Assoc. Prof. Dr. Preamjit Saonanon, oculoplastic ophthalmologist
What is ectropion?
Ectropion is when the edge of the lower eyelid turns away from the eye, so the pink inner lining shows. It is most common in older adults. The lower lid normally works like the rim of a basin, holding tears on the eye and guiding them to the tear duct. When that rim tips outward, tears spill onto the cheek while the eye itself dries out. Many people are puzzled that their eyes feel dry yet water all day.
Common symptoms are irritation, watering, redness and sensitivity to light and wind. Ectropion is different from entropion, where the lid turns inward and the lashes rub the eye.
What causes ectropion?
Aging: the tendons and muscle of the lower lid loosen. This is a common cause.
Scarring: scars or tight skin pull the lid down, for example after an injury, a burn or eyelid surgery.
Facial palsy: the muscles around the eye no longer support the lid.
Eyelid lumps: a growth weighs the lid down.
From birth: this is uncommon.
When do you need ectropion surgery?
For mild cases, artificial tears and a lubricating gel at bedtime can ease irritation, but they do not put the eyelid back in place. I consider surgery when:
irritation or watering disrupts daily life
the eye keeps getting red or inflamed
you cannot close your eye fully, or the cornea is drying out and developing sores
eye drops are no longer helping
If facial palsy may still recover, I may protect the eye surface and wait first.
How is ectropion surgery done?
Before surgery I check how loose the eyelid is, any scarring and how much skin there is, how well the eye closes, and the surface of the cornea. The method depends on the cause, so there is no single recipe. See our services.
Tightening a loose eyelid
This is used when the lid has loosened with age. I tighten the lid from the outer corner of the eye and reattach it to the tissue on the eye socket bone. This is called a lateral tarsal strip, and it brings the lid back against the eye.
Releasing a scar and adding skin
If a scar is the cause, I release the tight tissue pulling on the lid. If there is not enough skin, it may be added from another area, such as the upper eyelid or behind the ear.
Adding tissue inside the eyelid
In some people the tissue inside the eyelid has shrunk or is not enough. I may add support with a tarsal graft, or with a conjunctival graft taken from the lining of the eye. At Saonanon Clinic we perform lateral tarsal strip, tarsal graft and conjunctival graft for both entropion and ectropion, chosen according to each person's examination.
Treating an eyelid affected by facial palsy
This often means tightening the lid along with other methods that help the eye close better. The plan depends on how the nerve is recovering.
How should you prepare for surgery?
Tell me about every medicine you take. If you take blood thinners, do not stop them on your own. Ask your doctor first.
Tell me about any drug allergies and past eye surgery.
Skip eye makeup on the day of surgery.
Arrange for someone to take you home.
How long is ectropion surgery recovery?
Stitches usually come out in about 7–14 days, and bruising and swelling settle in about 7–14 days. In the early days, use cold compresses, sleep with your head raised, avoid rubbing your eyes and use your medicines as prescribed.
Surgery carries risks, such as bruising, infection, scarring, uneven eyelids or the lid turning outward again. Some people need further surgery. Results vary from person to person.
When should you see a doctor urgently?
See a doctor right away if you have severe eye pain, a very red eye, blurred vision, a swollen red wound with pus, or bleeding that does not stop. A cornea that stays dry for a long time can develop sores that affect your vision.
Frequently asked questions
Can ectropion go away on its own?
If it comes from short-term swelling, it may improve on its own. If it comes from age-related looseness or scarring, it usually will not. Artificial tears ease symptoms but do not correct the position of the eyelid.
Is ectropion surgery painful?
Most cases use local anesthesia. You will feel a sting during the injection and may feel tugging during surgery. There may be mild pain afterwards, which can be eased with medicine your doctor prescribes.
Can ectropion come back after surgery?
Yes, it can, because tissues keep changing with age and scars can tighten again. Some people need further surgery. The chance differs according to the cause.
Book a consultation with Assoc. Prof. Dr. Preamjit Saonanon in Thong Lo, Bangkok
Hours: Thursday 16:00–20:00 and Saturday 09:00–20:00
This article is general information and does not replace a medical examination. Results vary from person to person.
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