Entropion and Ectropion

Entropion means the eyelid (usually the lower lid) turns inward so the lashes rub the eye. Ectropion means the eyelid droops outward and no longer hugs the eye. Both disturb the tear film that keeps the eye moist and clear. This can cause redness, tearing, light sensitivity, and—in advanced cases—scratches or infection of the cornea that threaten vision. 1 2

Common contributors include age-related tissue loosening, scarring, prior surgery or injuries, nerve problems (like facial nerve palsy), masses, and rare birth differences.

Entropion symptoms may include:

• Scratchy or gritty feeling, watering, and redness.
• Pain from lashes rubbing the cornea.
• Sometimes blurred vision if the cornea gets irritated or scarred. 1

Ectropion symptoms may include:

• Dryness with constant tearing (tears cannot drain).
• Burning or stinging, crusting on lashes, and light sensitivity.
• A feeling of something in the eye.

Urgent tip: Call your eye doctor the same day if you have sudden pain, pus-like discharge, or a sharp drop in vision, as these can signal corneal injury that needs quick care. 4

Several things can push the lid in or out of position:

• Aging changes (most common): tendons and muscles that hold the lid in place loosen over time. 3
• Scarring or inflammation: burns, trauma, surgery, or long-standing eyelid skin disease can tighten or pull the lid edge the wrong way. 2
• Facial nerve weakness: e.g., Bell’s palsy reduces muscle tone so the lid sags outward.
• Masses or heavy tissue: a growth or swelling can weigh the lid down.
• Congenital variants: present from birth but less common.

Risk is higher with age, prior eyelid surgery or injuries, chronic eyelid inflammation (blepharitis), and frequent eye rubbing.

A full eye exam is usually enough to make the diagnosis. Your clinician will:

• Look closely at lid position, lash direction, and the lining of the eyelid (conjunctiva).
• Do gentle snap-back and distraction tests to check lid looseness. 1
• Examine the cornea with a slit-lamp microscope to find any scratches or ulcers.
• Review your history for scarring, skin problems, or nerve issues; if scarring disease is suspected, special tests may be ordered.
• For ectropion, your doctor may pull gently on the lids or ask you to close tightly to check tone; treatment depends on the cause and may include surgery. 6

First-line relief (non-surgical):

• Preservative-free artificial tears by day and lubricating ointment at night to protect the cornea.
• Moisture shields or goggles while sleeping.
• For entropion, a small piece of skin tape can gently roll the lid outward.
• In selected cases, a tiny dose of botulinum toxin can relax the muscle that turns the lid inward for short-term relief while planning surgery. 7 8

Definitive treatment: outpatient eyelid surgery tailored to the cause. Common steps include tightening loose tendons, re-attaching/tightening lower-lid retractors, or adding a small skin graft if tissue is missing from scarring. Surgery usually takes < 1 hour, uses local anesthesia with light sedation, and aims to restore normal lid position to protect the eye. 5

To lower irritation and protect vision:

• Wear wraparound sunglasses and a brimmed hat outdoors to shield wind and sun.
• Treat eyelid inflammation (blepharitis) with warm compresses and lid hygiene as advised.
• Avoid frequent eye rubbing, which can worsen lid laxity.
• Keep follow-up visits—small recurrences are easier to fix early than after corneal damage.

After surgery: sleep with your head raised, use cold compresses, and apply ointments as directed. 6 4

Most people feel quick relief once the eyelid is back in place, and vision is protected when the cornea is no longer exposed or scraped.

What affects cost? Prices vary by surgeon, location, facility type (clinic vs. surgery center), anesthesia, and whether a skin graft or other reconstruction is needed. Most repairs are outpatient with local anesthesia, which can lower facility costs compared with hospital surgery.

When is surgery covered? Repairs for medically necessary problems—like entropion or ectropion causing exposure, tearing, infections, or corneal damage—are typically considered reconstructive and may be covered by insurance or Medicare when medical records and photos support the need. 10 Coverage for purely cosmetic eyelid surgery is usually not approved; policies vary—check your plan details. 9

How to budget & reduce out-of-pocket costs:

• Ask for an itemized estimate that separates surgeon, facility, and anesthesia fees.
• Confirm whether the surgeon and facility are in-network.
• Ask if follow-up visits and stitch removal are part of a global fee.
• Request prior authorization and provide any photos or visual field tests your plan requires.
• Use HSA/FSA funds and ask about payment plans if needed.

If you have persistent tearing, gritty pain, red eyes, or a clearly turned-in or turned-out eyelid, book a visit with a board-certified oculoplastic (eyelid) specialist. They can confirm the cause, protect your cornea, and explain non-surgical and surgical options. 2 1

Scheduling tips:

• You can self-refer or ask your eye doctor for a referral.
• Let the office know if you have pain, discharge, or blurry vision—many clinics hold same-week spots for urgent eyelid problems.
• If waitlists are long, ask about cancellations and being added to a priority list.
• Bring a medication list and any prior eye records or photos.

You can also connect through Kerbside to reach the right specialist for a medical education consult and guidance on next steps. This is for education and planning; it does not create a patient–physician relationship.