Ectropion & Entropion
(Eyelid Malposition)

When an eyelid no longer sits properly against the eye, it can turn outward (ectropion) or inward (entropion). Both are most common on the lower lid, become more frequent with age, and can irritate or damage the surface of the eye. At Belaray Dermatology, eyelid malposition is evaluated and repaired by Dr. Rachel Ellis, a board-certified ophthalmologist and fellowship-trained oculoplastic and reconstructive surgeon in Hicksville, Long Island.

Ectropion (Out-Turned Eyelid)

In ectropion, the lower eyelid sags away from the eye. Because the drainage opening is pulled away from the surface, the eye often waters and becomes exposed.

• Common causes: Age-related tissue and tendon laxity (most common), facial-nerve weakness, scarring of the skin below the eye (including after skin cancer surgery or sun damage), and prior eyelid surgery.
• Symptoms: Watery eyes, irritation and redness, dryness from exposure, and a visibly drooping or everted lower lid.

Entropion (In-Turned Eyelid)

In entropion, the eyelid rolls inward and the lashes and lid skin rub against the cornea and conjunctiva.

• Common causes: Age-related muscle and tendon changes (most common), scarring on the inner surface of the lid, and spasm of the eyelid muscles.
• Symptoms: A feeling of something in the eye, redness, tearing, sensitivity to light, and irritation from lashes rubbing the eye (trichiasis). Untreated, it can scratch and scar the cornea.

Eyelid Malposition After Skin Cancer Surgery

Skin cancer and its removal near the lower eyelid — and the scarring that can follow — sometimes pull the lid out of position. At Belaray, when skin cancer is removed near the eye, the Mohs surgeon performs the tumor removal and Dr. Ellis performs the eyelid reconstruction, so lid position and function are restored as part of the repair. See Mohs surgery near the eye.

How It Is Repaired

After examining the eyelid’s tone, tendons, skin, and inner lining, Dr. Ellis selects the repair that addresses the specific cause — most often tightening a lax lower lid and, when needed, releasing scar tissue or adding support so the lid rests correctly against the eye. Most repairs are short outpatient procedures performed under local anesthesia. Lubrication and protective measures are used in the meantime to keep the eye comfortable.

Recovery

• Days 1–3: Bruising and swelling peak; cold compresses help.
• Week 1: Sutures are typically removed around 5–7 days; symptoms of irritation and tearing usually improve quickly.
• Weeks 2–4: Return to normal activity as swelling settles.

Frequently Asked Questions

What is the difference between ectropion and entropion?

Ectropion is an eyelid that turns outward, away from the eye, causing watering, exposure, and irritation. Entropion is an eyelid that turns inward, so the lashes rub against the eye, causing a foreign-body sensation, redness, and potential corneal damage. Both are most common on the lower lid and both are correctable with surgery.

What causes an eyelid to turn in or out?

The most common cause of both ectropion and entropion is age-related laxity of the muscles and tendons that hold the eyelid against the eye. Other causes include facial-nerve weakness, scarring of the eyelid skin or inner lining (including after skin cancer surgery or sun damage), and prior eyelid surgery.

Is eyelid malposition surgery covered by insurance?

Ectropion and entropion repair are functional procedures that protect the eye surface and relieve symptoms, and they are generally covered by insurance as medically necessary. Belaray verifies coverage before scheduling.

Can skin cancer surgery near the eye cause an eyelid to turn out?

Yes. Skin cancer near the lower eyelid, and the scarring after its removal, can pull the lid out of position (cicatricial ectropion). At Belaray, the Mohs surgeon removes the cancer and Dr. Rachel Ellis reconstructs the eyelid, restoring its position and function as part of the same care.