When the lower lid turns outward
Ectropion is the outward turning, or eversion, of the lower eyelid margin. Instead of resting flush against the eye, the lid hangs away from it, exposing the pink inner surface of the conjunctiva. This creates two problems simultaneously.
First, the punctum, the small drainage opening at the inner corner of the lid, is pulled away from the eye surface. Tears can no longer enter the drainage system efficiently, and they overflow onto the cheek. Second, the exposed conjunctiva and eye surface are no longer protected by the normal blink mechanism, leading to dryness, irritation, and reflex tearing.
The result is a persistently watery eye, often with redness and discomfort, and a visible change in the appearance of the lower eyelid.
Ectropion is one of the conditions I see most commonly in oculoplastic clinic. It is almost always correctable with a straightforward procedure, and the improvement in symptoms is typically immediate and dramatic. Many patients are surprised that something so treatable had been causing difficulties for so long.
What causes ectropion?
In the vast majority of cases, ectropion develops as a consequence of age-related laxity of the eyelid tissues. The lower lid is held in position by a series of ligaments and tendons that naturally become less taut with time. As laxity develops, the weight of the lid causes it to sag outward.
Less commonly, ectropion results from scarring of the skin below the eyelid (cicatricial ectropion), caused by previous surgery, radiation therapy, or chronic skin conditions, or from weakness of the facial nerve (paralytic ectropion).
How ectropion causes a watery eye
When the lower lid turns inward
Entropion is the inward turning of the lower eyelid, causing the eyelashes to rub against the surface of the eye with every blink. This is a more immediately symptomatic condition than ectropion. The constant abrasion of the lashes against the cornea and conjunctiva causes significant discomfort, a gritty or scratchy sensation, redness, and reflex watering.
In chronic or severe cases, the repeated trauma from the lashes can cause corneal scarring, which carries implications for vision. Entropion should be treated promptly once diagnosed.
What causes entropion?
The most common cause is the gradual laxity that comes with age. As the eyelid tissues lose their tension, the lid is no longer firm enough to resist the inward pull of the muscle that closes the eye. With each blink, that muscle overrides the weakened lid margin and rolls the lashes inward. At first this may come and go, but over months the position can become fixed, and the eyelid stays turned in permanently.
How entropion causes irritation to the eye and reflex tearing
Key differences at a glance
- Ectropion: lid turns outward, punctum displaced, overflow tearing and dryness
- Entropion: lid turns inward, lashes scratch the eye, gritty discomfort and reflex tearing
- Both are age-related in most cases, and both are reliably corrected by surgery
Both conditions are reliably corrected by surgery
Ectropion and entropion are effectively corrected by surgery. The procedures are usually performed under local anaesthetic as a day case, with no overnight stay required.
Ectropion repair
The most common procedure for involutional ectropion is a lateral tarsal strip, in which the outer corner of the lower eyelid is tightened and re-anchored to the bony orbital rim. This restores the correct position of the lid and punctum, allowing normal tear drainage to resume. The procedure takes around thirty minutes and leaves a small, well-concealed scar at the outer corner of the eye.
Entropion repair
Several surgical approaches exist for entropion, depending on the underlying mechanism. The most commonly performed procedure addresses both the lid laxity and the muscle overriding, restoring the normal position of the lid margin and eliminating lash contact with the eye. The symptomatic improvement is usually immediate.
Temporary measures while awaiting surgery
For patients awaiting surgical correction, several measures can help manage symptoms in the interim: taping the lower lid gently into position using micropore tape, lubricating drops and ointment to protect the eye surface, and in some cases botulinum toxin injection into the orbicularis muscle to temporarily correct entropion.
- Visible change in the position of the lower eyelid
- Persistent gritty discomfort, redness, or sensitivity to light
- Watery eye that does not settle
Common questions
Can ectropion cause a permanently watery eye?
Yes. When the punctum is pulled away from the eye surface, tears cannot enter the drainage system, and they overflow instead. This produces a persistently watery eye that typically does not improve without treatment. Surgical correction restores the lid position and usually resolves the watering promptly.
Is entropion dangerous?
If left untreated for a long time, yes. Repeated scratching of the cornea by the misdirected lashes can cause corneal scarring, which may affect vision. Entropion should be assessed and treated promptly. In the short term it is uncomfortable rather than dangerous, but delay carries real risk over time.
What does ectropion look like?
The lower eyelid appears to hang away from the eye rather than resting against it. The pink inner surface of the lid, normally hidden, becomes visible. The eye may look red and watery, and the lower lid may look puffy or drooping. The change is usually gradual and may be subtle in early stages.
Can these conditions be treated without surgery?
Temporarily, yes. Lid taping, lubricating drops, and botulinum toxin can provide symptomatic relief. However, they do not correct the underlying lid laxity. For patients with significant symptoms or corneal involvement, surgery is the appropriate long-term solution.
See it explained
These short animations show exactly what happens in ectropion and entropion, and why each causes a watery eye.
Ectropion and watery eyes
Entropion and watery eyes
Not sure whether a lid problem is causing your watery eye?
Use the Watery Eyes ToolLast medically reviewed: May 2026
This page is written for general educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. If you have concerns about your eye health, please consult a qualified healthcare professional. In an emergency, contact your nearest urgent eye care service or emergency department.
