Why is My Lower Eyelid Droopy?

As we age, our skin and connective tissues that support facial contours begin to loosen. This is a natural consequence of lower levels of collagen and elastin that they hold. Around the eyes, tissue degradation can be exacerbated by smoking, rubbing the eyes a lot, sleeping on one side, trauma, or eye surgery. Sometimes, the loosening of tissue on the lower eyelid can become so severe that the eyelid turns outward. This is referred to as ectropion, a condition that may affect one or both eyes. 

A lower eyelid that is droopy may not hug the surface of the ocular globe, eyeball, as it once did. This exposes the conjunctiva and may result in redness and irritation. Poor eyelid position may also cause corneal irritation. The cornea, situated at the front of the eye, may be at risk of scratching and scarring. The lower eyelids also hold tear ducts and, as the eyelid loosens, the tear duct may turn outward, causing excessive tearing. 

What Causes Ectropion?

Ectropion often has age-related factors that contribute to the loosening of the eyelid. Additional factors include:

• Frequent rubbing during the day or while sleeping
• Skin damage from sun and/or smoking
• Eyelid or facial surgery for cosmetic or functional concerns
• Trauma
• Skin cancer
• Facial nerve palsy

When Should I see a Doctor?

The signs of ectropion include:

• Sagging skin around the eye
• Excessive tearing
• Redness
• Mucus discharge
• Sensitivity to light and wind
• Ocular surface irritation and itching
• Impaired vision

Management and Treatment for Ectropion

An ophthalmologist can provide guidance in the management or treatment of ectropion. Recommendations can be made after a thorough examination of the eyelid and review of symptoms. In mild cases, a person may be advised to use lubricating ointments or artificial tears to maintain moisture on the ocular surface. More severe drooping and exposure of the ocular surface may warrant surgical correction of the affected eyelid.

Treatment to correct ectropion is arranged based on the reason the eyelid is pulling away from the eyeball. When the loss of collagen and elastin is the cause, the ophthalmologist can perform a minor surgery to tighten the tissue of the lower lid to fit against the globe of the eye. This is performed in the office using a local anesthetic. When scarring is the cause of ectropion, the doctor utilizes techniques to stretch the scar tissue to correct eyelid position. 

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