Why Eyelid Position Changes Happen and What You Can Do

Your eyelids help protect the surface of your eyes, spread tears when you blink and maintain eye comfort. However, these functions may be affected when an eyelid turns inwards or outwards.

These types of eyelid position changes can cause discomfort and, in some cases, affect eye health if left unaddressed. Understanding their possible causes and signs can help you recognise when to seek medical advice.

Why Do Eyelids Turn Inward or Outward?

Entropion and ectropion commonly develop when the tissues supporting the eyelids change or weaken. This can occur with age as the muscles and connective tissues around the eyes become looser, causing the eyelids to shift from their normal position.

However, ageing is not the only possible cause. Eyelid position may also be affected by:

• Scarring or previous injury: Scar tissue can pull the eyelid inward or outward.
• Previous surgery: Changes to the tissues surrounding the eye following surgery may sometimes affect eyelid position.
• Facial nerve weakness: Reduced muscle control on one side of the face can contribute to an outward-turning eyelid.
• Inflammation or skin conditions: Changes affecting the skin and tissues around the eyelid may alter its position.
• Congenital factors: Less commonly, an eyelid-position problem may be present from birth.

What Signs Should You Look Out For?

The signs you may notice will depend on the exact position of the eyelid, but there are several common changes and symptoms to look out for.

• Entropion

  Entropion is a condition where the eyelid turns inward, causing the eyelashes and skin to rub against the surface of the eye. Signs of an inward-turning eyelid may include:

  • A feeling that something is in the eye
  • Eyelashes rubbing against the surface of the eye
  • Eye redness or irritation
  • Newly developed sensitivity to light
  • Excessive tearing
  • Discomfort when blinking
    

• Ectropion

  Ectropion is a condition where the eyelid turns outward, leaving part of the eye exposed and potentially affecting normal tear distribution and drainage. Signs of an outward-turning eyelid may include:

  • The lower eyelid sagging or pulling away from the eye
  • Eye dryness
  • Eye irritation or redness
  • Excessive watering due to poor tear drainage
  • Difficulty closing the affected eye completely

How Can Changes in Eyelid Position Affect Eye Health?

An inward- or outward-turning eyelid can interfere with how the surface of the eye is protected and lubricated. The potential effects differ depending on the direction in which the eyelid turns.

With entropion, repeated contact between the eyelashes and the cornea can cause ongoing friction. If left unaddressed, this may damage the corneal surface and, in more severe cases, contribute to corneal abrasions, ulcers or infection.

With ectropion, the eyelid may not adequately protect the eye or distribute tears across its surface. Prolonged exposure can affect the cornea and conjunctiva, potentially increasing the risk of inflammation or surface damage.

These effects may become more pronounced when the eyelid remains out of position for an extended period, particularly if the surface of the eye is repeatedly irritated or exposed. Seek medical attention if you experience increasing pain, marked redness, sensitivity to light or changes in vision.

What Happens During an Eyelid Assessment?

During a consultation, your doctor will usually ask about your symptoms, when you first noticed the change in your eyelid and whether it has worsened over time. You may also be asked about previous eye or facial surgery, injuries and relevant medical conditions.

Your doctor may then examine your eyes and eyelids to assess:

• How the eyelid sits against the eye
• Whether the eyelid turns inward or outward
• How well the eyelids close and function when blinking
• The strength and position of the surrounding eyelid tissues
• Whether there is scarring, tissue laxity or other structural changes
• Whether the surface of the eye shows signs of irritation or corneal damage

Based on these findings, your doctor can determine the possible cause and severity of the eyelid problem and discuss whether monitoring, symptom management or oculoplastic surgery may be appropriate.

What Treatment Options Are Available for Entropion or Ectropion?

Treatment depends on whether you have entropion or ectropion, its underlying cause and how severely it is affecting your eyes. Depending on your condition, treatment may focus on relieving symptoms or correcting the position of the eyelid.

• Relieving Symptoms and Protecting the Eye

  Lubricating eye drops or ointments may be prescribed to help keep the surface of the eye moist and reduce dryness or irritation. In some cases, your doctor may recommend temporarily securing the eyelid in a more suitable position with medical tape.

  These approaches should be used under medical guidance because the appropriate technique differs according to the eyelid problem. They can protect the eye or relieve symptoms, but they do not usually provide permanent structural correction.

• Correcting Entropion

  Surgery may be considered when the eyelashes continue to rub against the eye or there is a risk of damage to the cornea. Entropion repair generally involves tightening or repositioning the tissues that support the eyelid so that its edge and eyelashes no longer turn towards the eye.

  The specific technique will depend on whether the inward turning is related to age-related tissue laxity, muscle changes or scarring. In scar-related cases, treatment may also need to address the tissue pulling the eyelid inwards.

• Correcting Ectropion

  Ectropion surgery aims to return the eyelid to a position where it rests against the eye more effectively. This may improve eyelid closure, tear distribution and tear drainage while reducing exposure of the eye’s surface.

  The procedure may involve tightening weakened eyelid tissues. If the ectropion is caused by scarring, previous surgery or facial nerve weakness, a different surgical approach may be required to address the contributing problem.

Get Your Eyelids Assessed at Eye & Aesthetic Surgeons

Noticing a change in your eyelid position can raise questions about whether treatment is needed and what your next steps should be. A structured consultation with an oculoplastic surgeon can help identify the underlying cause and determine a suitable approach to managing the condition.

At Eye & Aesthetic Surgeons, you can have your concerns evaluated by Ophthalmologist Dr Elaine Chee Wen Ling, who specialises in oculoplastic and reconstructive surgery. Dr Chee takes an individualised approach, considering how the condition affects your eye health, comfort and daily life before discussing the available options with you.

If you have noticed a persistent change in your eyelid position, consider booking an appointment for further evaluation.