# Ectropion (outward-turning eyelid) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Ectropion - StatPearls (NCBI Bookshelf NBK441929) - https://www.ncbi.nlm.nih.gov/books/NBK441929/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FD99.00 - condition scope only, no dose · Hypromellose ophthalmic solution, US over-the-counter label, Directions (DailyMed SetID 00da365d-2988-9c9e-e063-6294a90a8931) · Viscotears Liquid Gel Eye drops (carbomer) SmPC sections 4.1 and 4.2 (eMC product 2310) · Hypromellose ophthalmic solution (Vista Gonio Eye Lubricant), US over-the-counter label, Directions (DailyMed SetID 00da365d-2988-9c9e-e063-6294a90a8931) - instil 1 or 2 drops in the affected eye(s) as needed. · Viscotears Liquid Gel Eye drops (carbomer) SmPC section 4.2 (eMC product 2310) - adults, 1 drop 3 to 4 times daily or as required depending on severity. Section 4.1 gives the indication as a tear-fluid substitute for dry eye conditions and for an unstable tear film. - Verified date: 2026-08 ## Verified against - Hypromellose ophthalmic solution, US over-the-counter label, Directions (DailyMed SetID 00da365d-2988-9c9e-e063-6294a90a8931) - Viscotears Liquid Gel Eye drops (carbomer) SmPC sections 4.1 and 4.2 (eMC product 2310) - Hypromellose ophthalmic solution (Vista Gonio Eye Lubricant), US over-the-counter label, Directions (DailyMed SetID 00da365d-2988-9c9e-e063-6294a90a8931) - instil 1 or 2 drops in the affected eye(s) as needed. - Viscotears Liquid Gel Eye drops (carbomer) SmPC section 4.2 (eMC product 2310) - adults, 1 drop 3 to 4 times daily or as required depending on severity. Section 4.1 gives the indication as a tear-fluid substitute for dry eye conditions and for an unstable tear film. ## Treatment metadata - Hypromellose — eye - Carbomer — eye - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text ECTROPION (OUTWARD-TURNING EYELID) Sources: Ectropion - StatPearls (NCBI Bookshelf NBK441929) - https://www.ncbi.nlm.nih.gov/books/NBK441929/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FD99.00 - condition scope only, no dose · Hypromellose ophthalmic solution, US over-the-counter label, Directions (DailyMed SetID 00da365d-2988-9c9e-e063-6294a90a8931) · Viscotears Liquid Gel Eye drops (carbomer) SmPC sections 4.1 and 4.2 (eMC product 2310) · Hypromellose ophthalmic solution (Vista Gonio Eye Lubricant), US over-the-counter label, Directions (DailyMed SetID 00da365d-2988-9c9e-e063-6294a90a8931) - instil 1 or 2 drops in the affected eye(s) as needed. · Viscotears Liquid Gel Eye drops (carbomer) SmPC section 4.2 (eMC product 2310) - adults, 1 drop 3 to 4 times daily or as required depending on severity. Section 4.1 gives the indication as a tear-fluid substitute for dry eye conditions and for an unstable tear film. Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - Patients may report dry eye, eye rubbing, or a sense of eyelid instability [dry eye] - The unprotected eye dries out, and that dryness is what causes the redness, the watering and the feeling of something in the eye [foreign body · redness] SIGNS - what you find (7) - The lower lid margin sits low, normally 1 to 2 mm above the corneal limbus, exposing more cornea than usual - In severe cases the tarsal conjunctiva is visible along with chronic conjunctivitis and keratinization - Exposure keratopathy can leave the cornea dry with punctate erosions or ulceration [corneal changes] - Lid laxity is assessed with a distraction test - pulling the lower lid down and out - A snap-back test times how long the lid takes to return against the eye after being pulled down - The eyelid margin turns outward, and it is usually the lower lid - Red flag: at the extreme the cornea takes punctate epithelial erosions, then ulceration, then permanent loss of vision [loss of vision] IF NOT THIS - what else fits (5) - Basal cell carcinoma - Bell palsy - Floppy eyelid syndrome - Ichthyosis is on the differential - Squamous cell carcinoma of the eyelid Source StatPearls "Ectropion" - disease-level clinical article Status traced to the source above Rx: Artificial tears through the day | Thicker gel at night, when tears run out too fast | Main treatment ARTIFICIAL TEARS THROUGH THE DAY 1. HYPROMELLOSE [1st line] Adult 1 or 2 drops into the affected eye as needed, used freely rather than sparingly - Continuously, until the lid is surgically repaired Peds 1 or 2 drops as needed, the same as an adult. Ectropion in a child is usually cicatricial or congenital rather than age-related, and goes to oculoplastics early. Source Hypromellose ophthalmic solution (Vista Gonio Eye Lubricant), US over-the-counter label, Directions (DailyMed SetID 00da365d-2988-9c9e-e063-6294a90a8931) - instil 1 or 2 drops in the affected eye(s) as needed. Why With the lid margin turned outward the globe is no longer protected and the surface dries, and the article puts punctate erosions, ulceration and permanent vision loss at the end of that road. Its management begins almost always with lubrication using artificial tears, gels and ointments, with surgical repair for the lid itself. Four hypromellose products are marketed in Egypt. Caution Lubrication protects the cornea; it does not correct the lid. The article expects surgical repair to be needed for lasting protection. A facial palsy is the urgent version of this: the article warns that with the eye already compromised the cornea can decompensate quickly and scar, so that combination needs an ophthalmology opinion now rather than a routine referral. Reduced vision, a painful red eye or a visible corneal opacity means exposure keratopathy or ulceration, and is a same-day referral. Egypt HYDROBLEND 0.32% EYE DROPS 10*0.5 ML SDU GLOBAL ADVANCED PHARMACEUTICALS... 15.00 EGP GENTEAL EYE DROPS 10 ML NOVARTIS > NO... 18.00 EGP OPTILUBRIC 0.32% EYE DROPS 30*0.5 ML SDU EVA PHARMA 96.00 EGP HYDROBLEND 0.32% EYE DROPS 30*0.5 ML SDU GLOBAL ADVANCED PHARMACEUTICALS... 108.00 EGP THICKER GEL AT NIGHT, WHEN TEARS RUN OUT TOO FAST 2. CARBOMER [1st line] Adult 1 drop of the eye gel into the affected eye 3 to 4 times daily, or as required by how severe the drying is - Continuously, until the lid is surgically repaired Peds The label states that use at the adult schedule in children and adolescents rests on clinical experience, with no trial data available. Source Viscotears Liquid Gel Eye drops (carbomer) SmPC section 4.2 (eMC product 2310) - adults, 1 drop 3 to 4 times daily or as required depending on severity. Section 4.1 gives the indication as a tear-fluid substitute for dry eye conditions and for an unstable tear film. Why The article's lubrication is not only drops: it names artificial tears, gels and ointments together, because a watery drop drains away from an everted lid within minutes. A gel stays on the surface longer and is what covers the overnight hours, when the exposed cornea is at most risk. Three carbomer eye gels are marketed in Egypt. Caution A gel blurs vision for a few minutes after instillation, so it suits bedtime better than driving. Do not let the container tip touch the eye or any surface - the label warns this both injures the eye and contaminates the gel. Discard four weeks after first opening. Gel and drops complement each other rather than replace each other: drops through the day, gel overnight. Egypt VIDISEC EYE GEL 10 GM MINA PHARM > ... 13.20 EGP THILOTEARS 3 MG EYE GEL 10 GM ALCON > NOVAR... 19.20 EGP OCCUPLUS EYE GEL DROPS 20 X 0.6ML SDU COC Farmaceutici > RX HEALTHCARE 300.00 EGP MAIN TREATMENT 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Outward eversion of the eyelid margin, most often age-related, exposing the eye surface. A GP can offer lubricant drops/ointment to protect the exposed cornea while the patient awaits referral for surgical correction. - Refer, with advice Peds The drug rows above are instilled, not dosed by weight. The referral threshold and the safety-netting are the same at any age. Source No dose - referral pathway, no medicine given in primary care Why Outward eversion of the eyelid margin, most often age-related, exposing the eye surface. A GP can offer lubricant drops/ointment to protect the exposed cornea while the patient awaits referral for surgical correction. Caution The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral. RED FLAG - Corneal exposure with pain, redness or discharge risks exposure keratopathy or corneal ulceration: refer urgently. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)