That annoying, constant tearing that runs down your cheek even when you're not crying. The constant redness, irritation, and gritty feeling in your lower eyelid. Many people with ectropion, a common condition where the lower eyelid droops and turns outward, live this way every day. A minor surgery is usually the best way to fix the problem, but you need a primary care partner who is willing to help you manage your symptoms, keep your eye healthy, and coordinate your care. Direct Primary Care (DPC) is the best place to get medical care because it is a supportive home.
Ectropion is a condition in which the lower eyelid turns away from the eyeball. Most of the time, this happens because the eyelid tissues naturally relax and stretch as you get older. It can also be caused by a skin condition, facial nerve palsy, or scarring from a previous injury.
The Annoying Symptoms: When the eyelid turns out, it causes two main problems:
The air can get to the sensitive inner surface of your eyelid (the conjunctiva) and the surface of your eye (the cornea). This makes them red, dry, and irritated.
Excessive Tearing (Epiphora): This is a classic sign. The lid's outward turn pulls the punctum, which is the small tear duct opening, away from the eyeball. This means that your tears have nowhere to go, so they just run down your cheek, even though your eye feels dry.
The Purpose of Management: The first thing to do is protect the surface of the eye and ease your symptoms. A small surgery to fix the eyelid's position is usually the long-term goal for a permanent solution.
Disclaimer: DPC doctors don't do the surgery to fix ectropion. An ophthalmologist or an oculoplastic surgeon does that. DPC's most important job is to give you first-line support and help you find your way to the right treatment. Here's why DPC is the best place to start for this problem:
A quick diagnosis and immediate relief from symptoms: You want to be seen right away when your eye is red, watery, and itchy.
Quick Access: DPC's same-day or next-day appointments let you get your eye problem looked at right away.
A Plan That Is Quick and Clear: Your DPC doctor can quickly figure out if you have ectropion and, most importantly, start you on a supportive care plan that same day to protect your eye and make you feel much better. This keeps you from having to wait a long time for an appointment with a specialist.
Expert management of conservative treatments: Your DPC doctor is like a coach for how to take care of yourself at home.
They have time to show you how to use lubricating artificial tears during the day and lubricating ointments at night to keep the surface of your eyes healthy and comfortable.
Simple but useful tips like how to tape the outside corner of your eyelid up and in at night to keep your eye safe while you sleep.
A timely and well-planned referral: Your DPC doctor will help you find the right solution when you're ready.
They can help you get a quick, easy referral to a trusted eye doctor or oculoplastic surgeon for a surgical evaluation.
They are your main medical office, taking care of all your other health needs and talking directly to the specialist team before and after your procedure to make sure your care is coordinated.
Case 1: David, 80, goes to his DPC doctor because his right eye is always watering and red. The doctor says that the ectropion is caused by age. During that same visit, the doctor gives him preservative-free lubricating eye drops, shows his wife how to put a protective ointment on his eye at night, and sends him to an oculoplastic surgeon for a consultation, which David sets up for the next month. While he waits for his specialist visit, the supportive care makes him feel a lot better.
Case 2: Linda, 68, has a sudden case of Bell's palsy that causes her to develop a paralytic ectropion. Her DPC doctor sees her right away and makes a full "eye protection plan" to keep her cornea from getting hurt while the nerve palsy heals. This means giving her artificial tears often, taping her eye shut at night, and quickly sending her to an eye doctor to make sure her cornea stays safe and healthy while she heals.
Q: Why do my eyes water so much if the problem is dryness? A: This is the strange thing about ectropion. It is true that the surface of your eye is dry because it is in the air. That dryness makes your tear gland make a lot of "emergency" tears. But because your lower eyelid and tear duct are turned out, the tears can't drain properly, so they just run down your cheek.
Q: Is it possible to fix this without surgery? A: The supportive measures, such as lubricating drops, ointments, and taping, can make you feel a lot better and keep your eyes healthy, but they don't fix the problem of the loose eyelid. A small surgery is the only way to permanently fix severe ectropion.
Q: Who does the surgery to fix an ectropion? A: An ophthalmologist (a medical doctor and surgeon who specializes in eyes) usually does the surgery, especially one who has advanced fellowship training in oculoplastics (plastic and reconstructive surgery around the eyes). Your DPC doctor can help you choose the right specialist.
DPC has a clear advantage for this common and annoying condition because it:
Giving quick relief from symptoms: DPC's quick access lets you get a diagnosis right away and start a care plan that protects your eye and makes you more comfortable while you wait for a permanent fix.
Being great at teaching and coaching patients: The DPC model gives you time to learn how to use lubricants and tape to control your symptoms.
Giving care that is well-organized and effective: Being the main point of contact for managing the condition and making sure that the patient is referred to the right surgeon at the right time.
An ectropion can cause an eye to water all the time, turn red, and feel irritated, which can be very annoying. You need a medical partner who can help you right away and help you find a long-term solution. Direct Primary Care gives you the responsive, supportive care and expert coordination you need to keep your eyes healthy and help you find long-term relief.
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