Ectropion is a condition in which the eyelid turns outward away from the eye and the conjunctiva is often exposed to varying degrees, often in combination with incomplete lid closure, more commonly in the lower lid than in the upper lid. In the milder cases, the posterior lip of the lid margin leaves the eye, and in the more severe cases, the lid conjunctiva is exposed and the eyelid is even incompletely closed. Ectropion can be classified as scarring, paralytic, senile, or spastic depending on the cause of the ectropion. Chronic conjunctivitis occurs when the lid conjunctiva is exposed for a long time after ectropion, resulting in increased secretions and a dry, hypertrophic and congested conjunctiva. What are the causes of bilateral lid ectropion? 1. Primary orbicularis oculi spasm: This is a spastic contraction of the orbicularis oculi muscle that causes the eyelids to close involuntarily, often bilaterally, and progresses progressively. 2/3 are female and most develop over the age of 60. Its etiology is unknown. The frequency and duration of the spasms vary. In mild cases, the orbicularis oculi muscle has paroxysmal, frequent small twitches that do not affect eye opening; in severe cases, the twitches are so pronounced that eye opening is difficult, affecting vision and causing functional blindness. 2. Hemifacial spasm: It is a unilateral lesion involving periodic tonic contraction of the facial muscles. The spasm usually starts from the orbicularis oculi muscle and gradually expands to other parts of the area, and can occur during sleep or waking hours. It often starts in middle age and is more common in women. It may be accompanied by unilateral lateral muscle weakness. 3. Eyelid incomplete closure: This is a condition in which the upper and lower eyelids do not close completely, resulting in partial exposure of the eyeball, also known as lagophthalmus. The most common cause of incomplete eyelid closure is facial nerve palsy, followed by scarring lid ectropion. In addition, incomplete eyelid closure can occur when the orbital volume is out of proportion to the size of the eye, during general anesthesia or in severe coma.