Ectropion is more common in patients with lower lid laxity. Patients who have scleral show (more white of the eye showing) or a negative vector in which the cheek bone is slightly behind the bony orbital rim have a higher risk of ectropion. During a physical exam, if the patient shows poor tone of the lower lid during a distraction test or the lid retraction test (snap back), they are more prone to develop an ectropion.