Eyelids help protect the eyes from foreign bodies while keeping them lubricated. Any alteration in the shape, position or function of your eyelids can predispose your eyes to myriad ailments or interfere with our vision. Our eyelid is a complex structure consisting of three theoretical layers: the anterior layer contains the skin and orbicularis muscle; the middle layer contains the orbital septum and eyelid retractors; the posterior layer contains tarsus and conjunctiva. Eyelid malpositions include any unnatural or incorrect positioning and orientation of eyelids due to various factors that influence any of the three layers of the eyelids. Possible causes include aging, trauma, scarring, birth defects or medical disease involving any or all of the three layers. The most common forms of eyelid malposition are eyelid retraction, ptosis, entropion and ectropion
Types of Eyelid Malpositions
Both upper and lower eyelid malpositions can present problems. Upper eyelid malpositions include upper lid ptosis (drooping down of upper eyelid), retraction of the upper eyelid (causing apparently bulging eyes), entropion (in-turning of eyelid and lash line) and ectroprion (out-turning of the eyelid). For the lower eyelids, malpositions include retraction of lower eyelid (lid margin below inferior limbus), entroprion (inward rotation of the eyelid margin) and ectropion (outward rotation of the eyelid margin).
Common Consequences of Eyelid Malpositions
Consequences of eyelid malpositions include:
- decreased vision due to blockage of visual axis by the malpositioned eyelid or secondary to corneal ulcer formation;
- irritation of the eyes due to an eyelash rubbing the cornea or conjunctiva;
- corneal ulceration due to repeated rubbing of corneal surface by the eyelashes or eyelid margin;
- corneal/conjunctival dryness due to exposure leading to irritation, discomfort, keratitis or corneal ulcer; and/or
- repeated infections of the lachrymal sac due to a blocked punctum.
Common Symptoms associated with Eyelid Malpositions
Common symptoms of eyelid malposition include:
- Dry eye and irritation
- Painful eye
- Disfigurement of the eyes
- Excessive watering of eyes
- Corneal ulcer
- Decreased vision due to visual axis blockage by eyelids or corneal ulcer
Evaluation and treatment of eyelid malpositions should be disease-specific and tailored to the patient’s needs. This requires consultation with an eye surgeon familiar with treating various eyelid malpositions. Idaho Eyelid and Facial Plastic Surgery has extensive experience in both upper and lower eyelid malpositions.
Eyelid Positional Disorders
Ectropion and entropion are eyelid positions disorders:
- Ectropion is the medical term used to illustrate sagging and outward turning of the lower eyelid and eyelashes; the margin of the eyelid and the eyelashes revert (turn out) . This rubbing can lead to excessive tearing, crusting of the eyelid, mucous discharge and irritation of the eye.
- Entropion is the medical term used to illustrate sagging and outward turning of the lower eyelid and eyelashes: the margin of the eyelid and the eyelashes invert (turn in). This rubbing can lead to excessive tearing, crusting of the eyelid, mucous discharge and irritation of the eye.
Trichiasis is an eyelash disorder characterized by misdirected or abnormally positioned eyelashes. Trichiasis is sometimes caused by entropion and causes discomfort/irritation to the eye. It can result in permanent damage to the cornea and vision loss.
Other Eyelid conditions
Floppy eyelid syndrome is an eyelid malposition usually involving the upper eyelids. It presents as recurrent or chronic ocular surface irritation and chronic papillary conjunctivitis of the upper palpebral conjunctiva (from severe laxity).