Ectropion is a condition in which the lower eyelid is “rolled out” away from the eye, or is sagging away from the eye. Ectropion is generally the result of tissue relaxation associated with aging, although it may also occur as a result of trauma, scarring, skin cancer or facial nerve paralysis due to Bell’s palsy, stroke or other neurologic conditions. The sagging lower eyelid leaves the eye exposed and dry. If ectropion is not treated, the condition can lead to chronic tearing, eye irritation, redness, pain, and breakdown of the cornea due to exposure.
With ectropion, the wet, inner, conjunctival surface is exposed and visible. Normally, the upper and lower eyelids close tightly, protecting the eye from damage and preventing tear evaporation. If the edge of one eyelid turns outward, the two eyelids cannot meet properly and tears are not spread evenly over the eye.
Ectropion can be repaired surgically, via eyelid reconstruction. Most patients experience immediate resolution of the problem after surgery with little post-operative discomfort. After the eyelid heals, the eye feels comfortable and protected from corneal scarring, infection, and loss of vision.
Entropion is a condition in which the eyelid is rolled inward toward the eye, causing eyelashes and skin to rub against the eye surface, leading to irritation and discomfort. Entropion can occur as a result of advancing age and weakening of certain eyelid muscles. It may also result from trauma, scarring, or previous surgeries.
The turned in eyelid rubs against the eye, making it red, irritated, painful and sensitive to light. If it is not treated the condition can lead to excessive tearing and scratching or scarring of the cornea. A chronically turned in eyelid can result in sensitivity to light and may lead to eye infections, corneal abrasions, or corneal ulcers. It is important to have a doctor repair the condition before permanent damage to the eye occurs.
There are a number of surgical techniques for treating entropion. The most common surgical treatment involves tightening of the eyelid and its attachments to restore the lid to its normal position. Surgery is usually performed as an outpatient procedure and most patients experience immediate resolution of the problem following surgery. Sometimes a non-incisional entropion repair may be performed in the office using several strategically placed sutures which evert the eyelid.
Ptosis is the medical term for drooping of the upper eyelid(s). This lowering of the upper eyelid margin may cause a reduction in the field of vision when the eyelid either partially or completely obstructs the pupil. Patients with ptosis often have difficulty keeping their eyelids open. To compensate, they will often arch their eyebrows in an effort to raise the drooping eyelids. In severe cases, people with ptosis may need to lift their eyelids with their fingers in order to see.
There are many causes of ptosis including age related weakening of the muscle, congenital weakness, trauma, or sometimes neurologic disease. As we age, the tendon that attaches the levator muscle, the major muscle that lifts the eyelid can stretch and cause the eyelid to fall. This is the most common cause of a droopy eyelid.
Ptosis can be corrected surgically and usually involves tightening the levator muscle to elevate the eyelid. In severe ptosis, when the levator muscle is extremely weak, a “sling” operation may be performed, enabling the forehead muscles to elevate the eyelid. The surgeon will perform testing to determine the best form of correction for the individual patient. The goal is to elevate the eyelid to permit a full field of vision and to achieve symmetry with the opposite upper eyelid.
Blepharoplasty is surgery that includes repairing droopy eyelids by removing excess skin, muscle and fat. As we age, eyelids stretch and the muscles supporting them weaken. As a result, excess fat may gather above and below the eyelids, causing sagging eyebrows, drooping upper lids and bags under the eyes. This severely sagging skin around the eyes can impair peripheral or side vision.
A blepharoplasty procedure usually is performed through external surgical incisions made along the natural skin lines (creases) of the upper and lower eyelids. These creases then hide the surgical scar from view. Post-operatively there may be some swelling and bruising which will subside and resolve within 1-2 weeks. The final, stable results of the procedure will become apparent after several months.
Please contact Wolfe Eye Clinic at 1-800-542-7856 to ask any oculoplastic or eyelid surgery-related questions or for an appointment with our oculoplastic surgeon, Dr. Douglas Casady.