Published: Dec. 13, 2007
Updated: Feb. 24, 2012
With malposition of the lower eyelid, the lid margin may be turned inward toward the eye, or outward away from the eye (sagging eyelids). In both cases, there may be significant symptoms involving vision, appearance, or comfort.
Symptoms typically include ocular discomfort, tearing, mucous discharge, and reduced vision. In some cases, corneal infection and scarring may be seen.
Entropion refers to a condition where the eyelid and eyelashes are turned inwards. As a result, the eyelid skin and lashes rub against the cornea of the eye, causing irritation and pain. It is most often seen in older patients as a result of relaxation of the eyelid tissues. It may sometimes be seen as a congenital condition in young children. Trichiasis, a related disorder, occurs when eyelashes grow inward instead of outward.
The treatment of entropion involves tightening of the eyelid tissues to restore its elasticity and position. The exact surgical procedure depends upon the cause and the surgeon’s preferences. In more elderly patients who may not be able to undergo surgery, other procedures may be used, such as sutures or injected medications, although they tend not to be permanent.
Ectropion is the term used to describe an abnormal out-turning of the lower eyelid away from the eye, and may be referred to as sagging eyelids. As a result, the eye surface may become exposed and dried out. This condition is caused by a relaxation of the eyelid tissues, commonly related to aging. Scarring of eyelid skin, from cancers, scars, or skin diseases, can also cause a shortening of lower eyelid skin and ectropion.
When the eyelid is turned away from the eye, symptoms include drying of the cornea, chronic irritation, and the feeling of grit in the eye. Excessive tearing and reduced vision are also common complaints. In rare cases, severe eye damage can result.
The treatment of ectropion can be either medical or surgical.
Medical treatment can include topical lubricating drops and ointments to keep the eye surface moist. A protective shield may be worn over the eye at night, or the lids may be taped closed.
When laxity of eyelid tissue is responsible, it is best treated surgically. Tightening of these tissues will usually restore normal elasticity and allow the eyelid to be repositioned.
Surgery is performed under local anesthesia with the patient under light sedation. When scarring is the cause of the ectropion, excision of the scar or even a skin graft may be needed.
Learn more about oculofacial surgery:
For more information about malpositions of the lower eyelid, contact the Duke Eye Center to make an appointment near you in Raleigh, Durham, Cary, and many areas of North Carolina.