Eyelid Malposition (Eyelid Ectropion and Eyelid Entropion)
With malposition of the lower eyelid, the lid margin may be turned inward toward the eye (entropion), or outward away from the eye (ectropion). In both cases, there may be significant symptoms involving impaired vision, irritation, undesirable appearance, or discomfort.
Analogy: Imagine the lower eyelid as a tennis net. If the tennis net gets loose, it can flop in or out. Similarly, when the lower eyelid tendon gets loose over time due to aging (or other causes), the eyelid can turn in (entropion) or out (ectropion).
Entropion (Turned-in Eyelid)
Entropion is a condition in which the eyelid is rolled inward toward the eye. It can occur as a result of advancing age and weakening of certain eyelid muscles. Entropion may also occur as a result of trauma, scarring, or previous surgeries.
A turned in eyelid rubs the eyelashes against the eye, making it red, irritated, painful, and sensitive to light and wind. If it is not treated the condition can lead to excessive tearing, mucous discharge and scratching or scarring of the cornea. A chronically turned in eyelid can result in light sensitivity and may lead to eye infections, corneal abrasions, or corneal ulcers. If entropion exists, it is important to have it repaired before permanent damage to the eye occurs.
There are a number of surgical techniques for successfully treating entropion. The most common surgical treatment involves tightening of the eyelid to restore the lid to its normal position. The surgery to repair entropion is usually performed as an outpatient procedure under local anesthesia. Patients recovery quickly and experience immediate resolution of the problem following surgery. A non-incision entropion repair may be performed as an in-office procedure under local anesthesia. This procedure requires several strategically placed sutures which evert the eyelid. The procedure is an excellent treatment for patients who are not suitable for surgery, or until more definitive surgery can be performed.
Ectropion (Turned-out Eyelid)
Ectropion means that the lower eyelid is "rolled out" or sagging away from the eye. 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, crusting of the eyelid, mucous discharge, and breakdown of the cornea due to exposure.
Generally the condition is the result of tissue relaxation associated with aging, although it may also occur as a result of facial nerve paralysis (due to Bell's palsy, stroke or other neurologic conditions), trauma, scarring, previous surgeries or skin cancer.
With an ectropion, the wet, inner, surface of the eye, called the conjunctiva 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 is repaired surgically. Most patients experience immediate resolution of the problem once surgery is completed with little, if any, post-operative discomfort. After your eyelid heals, your eye will feel comfortable and be protected from corneal scarring, infection, and loss of vision. This surgery should be performed by an opthamologist trained in specialized plastic surgical technique.