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The Most Common Eyelid Problems

Ptosis

Ptosis refers to the droopiness of an eyelid, and it affects only the upper eyelid of one or both eyes, it results from a deficiency in the action of the elevating muscle or its tendon. Ptosis can be congenital or acquired;

Congenital ptosis either inherited or an isolated birth defect is almost always caused by the inadequate development of the elevating muscle and is noted shortly after birth. Rarely, adult ptosis may be caused by muscular disease as well.

Surgery for muscular ptosis is directed at tightening the elevating muscle tissue or, in severe instances, by connecting the paralyzed lifting mechanism to the healthier muscles of the eyebrow via an internal suspension system. While such procedures can lift the eyelid higher, the dystrophic muscle can never be made normal and so some degree of functional deficiency in opening and closing will always persist.

Fortunately, the vast majority of cases of acquired ptosis, the onset after birth, are as result of aging, trauma, or muscular and neurologic disease. The problem is related to a deterioration of the elevating tendon rather than the muscle itself. The areas of thinning, localized tears, or sometimes complete detachment are no longer able to transmit the lift. The surgery is intended to reattach the stretched muscle to its normal location or remove excess skin that weighs the eyelid down.

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Ectropion

Patients with ectropion have a sagging lower eyelid that leaves the eye exposed and dry. The supporting structure of the lower eyelid may be compared to a hammock, with a cartilage-like central stiffener piece and they are attached by two tendons to the socket bone on either side of the eye. If the tendons become stretched due to wear-and-tear or from trauma or even other eyelid surgery, the lid may lose its normal adherence to the eye surface and sag outward, a condition known as ectropion.

In the presence of ectropion, wind and dust may dry out and irritate the delicate tissue lining the back of the exposed eyelid. Tearing develops when the tear duct drain on the edge of the eyelid drifts away from the eyeball and can no longer pick up the moisture. Eventually, an eye with ectropion may develop scarring.

Ectropion eyelid surgery is designed to tighten the stretched tendons and shorten the stretched lid. If the tendons have become too shredded, an entirely new means of support may be created by borrowing from nearby healthy tissues.

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Entropion

Entropion is a condition in which the lower eyelid turns inward, the most common form of entropion develops from a weakening and stretching of the tendons supporting the eyelids to the orbital rim of bone. This allows the unstable eyelid to rotate inward against the eye. Pain from lashes and skin rubbing against the cornea can be severe, and the risk from entropion to vision is immediate.

Another form of entropion is associated with scarring from trauma or infection on the back lining of the eyelid and/or within the internal structure of the eyelid. While uncommon in the United States, this variant of entropion is a leading cause of blindness in underdeveloped countries.

Surgical correction on the more common type of entropion entails rotating the lid margin back to its normal position by tightening the tendons and the tendon-like sheath.

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Chalazion

A chalazion is a chronic inflammation and not an infection of an eyelid oil gland that stimulates the formation of a surrounding cyst.

A chalazion may appear suddenly and be confused with a sty or slowly over many days. While a chalazion may shrink over several weeks and become painless, its core frequently remains intact.
Sooner or later, the cyst flares up again and again and may gradually deform the eyelid and distort the eyelashes.

Chalazion removal is a minor surgical procedure that takes about ten minutes. Chalazion often is mistaken for a sty. A sty is an infection or small abscess around the root of the eyelash.

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