The Most Common Eyelid Problems
Ptosis refers to the droopiness of an eyelid. Ptosis usually occurs in the upper eyelid of one or both eyes and it results from a deficiency in the action of the elevating muscle or its tendon. Ptosis can be congenital or acquired.
Congenital ptosis is either inherited or an isolated birth defect. Congenital ptosis is almost always caused by the inadequate development of the elevating muscle and is noted shortly after birth.
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 the eyelid will always persist.
The vast majority of cases of acquired ptosis, which is acquired after birth, are as a result of aging, trauma, muscular and neurologic disease. Rarely, adult ptosis may be caused by muscular disease as well. In acquired ptosis, the elevating tendon deteriorates, rather than the muscle itself. The areas of thinning, localized tears to the tendon, or sometimes complete detachment of the tendon inhibit the ability for the muscle to lift. The surgery is intended to reattach the stretched muscle to its normal location or remove the excess skin that is weighing the eyelid down.
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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 that is attached to the socket bone on either side of the eye by two tendons.
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 outwards.
In the presence of ectropion, wind and dust may dry and irritate the delicate tissue lining the inner tissue of the exposed eyelid. In addition, the draining mechanism of the tears can no longer function normally, resulting in the stream of tears down one’s face. Eventually, an eye with ectropion may develop scarring from the dryness.
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 tissue from nearby healthy tissues.
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Entropion is a condition in which the lower eyelid turns inwards. The most common form of entropion develops from a weakening and stretching of the tendons that are connected to the orbital rim of bone. As a result, the eyelid rotates inwards against the eye. Pain from lashes and skin rubbing against the cornea can be severe.
Entropion may also affect vision secondary to corneal involvement. Surgical correction involves the rotation of the lid margin back to its normal position by tightening the tendons and the tendon-like sheath.
Another form of entropion is associated with scarring, usually from trauma or infection, on the inner surface of the tissue in 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.
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A chalazion, results from chronic inflammation, and not an infection, of an eyelid oil gland that stimulates the formation of a surrounding cyst.
A chalazion may appear suddenly 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. A chalazion often is mistaken for a style. A stye is an infection or small abscess around the root of the eyelash.
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