Introduction
Eyelids are a significant part of the anatomy of the eye. The two eyelids serve to protect the eye from being exposed too much, thereby provide protection from foreign matter and excessive light.
Eyelids also aid in the lubrication by spreading the tear film over the entire eye area therefore they eyes are protected from getting too dry.
If the eyelids are not in the position they are ideally supposed to be they can cause a lot of problems to the eyes. Depending upon how the eyelids are malpositioned, a number of conditions can occur.
However, problem of eyelid malposition is relatively common. They can be treated with surgery and the repositioning is often achieved successfully. The surgery can restore full function of the eyelids.
Types of eyelid malposition
- Ectropion: – it is the condition in which the lower eyelids get turned out away from the eye. Since they sag away from the eye, they leave the eye dry and exposed. If not treated in time, ectropion can lead to irritation in the eyes, pain, chronic tearing, crusting of the eyelids, cornea breakdown due to excessive exposure etc. it happens due to progressive relaxation of the eye muscles due to ageing, stroke/other neurological condition, facial paralysis etc. since the lower eyelid is turned out, the upper and lower eyelid cannot close tightly to prevent tear evaporation. The inner surface of the eye called the conjunctiva is exposed and gets dry.
- Entropion: – it is the condition in which the eyelid is rolled towards the eyes. Because of the turning in of the eyelid, the lashes rub against the cornea. It can cause redness, irritation, pain and increased sensitivity to the light and wind. It results due to weakening of muscles due to ageing. If not treated in time, it can cause permanent damage to the eyes.
- Eyelid retraction: – it is the condition in which the eyelid moves away from the surface of the eye. It can cause irritation, as the lid is not correctly performing its function of cleaning and lubricating the surface. Scarring from a [previously carried out surgery can cause eyelid retraction. Other reasons can include thyroid disease and loss of tightness of the eyelid due to ageing. The treatment involves graft implantation from the ear or other areas of body to reposition the eyelids.
- Floppy Eyelid Syndrome: – it is the condition in which the eyelid inverts spontaneously on its own and this condition is characterized by loose upper eyelids. This condition is generally observed in overweight people and in the middle aged men. The patients suffering from floppy eyelid syndrome also suffer from Obstructive sleep Apnea. The condition can cause itching in the eyes, irritation and stringy mucous discharge on awakening from sleep. In almost every case, patients generally have tried all kinds of eye drops; artificial tears etc. before reaching for the correct diagnosis. The surgical treatment removes a portion of the eyelids to tighten the eyelid muscles.
- Ptosis: – it is the condition characterized by the droopy or falling upper eyelid. The droopiness is more prominent after being awake for longer. The extent of droopiness can be small or it can droop enough to cover the eye entirely. This condition can cause restricted vision or can completely block the vision. This condition can be present at the time of birth and in that case it is known as congenital ptosis. Congenital ptosis does not improve on its own and requires surgical treatment. Congenital ptosis can cause the upper eyelids creases to appear asymmetrical. Ptosis can be congenital, but it can also occur later in life.
Treatment
In almost all cases of eyelid malposition surgery can improve the condition. Improper positioning of eyelids does not only restrict or even block the vision, but they can also completely damage the eyes. Therefore it is imperative that a specialist is consulted as soon as possible. In almost all cases of eyelid malposition, surgery has been highly effective and has shown great results, but one should still be aware of the possible risks of the procedure.
Risk factors
Eyelid malposition surgery carried similar risks as other surgeries. In rare cases, infection, reduced vision or bleeding may occur. But one must keep in mind, that theses complications are uncommon. One may find it difficult to close the eye post surgery, but this condition is temporary. Also, one must be realistic about the expectations from the outcome of the surgery. Although immediate improvement can be seen in the height of the eyelids, in many cases perfect symmetry may not be achieved, however, in all cases surgery results in protection of the eye from any damage. In some case, a patient may not be able to fully move the eyelids.
In conclusion, although surgery carries some minor risks, in almost all cases, patients have seen tremendous improvement post the surgical procedure.