Midwest Eye Care Institute

Eyelid Malposition

Ectropion

Ectropion refers to out-turning of the lower eyelid, and is a commonly seen eyelid malposition in the elderly. The most common cause of ectropion is loss of eyelid tone with aging, leading to laxity of the tissue, which allows the eyelid to hang away from the eye. Less common causes of ectropion include Bell’s Palsy, skin conditions (eczema or psoriasis), or congenital malformations.

Once the eyelid begins to lose contact with the eye, it is very common for people to experience irritation of the eye and tearing. The eyelid itself will often undergo secondary changes such as thickening of the lid margin, keratinization of conjunctiva (roughness of inner aspect of the eyelid), and redness with discharge (secondary inflammation and mucous production).

The correction of ectropion is surgical, and involves tightening the lower eyelid. In more complex cases, tightening of eyelid may be combined with a skin graft to the lower eyelid. Dr. Conlon, as an oculoplastic surgeon, is very familiar with the different surgical techniques available to correct ectropion.

Entropion

Entropion refers to in-turning of the lower eyelid. This condition is most commonly related to aging of the eyelid structures, but often there is a co-existent spastic component, which increases the intensity of the eyelid malposition. Entropion often develops insidiously with the patient first experiencing intermittent irritation of the involved eyelid and eye, but eventually it becomes constant, and quite uncomfortable.

The correction of entropion is surgical, and requires correction of the underlying anatomic defects which lead to the condition. In most cases the surgical correction involves correcting a component of eyelid laxity, combined with reattachment of a muscle complex, located deep within the eyelid, called the lower eyelid retractors. In complex cases, scarring of the inner lining of the eyelid (palpebral conjunctiva) needs to be addressed with some form of a mucous membrane graft.

Dr. Conlon has found many patients experience fairly immediate relief (within 3 days) of the spastic component of entropion by the use of Botulinum toxin A injection to the pre-tarsal muscle. Patients appreciate the pain relief, and the temporary paralysis induced by the BOTOX® facilitates the surgical repair.