Description/Introduction

• Eyelids protect your eyes from any foreign bodies while keeping them lubricated throughout. Any alteration in the shape, position or function of your eyelids can predispose your eyes to a plethora of ailments or interfere with our vision.  
• Our eyelid is a complex structure consisting of three theoretical layers:
  1. Anterior Layer contains the skin and orbicularis muscle
  2. Middle Layer contains  the orbital septum and eyelid retractors
  3. Posterior Layer contains tarsus and conjunctiva.
• Eyelid malpositions include any unnatural or incorrect positioning and orientation of eyelids due to various factors that influence any of the three layers of the eyelids. They may possibly be caused due to ageing, trauma, scarring, birth defects or medical disease involving any or all of the three layers.
• The most common forms of eyelid malposition are eyelid retraction, ptosis, entropion and ectropion.

Types of Eyelid Malpositions

• Upper eyelid malpositions: Upper lid ptosis (drooping down of upper eyelid), retraction of the upper eyelid (causing apparently bulging eyes), entropion (in-turning of eyelid and lash line) and ectroprion (out-turning of the eyelid)
• Lower eyelid malpositions: Retraction of lower eyelid (lid margin below inferior limbus), entroprion (inward rotation of the eyelid margin) and ectroprion (outward rotation of the eyelid margin)

Common Consequences of Eyelid Malpositions

• Decreased vision due to blockage of visual axis by the mal-positioned eyelid or secondary to corneal ulcer formation.
• Irritation of the eyes due to an eyelash rubbing the cornea or conjunctiva
• Corneal ulcer due to repeated rubbing of corneal surface by the eyelashes or eyelid margin.
• Corneal or conjunctival dryness due to exposure leading to irritation, discomfort, keratitis or corneal ulcer.
• Repeated infections of the lachrymal sac due to a blocked punctum.

Common Symptoms associated with Eyelid Malpositions

• Dry eye and irritation
• Painful eye
• Disfigurement of the eyes
• Excessive watering of eyes
• Corneal ulcer
• Photophobia
• Decreased vision due to visual axis blockage by eyelids or corneal ulcer
• Disfigurement

Evaluation and treatment of eyelid malpositions needs to be disease-specific and tailored to the patient’s needs. This requires consultation with an eye surgeon familiar with treating various eyelid malpositions. More detailed explanations on each particular eyelid malposition is provided elsewhere for your ready reference

 Eyelid Positional Disorders

Ectropion

Ectropion is the medical term used to characterize sagging and outward turning of the lower eyelid and eyelashes. The margin of the eyelid and the eyelashes revert (turn out) . This rubbing can lead to excessive tearing, crusting of the eyelid, mucous discharge and irritation of the eye

Entropion

Entropion is the medical term used to characterize sagging and outward turning of the lower eyelid and eyelashes. The margin of the eyelid and the eyelashes invert (turn in) . This rubbing can lead to excessive tearing, crusting of the eyelid, mucous discharge and irritation of the eye

Eyelash Disorders

Trichiasis: Lashes pointing to the eye