The term "entropian" describes the rolling inward of the lid margin towards the eye. As a result, the eyelashes constantly rub against the cornea (front transparent part of the eye) and the conjunctiva (the membrane that encloses the eye), sometimes damaging these structures.
The most common cause of entropian is the laxity of tissues that support the lower eyelid, seen as part of the normal aging process. This results in the inward rolling of the eyelid margin.
Occasionally, entropian is caused by the scarring of the inner surface of the eyelid due to inflammation, chronic infections or trauma.
Longstanding, uncorrected entropian can lead to gradual scarring of the cornea, as well as increase the risk of corneal infection. Therefore, it is important to have this condition repaired before these complications permanently damage the eye. If entropian is present in an eye requiring cataract removal, it is advisable to correct the lid abnormality first, before cataract surgery.
Surgery is usually required to tighten the lower eyelid and its attachments which will restore some of its elasticity and to reposition it. If you need to delay surgery, tap or sutures can be used to temporarily reposition the eyelid and protect the eye. Lubricating eye drops and ointments are also helpful. Unfortunately, these measures do not result in permanent cure.
Entropian causes irritation, which in severe cases may lead to permanent blurring of vision. It should be treated by ophthalmic surgeons who are trained to manage this condition.
UPPER EYELID DROOPING (PTOSIS)
Ptosis is the medical term for the drooping of the upper eyelid, which may affect one or both eyes. As the edge of the upper eyelid falls further, the upper field of the vision can become diminished.
Ptosis may be present at birth (congenital) or appear later in life (acquired). Congenital ptosis is usually a result of improper development of the levator muscle responsible for lifting the upper eyelid.
There are several cases of acquired ptosis. The most common cause is the stretching of the levator muscle due to the aging process. It is not uncommon to develop ptosis after cataract surgery which can sometimes cause the attachment of the already weakened and aged muscle to stretch further.
Occasionally, an injury to the nerve that stimulates the levator muscle can also cause ptosis. In rare cases, ptosis may be the first sign of myasthenia gravis, a condition in which body muscles tire easily.
Difficulty in keeping the eyes open, or eye strain and eyebrow ache from the increased effort to raise the lids. There may also be fatigue when reading. In severe cases, it may be necessary to lift the head backwards in order to see from under the eyelid. Family and friends may also notice a tired appearance. Children with congenital ptosis are at risk of developing “lazy eyes” or ambylopia, squints and/or astigmatism.
Ptosis is treated surgically. The main goal of the surgery is to elevate the upper eyelid to permit a full field of vision, and attempt to achieve symmetry when the patient is looking straight ahead. Patient with congenital ptosis will still have a drooping lid on up gaze and the white of the eye (sclera) will become visible on down gaze. There may also be inadequate lid closure during sleep.
However, when operating on an abnormal muscle, it is not possible to achieve a completely normal lid position and function after surgery. The specific operation required is based on the underlying cause of the ptosis, as well as the severity of it and the strength of the levator muscle. Surgery is usually performed under local anaesthesia in adults where a small injection is given around the upper lid to numb the area.
Ptosis or droopiness of the upper eyelids may be mild or severe. when severe, surgical correction is generally recommended. This can be easily verified by paying a visit to your eye doctor.
COSMETIC EYELID SURGERY
Your eyes are the first thing people notice about your face, and are an important aspect of facial attractiveness. Unfortunately over time, the upper and lower eyelids may become droopy or baggy due to the stretching of the skin, weakening of the muscles, and bulging fat pockets around the eyes, giving rise to unsightly, “eye bags” or “rings”. The eyebrows may also sag or droop in the same way.
Besides affecting your appearance, such conditions can also cause you to have a “tired” or older look, or cause symptoms of ocular fatigue. When severe, it might even lead to impaired vision.
Blepharoplasty is the term used for eyelid surgery to correct the baggy and sagging tissues around the eyes. The aims are to achieve a more youthful appearance as well as better lid function. Excess skin, muscle or fat will need to be removed to achieve this.
Surgery is usually performed under local anaesthesia. Incisions are made along the natural folds of the eyelid so that they are virtually unnoticeable when they heal. These incisions are usually closed with fine sutures.
If the eyebrows are also droopy, a procedure called a brow lift can be performed at the same time.
There is usually only a mild discomfort after surgery. You may expect some swelling, bruising and tightness of the eyelids, but they will resolve once the wounds heal. In a small number of cases, slight asymmetry in the eyelid appearance or position may occur and may require additional surgery to correct.
Cosmetic eyelid surgery should always be performed by qualified surgeons who are appropriately trained as incorrect surgery may lead to more problems.