Eyelid Disorders

ENTROPION

Entropion is a condition characterised by the inward folding of the eyelids (usually the lower lid). This can cause the eyelashes and skin to rub against the surface of the eye leading to irritation and damage to the eye. In elderly, it is caused by weakening of the muscles and tendons under the eyes, it occasionally occurs with scarring of the inside of the eyelid (conjunctiva).

EPIBLEPHARON

Inward turning of the eyelids, more commonly the lower eyelid in down or upgaze but an otherwise normal eye lid position. Usually occurring in children and young adults and more commonly in Asians.

ECTROPION

A condition characterised by outward turning of the eyelids (usually the lower lid), commonly found in the elderly. The eyelid muscles and tendons have weakened or stretched in addition often to downward traction from tightening of the skin from sun damage or mid facial droop. It can also be found in patients with facial palsy or scarring of the eyelid. Ectropion prevents the eyelid from closing properly and protecting the cornea (transparent front part of the eye). This can cause conjunctivitis and damage the cornea and affect normal vision.

PTOSIS

Drooping of the upper eyelid from either stretching or a weakness of the muscles that lift the eyelid. If significant enough, the eyelid will encroach onto the visual axis affecting vision. More common in the elderly however there are congenital (born with) forms of ptosis.

PERIORBITAL SKIN CANCER, “LUMPS AND BUMPS”

Up to 50% of Australians will develop skin cancer and 90% of these will occur on the head and neck so unfortunately it is not uncommon for skin cancer to involve the eyelids. In order of descending incidence, is BCC (basal cell carcinoma), SCC (squamous cell carcinoma) and melanoma. Removal of the cancer and reconstruction of the lids in a way to preserve function to maintain vision, comfort and aesthetic appearance is a highly specialised area of surgery.

There are also many benign (non-cancerous) lumps that occur in the periorbital region. Common lesions include xanthelasma (yellow cholesterol deposit within the skin), seborrheic keratosis (brown waxy plaque on the skin), skin tags (localised overgrowth of skin into a stalk or plaque of thickened skin) and hydrocystomas (blocked sweat gland forming a cyst).

PERIORBITAL AGEING

Ageing results in drooping, descent and loss of volume of periorbital tissues and can affect how people perceive our mood, giving the appearance of anger, sadness or being tired when this is not how we are feeling. Redundant skin and drooping of the upper lids can interfere with one’s vision.

Blepharoplasty is the surgical manipulation of the tissues of the eyelids and the area immediately adjacent to improve vision and/or gain an aesthetic improvement.

Modern blepharoplasty surgery is aimed at tissue conservation where possible. A tailored removal of skin whilst sculpting and repositioning the underlying muscle and fat and redefining anatomic landmarks to give a more functional and refreshed result.

EYELASH DISORDERS

Eyelashes are small hairs originating from the eyelid margins. They prevent dust and debris from getting to the eyeball. Disorders of the eyelashes include the following:

  • Madarosis: Loss or absence of eyelashes due to infection
  • Blepharitis: Inflammation of the eyelids leading to madarosis
  • Trichiasis: Malposition of the eyelashes where the eyelashes grow in towards the globe of the eye
  • Distichiasis Growth of abnormal lashes

LAGOPHTHALMOS

Lagophthalmos is the inability to completely close eyelids. Lagophthalmic patients may have dry and irritated eyes due to exposure of the cornea (clear dome-shaped covering of the front of the eye) and excessive evaporation of the tear film. Some of the more serious complications of lagophthalmos include corneal ulceration and keratitis (inflammation of the cornea). Facial nerve paralysis (paralytic lagophthalmos) associated with Bell’s palsy is the main cause of lagophthalmos. Some of the other causes include trauma, infections, and tumours.

CHALAZION

A chalazion is a painless inflammatory cyst formed when an oil producing (Meibomian) gland in the eyelid blocks, it presents as a lump or nodule on the upper or lower eyelid. A chalazion occasionally affects vision if it becomes large enough to put pressure on the eye.

If the chalazion become secondarily infected, it becomes painful this is a “stye” or hordeolum.

Certain factors increase the risk of developing a chalazion. These include

  • Chronic blepharitis (inflammation of the eyelids or eye lashes)
  • Acne rosacea (redness due to blockage of blood vessels on the face)
  • Seborrhoea (overactive sebaceous glands causing oily skin)

EYELID SWELLING

Eyelid swelling occurs due to inflammation or edema (fluid build-up) in the connective tissues surrounding the eye. It can be painful and is often accompanied by puffiness, itching, redness, and excessive tearing of one or both eyes. Some of causes that can lead to the swelling of the eyelids include allergies, conjunctivitis (pink eye), stye, chalazion, blepharitis, and trauma. Swelling of the eyelids can be a predecessor of more serious sight-threatening conditions and it is important that you contact your eye doctor without delay.

LID LAXITY

Lid laxity refers to loosening of the tendons that support the eyelids. Some of the causes include the natural ageing process, facial nerve paralysis or scarring from trauma or previous surgery. Lid laxity is often an important component of ectropion, entropion, and floppy eyelid syndrome (upper eyelid is lax and easily everted).