When an Eyelid Turns the Wrong Way
- Posted on: Jul 15 2018
For various reasons, a person’s eyelid can turn the wrong way. In some cases the eyelid “turns in”. In others it “turns outward.” These conditions can lead to pain, irritation, and problems with tear drainage. Dr. Chandler has extensive experience with surgery to correct these conditions.
If the eyelid turns inward, this is known as entropion. This usually occurs on the lower eyelid. The lid may be turned inward at all times, or only when the eyelids are closed tightly. Either way, when this happens the skin and lashes rub on the front surface of the eye (the conjunctiva or the cornea), which can be very painful. It can also make the eye sensitive to light and wind.
Causes of entropion
Entropion is usually simply the result of aging, as the muscles around the eyes weaken. A spasm or relaxing of the muscles near the eye can cause the lower eyelid to turn inward. Other causes can be injury to the lid, a congenital defect, skin infections or certain inflammations. People who have had facial surgery, particularly in the mid-face, are more prone to entropion.
Few non-surgical options to remedy entropion make a significant improvement — this condition usually requires surgery.
The area is numbed with local anesthetic, sometimes with light sedation depending on the patient. If the entropion is due to muscle weakness, Dr. Chandler may remove a small section of the eyelid to tighten the muscles in the area. If entropion is due to scars from injury or a prior surgery, Dr. Chandler may refer the patients to specialists who work with more severe conditions requiring grafts or other treatments.
The opposite of entropion is ectropion, a “turning out” of the eyelid. Again, this typically occurs on the lower eyelid. The sagging skin of the inner eyelid is exposed, either in one part of the lid or across the entire lid. Ectropion prevents tears from draining correctly out of the eye, leading to chronic tearing, redness, pain, a gritty feeling, crusting of the eyelid, mucous discharge, even a breakdown of the cornea.
Like entropion, ectropion is usually a result of the muscle weakness that comes with age. Usually the position of the cheek and sagging of the entire aging face contributes to pulling the lower eyelid out of position. But ectropion can also result from nerve damage, sun damage, tumors, burns, or eyelid surgery (blepharoplasty) where too much skin was removed. The condition can also be congenital.
Correcting ectropion / Cheek Lift
Artificial tears can provide temporary relief from the dryness that accompanies ectropion, but surgery is usually necessary to fix the condition. The surgical options/methods are similar to those for entropion. If muscle weakness is the cause, a small portion of the eyelid may be removed and the muscles tightened. This surgery can be complex, and often a cheek lift may be required at the same time as any localized eyelid surgery.
Correcting entropion or ectropion should be trusted only to an oculofacial plastic surgeon with extensive eyelid surgery expertise such as Dr. Chandler. Both conditions can cause irritation and pain to the eyes and their correction can be very challenging.
If you have a problem with your eyelids, or are curious about cosmetic eyelid surgery to reduce the signs of aging, please call Dr. Chandler at (609) 877-2800 to schedule a consultation.