Eyelid problems can be from an inversion of the eyelids or from an eversion. In both cases there is irritation of the cornea and of the conjunctiva, the lining of the eyelids from inside and lining over the conjunctiva.
When the eyelids loose elasticity with age the tracking mechanism of the eyelids is abnormal. The lower eyelids can turn inward (entropion) or outward (ectropion) .
When the patient has an ectropion the inner eyelid is turned out, which makes it vulnerable to drying out and being irritated. lubricating eye drops can help to keep the cornea moisturized and help coping with the irritation. But eventually it is wiser to undergo plastic surgery where the eyelid is tightened.
In the case where your ectropion is due to aging some of the elongated eyelid muscle and ligament has to be shortened, which is done from the outer edge of the lower eyelid under local anesthetic. When the tendons and muscles are stitched together the eyelid will be just the right length as it used to be when you were younger and the eyelid falls into its proper place. This normalizes the tearing system and moisturized the cornea when you blink your eyes.
In the case of an entropion the following plastic surgery procedures is done. The surgery may be done from the outside corner of the eye or below the lower eyelid. The surgery is done under local anesthetic. If there is muscle and ligament laxity due to old age, a tightening is done by removing a pice of muscles and ligaments. When it is stitched back into place it tightens things to the point where the eye lids are back to normal. In more severe cases the specialist may have to place additional sutures below the lower eyelid to pull the rim of the lower eyelid back into its proper place. Like with the repair of the ectropion, the end result will be that there is a perfectly normal position of the eyelids, which takes care of the lubrication of the cornea when you blink your eyes.
Eyelid Problems (Entropion Of Lower Eye Lid)
The image above illustrates an entropion and you can also see an arcus senilis (senile arc) in the cornea. This is due to an elevated cholesterol level that has been present for some time forming this precipitation ring at the periphery of the cornea.
References:
1. The Merck Manual: Eye diseases
2. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
3. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
