RECONSTRUCTIVE        Eyelid Malpositions

The eyelids are crucial for the protection of the eyes and abnormalities of contour, strength, or position can dramatically affect ocular comfort and vision. Dr. Shome is an expert in correcting eyelid malpositions and has written many papers on the same.

Entropion
Entropion is a malposition resulting in inversion of the eyelid margin. It is very uncomfortable, as the eyelashes rub against the cornea constantly. Entropion is usually caused by genetic factors and may be congenital. Trachoma infection may cause scarring of the inner eyelid, which may cause entropion.. Successful management of this condition depends on appropriate classification and a procedural choice that adequately addresses the underlying abnormality.

Symptoms of entropion include:
• Redness and pain around the eye
• Sensitivity to light and wind
• Sagging skin around the eye
• Excessive tearing
• Decreased vision, especially if the cornea is damaged

Treatment includes simple surgery to correct the eyelid malposition.


Ectropion
Ectropion is an abnormal eversion (outward turning) of the lid margin away from the globe. Without normal lid globe apposition, corneal exposure, tearing, keratinization of the palpebral conjunctiva, and visual loss may result. Ectropion usually involves the lower lid and often has a component of horizontal lid laxity. Treatment is individualized based on the appropriate identification of the etiology.

Causes:
• Ectropion may be congenital (present at birth) or acquired.
Congenital ectropion is rare and usually involves the lower lid. The cause often is a vertical deficiency of the skin. Congenital ectropion is rarely an isolated anomaly. It may be associated with blepharophimosis syndrome, microphthalmos, buphthalmos, orbital cysts, Down syndrome, and ichthyosis (collodion baby). Occasional congenital ectropion cases are on a paralytic basis.
• Acquired ectropion may be involutional (due to advancing age and lax eyelid skin), paralytic, cicatricial, or mechanical.
• Involutional ectropion is the most common form of ectropion. A major factor is horizontal lid laxity, usually due to age-related weakness (most patients are elderly) of the canthal ligaments and the pretarsal orbicularis. Patients with involutional ectropion have been suggested to have an age-normal or larger than normal tarsal plate, which may mechanically overcome normal or decreased orbicularis tone, in conjunction with canthal tendon laxity.
• Patients with an anophthalmic socket may have involutional ectropion due to chronic pressure of the ocular prosthesis.
Treatment includes simple surgery to correct the eyelid malposition.
These common forms of eyelid malposition and hundreds of other less common forms can be corrected by Dr. Shome with an evaluation and subsequent surgery. If you are looking for an expert in correcting your eyelid malposition look no further than The Esthetic Clinic.