Drooping, In-turned and Out-turned Eyelids

What is eyelid Ptosis?

Ptosis is the medical name for drooping of the upper lid, which can be present in one or both eyes. A low lying upper lid can interfere with vision by affecting the top part of the visual field and may also be a cosmetic problem.

It might cause difficulty keeping the eyelids open, eyestrain or eyebrow ache from increased effort needed to raise the eyelids, and fatigue, especially when reading.

Ptosis most commonly occurs with aging, but can also be present from birth (congenital). It can also be caused by long-term contact lens wear, trauma, eye  surgery (including cataract surgery) and occasionally from neurological or muscle disease.

In clinic, Mr Rajak,  our oculoplastic surgeon (eyelid plastic surgeon) will assess your eyes, and eyelids. If you have ptosis it can be helpful if you show us old photographs (for example passport or driving licence). We will take photographs of your eyelid in clinic as a record of the eyelid position before treatment and to help plan the surgery.

Surgery for ptosis involves re-attaching/shortening/tightening of the muscle that raise the lid (the levator palpebrae superioris muscle). This is usually made through an incision in the upper lid which is hidden in a skin crease and will be invisible within a few weeks after the surgery. The skin incision is closed with sutures that are removed 1-2 weeks after the surgery.

Entropion

Entropion is the medical term used to describe an inward turning of the eyelid. It is usually a problem that occurs in older age and mainly affects the lower eyelid except in the Developing World where a disease called trachoma causes the upper eyelid to turn inwards.

Entropion causes the lower eyelid lashes to rub on the surface of the eye leading to excessive tearing, redness, mucous discharge and irritation and pain in the eye.  There is also a risk of permanent damage to the surface of the eye from the eyelashes scratching the surface of the eye.

At your clinic appointment, our oculoplastic (eyelid plastic) surgeon will assess your eyes and eyelids. You may receive treatment such as gels, drops or creams, and it is likely to be advisable to have surgery to return the eyelid to its normal position where the eyelashes face outwards and do not rub against the eye.

Ectropion

Ectropion is the medical term used to describe the outward turning of the eyelid. It is usually a problem of older age and mainly affects the lower eyelid. Most commonly it result from either the laxity and loss of elasticity of the skin that happens with ageing and/or from sun damage to the skin of the eyelid and cheek over many years.

Ectropion can lead to excessive tearing, redness, mucous discharge, irritation of the eye and be cosmetically unsightly. Very occasionally severe ectropion can cause permanent damage to the surface of the eye.

In clinic, our oculoplastic surgeon will assess your eyes and eyelids. Ectropion does not always need to be corrected and some individuals may prefer not to have intervention, but it may be advisable to surgically correct ectropion to improve the symptoms and appearance of the eyelid.

Ptosis, Entropion and Ectropion Surgery

Ptosis, entropion and ectropion surgery takes about 30-45 minutes per eye and is almost always a day case procedure.  It is usually done with local anaesthetic (injections to numb the eyelid skin) as this enables the surgeon to assess the eyelid position during the operation (by asking you to open and close your eyelids) and make adjustments as required. However, in some operations, for example for patients with severe tremor or anxiety, we may recommend sedation, which makes one very sleepy during the anaesthetic injections and relaxed and a little sleepy during the operation. If both eyes have ptosis, entropion or ectropion it is usually best to operate on both sides at the same time, in which case you may need a patch for an hour or so after the surgery but these would be removed before you go home so you will be able to see comfortably out of both eyes.