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What are they?

Eyelid malpositions are changes to the correct position of the eyelids, upper or lower. These changes are frequent, affecting the normal appearance of the eyelids and may cause visual problems in certain cases. 

Symptoms

Depending on the type of eyelid malposition, a patient's symptoms may be different. If it affects the axis vision, ptosis may cause a reduction of the visual field. Patients with entropion may feel rubbing against the eye's surface, eye watering, irritation or if it causes corneal lesions it may affect the vision.  

Ectropion may cause irritation, reddening of the eye's surface, foreign body sensation, eye watering and a predisposition to suffering infections of the eye's surface.

Causes

The change in the position of the eyelids is usually a side effect of a loss of tissue elasticity due to ageing, although it may also apper as a result of an facial nerve paralysis or scars. Ageing is the main cause.  

Types

  • Ptosis is a drooping upper eyelid, with difficulty to open the eyelid voluntarily. In some cases, it is so severe that the eyelid covers the axis of the pupil and hinders correct vision in the affected eye.  
  • Entropion is the eyelid turning inward towards itself. It may be the lower eyelid (most commonly) or the upper eyelid, causing the  eyelashes to rub against the cornea and eye surface. 
  • Ectropion is the rotation towards the outside of the lower eyelid. Very often, it causes the tears to build up at the half-way point without being able to drain and it's normal that the patient notices their eye watering. 

Prevention

Malpositions cannot be prevented, but they can be treated early, because they can be diagnosed in an eye exam.

Treatment

Malpositions are treated with surgery. The purpose of the surgery is to relocate the eyelid so it can recover its function and aesthetic appearance. In the case of patients with ptosis, surgery acts on the levator muscle of the upper eyelid, repositioning it so that it the height of the eyelid is correct and the patient can see properly. 

This can be carried out by the external route (through the skin) or the internal route (through the conjunctiva): the choice of technique depends on the result of a test carried out in the consultation with the ophthalmologist. 

In entropion and ectropion it's important that all the eyelid structures are properly assessed, to select the best treatment option in each case. For example, patients who have undergone surgery or have scars from accidents, the surgical technique of choice will aim to rebuild the affected eyelid layer, be it the skin or the conjunctiva via implants. 

In case it is due to age, surgery is usually a canthal strip, where by making a small incision in the external canthus of the eye the eyelid edge is anchored to the bone ridge to put it back in its normal position. In the majority of cases, the different sugeries offer an immediate slution to eyelid malposition and its associated complications. 

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