Table of contents:

1. What are eyelids?
2. Ectropia, or
3. Types of anomalies
4. Diagnosis of the condition, treatment
5. Prevention

An anomaly such as eyelid protrusion can involve the entire eyelid or just a fragment, or part of it:

• medial,
• lateral,
• central.

What are eyelids?

This organ is one of the so-called 'movable' soft parts of the face that surrounds the eyeball from the front. The upper and lower eyelids that make up this organ - are part of the apparatus whose job it is to protect the eye.

The outer, cutaneous area of the eyelid develops into the inner area (conjunctiva) at its free edge.

The skin that covers the eyelids is:

• thin,
• houses the sweat and sebaceous glands,
• its edges have eyelashes.

The eyelid muscles are located behind the subcutaneous tissue - these include:

• the tendon of the upper eyelid lever muscle,
• a fragment of the circular muscle of the eye.

The eyelid owes its specific stiffness to the eyelid disc, which is located behind the muscular layer.

Ectropion, viz

Theoutward protrusion of the eyelid, is one of the most common defects of eyelid malposition. In addition to the loss of tears, this condition causes the eyeball to dry out (conjunctivitis occurs due to insufficiently moistened conjunctiva).

Eyelid protrusion is the result of a process of weakening of the connective tissue muscles.

Important! The condition usually affects the older part of the population.

Eyelid, photo: panthermedia

In addition, the anomaly can cause:

• a scar formed after an injury,
• facial nerve palsy,
• allergy,
• congenital causes (harlequin syndrome),
• pharmacological agents,
• complete resection of the jaw (there is a loss of bone base),
• excessive excision of the lower eyelid skin during lower eyelid plastic surgery.

Ectropion manifests itself:

• a retracted eyelid (usually the lower eyelid),
• redness and pain in the conjunctiva,
• constant tearing.

Important! Redness and lacrimation are the result of retraction of the ciliary margin. Exposure of the eyelid conjunctiva, eyeball conjunctiva and also retraction of the eyelid margin from the eyeball - causes overgrowth of the conjunctival epithelium and inflammation.

Types of anomalies

As mentioned earlier, eyelid protrusion can affect the eyelid as a whole or only specific parts of the eyelid.

Complete - the tear points do not adhere to the surface of the eyeball, there is a cessation of the physiological process of tear outflow through the tear ducts.

Medial - the function of the tear pump is impaired. This results in what is known as 'pathological lacrimation' (a defect characterised by tears overflowing the edge of the eyelid).

It also occurs:

• eyelid regurgitation,
• dryness of the eye.

Important! Possible complications include narrowing and distortion of the tear point. This results in dryness and keratosis of the conjunctiva.

Lateral - results in the accumulation and shedding of tears at the lateral angle of the eye. This process is caused by pulling the eyelid margin forward and medially.

Central - chronic conjunctivitis occurs due to the downward sloping effect of the eyelid margin or its separation from the eyeball.

Diagnosis of the condition, treatment

The condition is diagnosed by an ophthalmologist through a series of specialised examinations:

• visual inspection in daylight, which will allow a close look at, among other things, the abnormal protrusion of the eyelid lash margin,
• slit-lamp examination,
• examination of facial muscle strength (to check for facial nerve palsy).

Important! A spatial accuracy test is also performed. The patient touches his or her thumb to the area below the lateral angle of the eye (where the upper and lower eyelids meet), then looks up and also to the side. If the eyelid margin does not return to its position after this test, it can be concluded that an eyelid rollover process has occurred.

The symptoms of the condition can be alleviated by taking suitable medication:

• sulphonamides,
• antibiotics,
• artificial tear preparations,
• anti-inflammatory drops.

Important! The only effective method of eradicating the condition is through surgery.

The method of surgery chosen by the surgeon depends on the cause of the eyelid protrusion defect.

Correction of themedialpart - this is done by performing a horizontal shortening of the eyelid. The doctor cuts out the rhomboid piece of the conjunctiva and also the disc below the tear point. He also cuts (T-shape) the eyelid to its full thickness and then removes the anterior branch of the medial ligament.

Correction of the central protrusion of the lateral eyelid - this is carried out using the Bick method (a pentagonal piece of the full thickness of the eyelid in part of the lateral angle of the eye is cut out).

Correction ofinferior lateral eyelid protrusion - is carried out by anastomosing the lateral edge of the disc with the periosteum of the inner region of the lateral orbital rim, under the upper branch of the lateral eyelid ligament, with simultaneous elimination of the excess skin of the lower eyelid.

The procedure is carried out under local anaesthesia and lasts approximately one hour. Recovery and healing period is approximately 10 days.

In the case of a successful surgery to correct a protrusion of the eyelid, the patient's anatomical condition of the eyelid is restored to normal. In addition, all ophthalmic symptoms disappear.

Important! In some cases, several surgeries are necessary to achieve satisfactory treatment results.

Prophylaxis

Depending on the factors that trigger the affliction, certain forms of 'prevention' can be applied.

• in cases of paralysis (facial nerve reconstruction),
• in cases of maxillary resection (simultaneous or early reconstruction of the bone base),
• in cases of plastic surgery of the lower eyelid (caution when cutting away excess skin).

Important! There is no effective prophylaxis for eyelid protrusion associated with the ageing process.