Ptosis

Ptosis is the term describing the drooping of the upper eyelid. Normally the margin of the upper lid covers about one to two millimeters of the superior part of the cornea. In this condition it is more than two millimeters.

It can be present at birth or acquired.

If present at birth it is called congenital ptosis and needs surgical treatment to prevent ambylopia or lazy eye in children.

It can also be acquired due to trauma, systemic diseases such as myasthenia gravis, diabetes mellitus and most commonly aging [ aponeurotic ] This can be corrected surgically depending on the function of the muscle, the levator aponeurosis. The surgery can be performed under general anaesthesia [ in children ] or local anaesthesia [ preferably in adults ] as a day care procedure. The success of the surgery depends on the strength of the muscle and therefore sometimes it is not possible to achieve symmetry of the upper eye lid in some conditions.

Entropion

This is defined as inturning of the lid margins. It can involve both the upper and lower lids. Most patients complain of tearing and redness because of irritation by the inturned lashes.

It can be congenital called epiblepharon. Most often it is present in the Oriental on the nasal half of the lower lid.This condition will most often improve as the child grows. However if symptoms persist and cause corneal damage patient will need surgery. The surgery involves the removal of a small strip of the skin and muscle on the nasal aspect. In children this procedure is carried out under general anaesthesia.

The acquired form occurs due to normal aging process called involutional entropion. The surgery is performed via an incision under the lid margin. under local anaesthesia.

Other causes can be due to chronic inflammation, infection or trauma of the conjunctiva.In this condition the conjunctiva is contracted. The surgery involved here is additional. It may require a graft to length the conjunctiva.

The lid correction has to be performed if it is causing corneal damage and also in patients before cataract surgery.

Ectropion

This condition involves outrolling of the lid margin away from the globe. This prevents the tears from draining into the punctum and instead rolls down the face. The most common cause is due to normal process of aging. Other causes are due to paralysis of the facial nerve, trauma or tumours. Most often the treatment is surgical and it depends on the cause. If it is due to involutional causes the surgery involves a tightening procedure of the lower lid under local anaesthesia.

Dermatochalasis

Laxity of the skin and with prolapse of the fat are all part of the aging process in the eyelids. The skin appears wrinkled and this is not accepted aesthetically by many. Sometimes the excessive upper lid skin which look like hoods can also obscure the vision.

The surgery is called blepharoplasty and it is performed under local anaesthesia . The incision is usually placed below the lid margin for lower lid and in the upper lid along the skin crease . However if it is a pure fat removal the surgery can be performed via a conjuctival incision. After the surgery the lids will be swollen and sometimes bluish black. This is temporary and can be reduced with cold compress.

Lid tumours

Most of the eye lid tumours are benign and these are inflammatory lesions such as chalazion or keratosis, xanthalesma and nevi.

The most common cancer of the eyelids is basal cell carcinoma. It usually presents in the lowerlid on the medial aspect as a nodule or as a ulcer. The other cancers which are less common are squamous cell, sebaceous cell carcinomas and malignant melanomas. Most of these cancers are slow growing and occurs in the middle aged or elderly. One must have a high index of suspicion if there is a slowly enlarging lump, loss of eye lashes, prominent blood vessels, pigmentation or recurrent blepharitis. Treatment of these suspicious lumps are treated with total excision with frozen section control followed by reconstruction.