Ocular aesthetics - misplacement of the eyelids

Dermatocalasy

Introduction.

The eyelids help to project our eyes and in normal circumstances, when they are doing their job properly, we do not pay any attention to them. They are essential to keep our eyes lubricated, to avoid irritation, to help clean particles from the surface of the eye also their reflex action protects against injuries.

Eyelid disorders

These are numerous . The eyelid can become inflammed, infected or tumours can form. Other disorders are caused by wrongly positioned eyelids or eyelashes. Among the most frequent we find:

Dermatocalasy

This is an eyelid condition associated with ageing, characterised by flaccidity of the upper lid ( sometimes the lower one too.) This will make the upper eyelid skin droop which can reach the lashes.

This loss of elasticity and stretchiness of the skin owing to age can cause functional alterations such as loss of visual field and stigmatism. The patient will have a sad, sleepy look. The only possible treatment is blefaroplasty which is outpatient surgery carried out under local anaesthetic. Superfluous skin is eliminated, the lid tightened up and any excessive fat is extracted.

 

Xantelasmas

These are yellowish plaques of cholesterol esters which appear on the internal palbebral angle of the eyelids. The cause isn’t clear although a high incidence has been noted when there are high levels of cholesterol in the blood. There are no symptoms, aesthetic treatment is by surgery but they do sometimes reappear.

Triquiasis and Distiquiasis

This is where the eyelid is in its normal position with respect to the eyeball but the lashes grow inwards, producing erosion of the cornea which can even lead to loss of sight.

This is where extra lashes grow outside the normal lashline thereby making a double line. This disorder has the same effect on the cornea as the previous one. Treatment in both cases can be surgical: electrocauterization in the operating theatre or else ablation of the lashes by argon laser.

Ectropión

This is an anomaly in the position of the eyelid, usually the lower one, which turns outward owing to a weakness in the tendons joining the lid to the orbital bone. As a result the lid peels away from the eye thereby leaving it exposed to dryness, irritation, red eye, and sometimes secretions. There are various causes, the most frequent being senile involution. It can also be associated with traumas, burns, skin cancer and facial paralysis. Treatment is usually started with artificial tears and lubricating creams to protect the cornea. If this isn’t effective outpatient surgery is carried out using a local aneasthetic. Depending on the cause, it will consist of trying to reinstate normal palbebral anatomy by bringing back tension to the lower lid , using surgery together with a tarsal strip.

Entropión

This is the opposite to Ectropión as the eyelid and lashes turn inwards touching the eyeball. There are various causes, the most frequent being involution related to age. The symptoms are pain, a feeling of a foreign body, tears and sometimes corneal ulcers which can cause loss of sight.Treatment depends on the cause. There are various surgical techniques all of which tend to reinstate the palpebral anatomy to its correct position.

Ptosis

This is where the upper eyelid droops down, affecting just one or both eyes and it will obstruct sight in cases where it covers the visual axis. There are two common types, one happening to the child the other to the adult. In the first case, it will be noticible from birth and is usually caused by malfunction or insufficient movement of the lifting muscle in the upper lid controlled by opening the eye. In the adult, it it is usually caused by a displacement of this lifting muscle from its correct position. Patients have varying degrees of droopping lid and of holding their head back in order to be able to see. Apart from being unaesthetic in the adult, it can cause a permanent visual deficit in the child if it covers the visual axis in the early stages of its life. Treatment in most cases is surgical, trying to repair the tendon of the lifting muscle so that the eye can open fully. There are various techniques, each one having a specific indication. Among them we have: reinsertion of the aponeurosis of the lifting muscle, cutting back of the lifting muscle or pullling up of the frontal muscle.

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