Types and what happens to the eyelid
The edge of the eyelid is held in the correct position by muscles, ligaments and a dense cartilage plate. With age, the ligaments stretch, the muscle that closes the eyelid shifts, and the edge may roll inward or droop outward. Scar processes after burns, injuries and chronic conjunctivitis shorten the back surface of the eyelid and pull it inward. Facial nerve paralysis, on the contrary, deprives the eyelid of tone, and it moves away from the eye. In newborns, there is sometimes an extra fold of skin that curls up the eyelashes.
- Age-related (involutional) - the most common option
- Cicatricial - after burns, injuries, trachoma
- Spastic - against the background of prolonged inflammation and squinting
- Paralytic eversion - with facial paralysis
- Congenital - epiblepharon in children
- Mechanical - for tumors and edema of the eyelid
Causes and risk factors
The main factor is age: after sixty, the tissues of the eyelid lose their elasticity, and the likelihood of the edge shifting increases. The second major block of causes is scarring of the conjunctiva: the consequences of chemical and thermal burns, severe allergic and infectious conjunctivitis, previous trachoma, and some skin diseases. Separately, there are neurological causes and consequences of eyelid surgery, when too much skin is removed. Chronic blepharitis and frequent squinting support spastic volvulus.
- Age-related weakening of the eyelid ligaments
- Burns and conjunctival injuries
- Past trachoma
- Facial nerve paralysis
- Eyelid surgery, including cosmetic surgery
- Chronic blepharitis and long-term inflammation
Symptoms
During volvulus, a person describes the feeling of a speck that cannot be removed: the eyelashes scratch the cornea with every blink. The eye turns red, waters, photophobia and a desire to constantly rub the eyelid appear, which only aggravates the situation. With eversion, the main complaint is incessant lacrimation running down the cheek, since the lacrimal punctum no longer touches the eyeball. The open conjunctiva dries out, thickens and turns red, and the skin under the eye becomes irritated from constant moisture.
- Sensation of sand and foreign body in the eye
- Redness and tearing
- Photophobia and frequent blinking
- Mucous discharge
- Constantly wet skin under the lower eyelid when everted
- Decreased vision due to corneal damage
Diagnostics
The diagnosis is made during a routine examination, but it is important to evaluate the condition of the cornea: it is stained with a special dye to see pinpoint damage and erosions that are not visible to the naked eye. The doctor checks the tone and mobility of the eyelid using simple techniques, determines whether there is a sprain, and finds out the type of violation - the choice of surgery directly depends on this. In case of lacrimation, the patency of the lacrimal ducts is checked so as not to miss their obstruction as an independent cause.
- Slit lamp examination
- Staining the cornea with dye
- Eyelid stretch and tone tests
- Assessment of the position of the lacrimal punctum
- Rinsing the lacrimal ducts for lacrimation
- Examination by a neurologist for suspected facial paralysis
Treatment
Conservative measures are temporary: moisturizing drops and gels protect the cornea, a soft therapeutic contact lens reduces friction, a strip of plaster can briefly hold the eyelid in the desired position. Epilation of individual eyelashes growing towards the eye gives a break, but the eyelashes grow back. A radical solution is eyelid surgery: the surgeon shortens and tightens the stretched structures, and in the case of a scar form, compensates for the lack of tissue with a graft. The operation is performed under local anesthesia on an outpatient basis. The sooner the eyelid position is restored, the lower the risk of irreversible changes in the cornea.
- Moisturizing drops and gels to protect the cornea
- Therapeutic contact lens for severe irritation
- Epilation of eyelashes for trichiasis
- Surgical eyelid surgery is the main method
- Treatment of blepharitis and chronic inflammation
- Observation by an ophthalmologist after surgery
