Ectropion is the most common lower eyelid malposition. It is often an ageing change resulting in eyelid laxity allowing the lid to sag away from the eye. Mild cases may not visibly turn away from the eye but can cause tearing, irritation, and/or dryness of the cornea. More severe cases will result in the eyelid truly turned away from the eye.

Symptoms may include excessive tearing, chronic irritation, redness, pain, a gritty feeling, crusting of the eyelid, mucous discharge, and in extreme cases breakdown of the cornea.

Ectropion most commonly results from ageing changes causing tissues to stretch and the eyelid to loosen. However, it may also occur from facial weakness (from Bell’s palsy, stroke, or other neurologic conditions), trauma, skin scarring, previous surgeries, or eyelid tumours.

Entropion is the term used to describe rolling inward of the eyelid. Once turned in, the eyelid and eyelashes rub against the eye, usually causing significant irritation, redness, and sensitivity to light and wind. If left untreated, chronic entropion can cause corneal scarring and loss of vision. If entropion exists, it is important to have it fixed before permanent damage to the eye occurs.

Like ectropion, the most common cause of entropion are laxity and ageing changes. However, trauma, scarring, inflammatory conditions and eyelid tumours can also result in entropion.

Entropion should be repaired surgically before the rubbing damages the cornea by causing infection or scarring.

Temporary measures including taping the lower lid to mechanically evert the lid and Botox therapy to weaken the orbicularis muscle may be used prior to definitive surgical repair, or in patients who are not well enough for surgery.

Definitive treatment of entropion requires surgical repair. Most commonly, the eyelid is tightened at the outside corner of the eye and the retractor muscles are tightened to restore and stabilise the eyelid to its normal position. Approaching both anatomical components significantly improves surgical success and reduces recurrence.

The surgery is performed as a day procedure and often results in rapid resolution of the eyelid malposition. Bruising can be expected for up to 2 weeks. In the vast majority of cases, after the eyelid has healed the small scar from this minimally invasive procedure should barely be noticeable. The eye will feel comfortable and should be protected from further irritation and rubbing as the eyelid will be returned to its anatomical position.

Ptosis (pronounced “toe-sis”) is the medical term for an abnormally low or droopy upper eyelid. It is different from dermatochalasis, which is the medical term for excess skin of the upper eyelid, although both are often present in the older population.

Patients often raise their eyebrows or adopt a “chin up” head position in an effort to increase their field of vision. In advanced cases, people need to lift their eyelids with their fingers to see, particularly at the end of the day. Patient often complain of heavy lids and a restriction of vision or headache due to the low upper lids blocking their field of view.

The most common cause of ptosis is age related weakening or stretching of the major muscle that lifts the eyelid, the levator muscle.

It is important to be evaluated for the rare causes of ptosis including certain neurologic diseases (myasthenia gravis, cranial nerve palsy, myopathy), trauma, or congenital weakness. Ptosis may become more apparent following refractive or cataract surgery.

Most cases of ptosis can be corrected surgically, usually by tightening the levator muscle. Occasionally, in severe cases with poor eyelid muscle function, other techniques such as frontalis suspension may be required.

The surgery is performed as a day procedure with local anaesthetic and sedation. Bruising can be expected for up to 2-4 weeks.

The goal is to raise the eyelid to allow for improved visual field and to increase symmetry with the opposite upper eyelid. It is helpful to expect an improvement in appearance and symptoms rather than a complete change in appearance.

Dermatochalasis is the medical term for excess skin of the upper eyelid. The excess skin can, at times, hang over the eyelid margin and thereby block the pupil. Patients often raise their eyebrows in an effort to raise the drooping excess skin. In severe cases, people may need to lift their eyelids with their fingers to see. While surgery to correct mild cases of dermatochalasis is considered cosmetic, cases where a patients visual field is restricted or when the excess skin is resting on the eyelashes is considered to be non-cosmetic by Medicare.

The most common cause of dermatochalasis is age related weakening or stretching of the skin and deeper tissue overlying the upper eyelid.

Dermatochalasis can be corrected by blepharoplasty surgery, which predominately involves the removal of excess skin. Removal and/or sculpting of underlying bulging fat is often performed to achieve the best aesthetic outcomes, resulting in a more youthful appearance.

A thin incision in created in the natural skin crease and the thin scar is usually barely noticeable once the lid has fully healed. The surgery is performed as a day procedure with local anaesthetic and sedation. Bruising can be expected for up to 2-4 weeks.

The goal is to remove the excess skin to allow for improved visual field and reduced heaviness, It is helpful to expect an improvement in appearance and symptoms rather than a complete change in appearance.

Blepharitis is a common, chronic inflammation of the eyelid. There is often a sandy or itchy feeling of the eyes, especially in the morning. There is usually a redness, as well as inflammation of the eyelid with scaling, deposits or discharge.

It is important to note that treatment can often take up to a month, may be ongoing and require occasional follow up.

The most common treatment is the use of antibiotic ointment and daily cleaning of the eyelids (with baby shampoo). To do this, first dilute a few drops of baby shampoo into a small bowl of warm to hot water, then with a cotton bud gently wash and wipe the eyelids. This should be done once at night and once in the morning.

Once the lids have been washed and allowed to dry, apply the antibiotic ointment following the instructions given.

A chalazion is a chronic inflammation of a gland in the upper or lower lid.

Often the affected area can become swollen, painful and inflamed until a cyst forms. There may be blurring of vision caused by pressure from the cyst distorting the eye.

In some cases, the cyst may settle with conservative treatment, which involves hot compresses and antibiotic ointment applied to the affected area.

If persistent, the chalazion is cut and drained under local anaesthetic, followed by the use of an antibiotic ointment for one week.

Recurrent chalazion are frequently associated with chronic infection of the lid. The infected area should be treated with antibiotic ointment daily for a month or more and cleaning of the eyelid with a cotton bud dipped in warm after and a little baby shampoo. Causes of the infection should be investigated and treated.

Ectropion repair is tailored to the underlying cause of the malposition.

Most commonly, the eyelid is tightened at the outside corner of the eye and may include tightening of the lax retractor muscles to restore and stabilize the eyelid to its normal position.

The surgery is performed as a day procedure and often results in rapid resolution of the eyelid malposition. Bruising can be expected for up to 2 weeks. In the vast majority of cases, after the eyelid has healed the small scar from this minimally invasive procedure should barely be noticeable. The eye will feel comfortable and should be protected from exposure and corneal scarring, as the eyelid will be returned to its anatomical position.