When is an Eyelid Surgery for Malposition Needed?
Eyelid malposition is not uncommon and can affect both men and women. It can be caused by age-related laxity of the eyelid tissue, weakness of the eyelid muscle (e.g. Bell’s palsy, facial paralysis), previous eye or eyelid surgery/trauma/burn, scarring of the skin or conjunctiva, infections, and inflammatory disorders (e.g. ocular cicatricial pemphigoid).
The malposition can take various forms including entropion (eyelid turning inwards with the eyelashes brushing against the eye), ectropion (eyelid turning outwards), and retraction (eyelid drooping downwards). Any of these conditions can cause eye irritation, tearing, and even pain and reduced vision.
Eyelid surgery for entropion is performed by providing structural support to the lower lids through tightening of the tendons and the lower eyelid soft tissue. This usually involves tiny incisions hidden in a laugh line in the outer corner of the eye and immediately under the eyelashes. Sometimes excessive lower eyelid skin and muscle may be removed if it is contributing to the structural instability of the lower eyelid and thereby the entropion. If the entropion is caused by scar tissue on the under surface of the eyelid (conjunctiva), other membrane grafts may be needed. At your comprehensive evaluation, Dr. Shannon S. Joseph will assess the cause of your entropion and work with you to design a surgical plan tailored to your needs.
Eyelid surgery for ectropion is performed by providing structural support to the lower lids through tightening of the tendons and the lower eyelid soft tissue. Often the incision is hidden on the under surface of the eyelid. Some patients with ectropion due to skin scarring may require skin grafting and a skin incision hidden in a wrinkle/scar or just under the eyelashes. In patients with heavy cheeks which are pulling down on the lower eyelids, thus contributing to the ectropion, surgical repair may be performed in conjunction with a midface lift to provide further support to the lower eyelids.
Eyelid surgery for lower eyelid retraction is performed by addressing the cause of the retraction. This may include simply performing horizontal tendon tightening to address eyelid laxity, autologous tissue graft to provide vertical structural support, midface lift to address heavy midface pulling down on the lower lid, and skin grafting for eyelid retraction caused by skin scar tissue from prior surgery, burn, or trauma. Additional information is available from the American Academy of Ophthalmology EyeWiki about entropion and ectropion.
Eyelid surgery for malposition may be performed with patients awake, under twilight anesthesia, or fully asleep. We individualize the plan for anesthesia based on patient preference, whether additional procedures are planned, and the patient's overall health.
Surgical recovery varies from person to person, but most patients can return to work within a week after surgery. Most patients experience only mild discomfort and do not need strong pain medications. Following surgery, most patients will be seen in the office approximately 5-10 days later to evaluate healing. Bruising and swelling will be present after surgery. Minor swelling can persist for a number of weeks. If desired, most patients may begin wearing eye makeup following the first appointment after surgery.
Please refer to our additional resources for general pre-operative and post-operative instructions.
In most cases when the eyelid malposition affects the health of the eye and function of the eyelid and causes symptoms such as eye irritation and redness, insurance typically covers these procedures. At your consultation, Dr. Joseph will perform the testing and measurements necessary for your insurance to review and confirm your eligibility for coverage.
Schedule a Consultation
If you are having irritation of your eye and think you may have eyelid malposition, please contact us to schedule a personal consultation with Dr. Joseph. She will listen to your concerns and perform a comprehensive evaluation to determine the cause of your symptoms. She will then develop a surgical plan to address any eyelid malposition you may have in order to protect the health and function of your eyes and vision. We take care of patients from Troy, Birmingham, Bloomfield Hills, West Bloomfield, Rochester Hills, Rochester, and the rest of Metro Detroit and Southeastern Michigan.