Malposition of the eyelid should be kept in mind as a possible cause of recurrent ocular inflammation in an elderly person.
Ectropion should be treated before conjunctival hypertrophy or corneal ulcers develop.
Entropion should be treated before corneal ulcers develop.
Symptoms and signs
The lower lid is more frequently affected. With advancing age the connective tissue in the lids becomes loose, the amount of adipose tissue decreases, the skin becomes thin, and its flexibility decreases.
Entropion
The lid is inverted. The eyelashes turn inwards and rub the ocular surface, causing pain or a feeling of a foreign body, tear-flow and erythema of the conjunctiva.
As the irritation continues, opacities and ulcers develop on the cornea predisposing to secondary infections.
The condition is usually associated with advanced age.
May occur in associated with scarring of the conjunctiva or also in younger patients (e.g. immigrants) caused by chronic infection (e.g. trachoma).
Ectropion
The eyelid is everted. Either the lid margin or the whole tarsus of the lid may be malpositioned. As the conjunctiva is exposed it becomes irritated, erythematous and hypertrophic.
At a later phase ulcers can develop on the cornea.
(Bilateral) senile ectropion of the lower lid is the most common lid abnormality.
Facial nerve palsy may cause paralytic ectropion of the lower lid (m. orbicularis oculi, which is responsible for closing the eyelids, is innervated by the facial nerve).
Scars in the skin (trauma, burn or chemical injury) may cause scar traction and eventual ectropion of the lower eyelid.
Treatment
Both in entropion and ectropion, the patient should be prescribed symptomatic moisturizing eye drops which reduce corneal desiccation and decreases the injurious effect of the eyelashes on the cornea.
Traction with tape can alleviate the symptoms of entropion temporarily: a butterfly tape is applied on the lid skin to keep the lid in the correct position.
Both entropion and ectropion should be treated surgically. Surgery is not necessary if the malposition is only mild but if it becomes symptomatic (irritation, tearing, redness, recurrent conjunctivitis or keratitis), surgery is indicated.
Surgery should be performed at an early phase.
Entropion should be corrected before the cornea is damaged.
Ectropion should be corrected before conjunctival hypertrophy develops.