Eyelids. Diseases of the eyelids: description, symptoms and treatment features

Mechanism of appearance and ICD-10 code for eyelid deformities

The pathology is accompanied by tucking of the skin. There are two deformations: entropion - inversion and ectropion - outward.

Eversion of the lower eyelid - code according to the international classification H02.0 - is more common. The situation is explained by the structure of cartilage. In the lower ones they are smaller. Cartilage is easily subject to pathological changes under the influence of unfavorable factors of the external and internal environment. The deformation leads to a cosmetic defect and the development of secondary complications.

The causes and characteristics of deformations are identified.

Ectropion

Ectropion of the eyelid is a pathological condition of a loose fit of the edge of the eyelid to the eye. An eversion occurs. Main causes:

1. Senile form, resulting from involutional changes in the ocular apparatus.
2. Pathological changes in tissue - loss of elasticity, skin tone - around the eye lead to the development of the disease.
3. Eversion associated with chronic inflammatory eye diseases. Blepharitis and conjunctivitis provoke spasm of the musculus periorbitalis.
4. Congenital ectropion is caused by a violation of formation in the embryonic period.
5. Volvulus may be one of the manifestations of Down syndrome, Miller syndrome, or lamellar ichthyosis.
6. The defect occurs after unsuccessful plastic surgery, which is accompanied by the removal of a skin flap and the placement of a large implant in the cheeks.
7. Autoimmune connective tissue diseases: SLE, dermatomyositis, scleroderma.

Ectropion is provoked by injuries, burns, tumors.

Both deformities have similar symptoms:

1. Excessive tearing.
2. Severe swelling, maceration of the pathological area.
3. Unpleasant sensations in the form of a foreign body.

Meibomian gland diseases

Meibomitis is an inflammation of the meibomian glands in the cartilage of the eyelids. It occurs due to the penetration of coccal flora into them. It occurs acutely and chronically. In this case, there is a thickening of the edge of the eyelids and its hyperemia. Enlarged and thickened yellowish meibomian glands are visible through the conjunctiva. Yellowish crusts form at the ciliary edge. The secretion of the meibomian glands, if it enters the conjunctival cavity, can cause chronic conjunctivitis.

For treatment, lubricate the eyelids with alcohol or a solution of brilliant green. Instillations of antibiotics and dexamethasone are prescribed. Lubricate the skin with antibiotic ointments. In some cases, the abscess is opened surgically.

A chalazion is a dense formation in the cartilage of the eyelid, resulting from chronic inflammation of the meibomian gland. The simultaneous formation of several chalazions is possible.

At first, a chalazion is a small nodule, gradually increasing to 5-6 mm or more. The skin above it is raised, the eyelid is somewhat deformed. When pressed, a painless dense formation is determined. The conjunctiva in the area of ​​formation is raised, thickened, and hyperemic. In the future, thinning or perforation of the conjunctiva is possible, releasing the contents of the chalazion.

In treatment, instillations of hydrocortisone emulsions and antibiotic solutions are used. Ointments are prescribed: hydrocortisone, maxitrol, and dry heat. Injections of dexamethasone or Kenalog solution into the chalazion are necessary. If there is no positive effect, surgical treatment is performed. Small chalazions, in rare cases, resolve on their own.

By contacting the Moscow Eye Clinic, each patient can be sure that some of the best Russian specialists will be responsible for the results of treatment. The high reputation of the clinic and thousands of grateful patients will certainly add to your confidence in the right choice. The most modern equipment for the diagnosis and treatment of eye diseases and an individual approach to the problems of each patient are a guarantee of high treatment results at the Moscow Eye Clinic. We provide diagnostics and treatment for children over 4 years of age and adults.

Causes of pathology

Ectropion can develop due to:

1. Rarely occurring congenital pathological conditions in which the volume of muscles and the area of ​​the skin of the eyelids is less than necessary for a tight fit of the latter to the eyeball. One example is Down syndrome.
2. Paralysis of the facial nerve or cerebrovascular accident with the development of hemiparesis. With these diseases, ectropion of the lower eyelid often develops, since the innervation of the facial muscles is disrupted and, accordingly, their tone decreases.
3. Age-related changes in the subcutaneous tissue, skin and muscles, as a result of which they lose their tone and elasticity with the simultaneous gradual development of gravitational ptosis of the soft tissues of the face.
4. Systemic autoimmune connective tissue diseases (ichthyosis, systemic lupus erythematosus, scleroderma, dermatomyositis, etc.).
5. Cicatricial deformation of tissue in the periorbital region and in the eye area. Scars can develop after mechanical trauma or burns.
6. Plastic surgery on the face. Due to the frequent plastic surgeries on the face in recent years, eyelid inversion after blepharoplasty has become the most common complication. It can be caused by both cicatricial changes after transconjunctival blepharoplasty and removal (usually by a surgeon with insufficient practical experience) of a piece of skin whose dimensions exceed the possible area of ​​the skin flap in a particular patient, resulting in open areas of the sclera. In addition, ectropion of the eyelids can occur as a result of severe ptosis of the tissues of the buccal areas with depression of the soft tissues of the periorbital area, not only due to their involutive changes, but also as a result of surgery with placement of implants in the buccal areas.
7. Inflammatory processes accompanied by increased tone (spasm) of the periorbital muscle (blepharitis, conjunctivitis, dry eye syndrome).
8. The presence of a tumor in the orbital or facial area.

Eversion of the upper eyelid, compared to the lower eyelid, is much less common, which is due to some differences in their anatomical structure. The cartilage tissue contained in the eyelids in the form of a plate gives them a certain density and configuration. In the lower ones, the cartilaginous plates are thinner and their density is less than in the upper ones, which provides the latter with a higher degree of resistance to changes in position and deformation. How to correct lower eyelid inversion?

Congenital eversion

An extremely rare pathology explained by the shortened dimensions of the cutaneous-cartilaginous plate of the lower eyelid. Often combined with other autoimmune diseases.

If the deformity is not clearly expressed, the disease does not require treatment. Surgical intervention to narrow the distance to the ciliary edge is carried out only in case of a significant deviation from the norm.

For example, when a child sleeps, a gap is noticeable, during the day the baby is bothered by constant lacrimation, and vision decreases.

Spastic eversion

This form of the disease develops as a result of chronic inflammatory processes occurring in the area of ​​the eyelids and conjunctiva.

Such conditions lead to constant tension in the muscle fibers and spasm of the orbicularis oculi muscle.

Mechanical eversion

Mechanical ectropion is a displacement of the eyelid under the pressure of a volumetric neoplasm formed in the eye area.

Most often, the pathology occurs in elderly patients. Correction of deformity is possible only after removal of the formation.

Paralytic ectropion

Paralytic ectropion is a drooping eyelid due to paralysis of the facial nerve and decreased tone of the facial muscles.

Treatment methods and prognosis will depend on the cause and persistence of the condition. If the condition worsens temporarily, you can get by with the prescription of moisturizing medications to prevent the cornea from drying out.

With complete paralysis of the facial nerve or progression of the disease, surgical intervention is indicated.

Cicatricial eversion

In this case, we are talking about pulling outwards and shortening the eyelid plate as the skin scars at the site of the scar maturation.

Pathology is diagnosed at any age. The main reason is trauma, burns, surgery and some skin diseases.

Treatment is surgery to excise the scar followed by correction of the eyelid position. If the deformity is severe, skin grafting may be required.

Other diseases

Ankyloblepharon - with this defect, a partial reduction of the edge of the eyelid occurs. Sometimes this disease occurs in newborns, but it also happens that this disease occurs as a result of scarring. In this case, the treatment of eyelid diseases consists of surgical intervention.

Ptosis is one of the most dangerous diseases of the upper eyelid. Such a defect is identified by the following symptoms: the upper eyelids in an unnatural shape fall down in relation to the eyeball. Basically, this disease appears as a result of damage to the motor nerve of the eye.

To get rid of such a disease of the eyelids (eyes), a whole range of measures is used, this is surgical intervention and parallel medical therapy.

Classification

The classification of forms of entropion of the upper and lower eyelids is determined by the causes of the disease. There are two types of entropion - congenital and acquired.

• Congenital is diagnosed from childhood, it manifests itself if there is a genetic tendency;
• Acquired volvulus can occur for a number of reasons. These are injuries, tumors, weakening of the eyelid muscles, and a number of diseases of vital systems.

There are 4 types of acquired entropion:

• Mechanical - appears as a tumor complication. New growths cause tissue to grow and distort the eyelids. When treating mechanical entropion, the main goal is tumor removal. Then you can correct the shape of the eyelid, and it will take an anatomically natural position.
• Cicatricial - with this form of the disease there is a scar that appears between the eyelids and the mucous membrane of the eye (conjunctiva). The cause of cicatricial volvulus is trauma, burns (including chemical ones), and severe inflammation. The condition gets worse quickly, and this form of eyelid disease progresses markedly if left untreated.
• Spastic - occurs only on the lower eyelids. It occurs from constant inflammation of the mucous membrane in combination with contraction (spasm) of the retractor of the eyeball. The cause of spastic entropion may be a decrease in the palpebral fissure, the cause of which was surgery or the application of a tight bandage on the eyes. Spastic entropion may be almost invisible at a quick glance at a person. The deformation is visible only when the eyeballs move and with a certain position of the eyes (if they are deep-set).
• Senile - can appear in older people who have severely weakened muscles and cartilage that hold the eyelids in a normal position. With age, the skin stretches, the muscles become weaker - as a result, the eyelash edge turns inward. Entropion is more common in the lower eyelids of both eyes.

Entropion of the lower eyelid is diagnosed more often than the upper eyelid (the causes of the disease do not affect the statistics). This happens because the cartilage on the lower eyelids is almost twice as weak and smaller as compared to the upper ones. That is, they are easier to injure and more vulnerable to deformation.

Allergic diseases of the eyelids

Allergic dermatitis is an erythematous-exudative disease of the eyelids that occurs under the influence of allergenic medications or cosmetics. Develops within 6 hours from the onset of exposure to the allergen. It occurs with increasing hyperemia and swelling of the eyelids, vesicular or bullous rashes, which can cause maceration of the skin.

During treatment, the suspected allergen is eliminated. Use topical corticosteroids (without antibiotics). Desensitizing agents are prescribed internally.

Eczema is an inflammatory lesion of the eyelids, with itchy rashes of an erythematous-vesicular nature. As a rule, the course is chronic.

The eyelids are hyperemic, swollen, covered with small blisters. After opening them, serous exudate remains. The exudate dries into straw-colored crusts. Gradually, inflammation occurs, the stratum corneum is restored, and the skin takes on a normal appearance. Prolonged course of eczema can lead to thickening of the eyelid and its inversion, persistent loss of eyelashes.

To treat the acute stage, lotions made from cold lead water and boric acid solution are used. As the inflammatory reaction subsides, ointments with corticosteroids are used.

Diagnosis of ectropion

Ectropion of the century is easy to recognize on your own. During examination, the ophthalmologist confirms the diagnosis, identifies signs of complications, and establishes the causes and form of the pathology.

The type of pathology is determined by the results of an external examination and mechanical manipulation of the eyelid: for example, with cicatricial ectropion, scars from tissue damage are visible; the eyelid can be returned to the anatomically correct position if the skin is pulled to the side.

Most neoplasms can also be seen with the naked eye.

Paralytic ectropion is additionally indicated by a decrease or complete loss of sensitivity in the skin around the eyes.

Horizontal weakness of the eyelids can be detected by pulling the skin 8 mm away from the eyeball in the middle of the eyelid. In this case, the skin will return to its original position only after blinking.

Weakening of the lateral (outer) angle is recognized by the rounded shape of this part of the palpebral fissure. In addition, the outer corner can be pulled inward by only 2 mm.

Weakening of the medial (inner) angle can be determined by pulling the lower eyelid outward. With a slightly pronounced ectropion, the lowest point touches the limbus, with a more significant eversion - the pupil of the eye.

Diagnostics

The patient can suspect the development of the disease on his own. Just look in the mirror. The ophthalmologist subsequently only confirms the diagnosis and prescribes a series of examinations to identify the cause of the disease and select appropriate treatment.

Biomicroscopy and visometry are mandatory. The first procedure involves a non-contact examination of the organ of vision using a slit lamp. The second technique is prescribed to determine eye acuity using special tables.

Clinical manifestations

The formation of symptoms of ectropion of the eyelid is caused mainly by a violation of the mechanism of outflow of tear fluid. It participates in the metabolic processes of the eyes, moisturizes the conjunctiva of the eyes, protecting it from drying out, and protects against the ingress of foreign particles. Tears are produced in the required volume by the corresponding glands, the ducts of which open mainly under the upper, and in small quantities under the lower eyelids.

Renewal and the impossibility of lacrimation (in the absence of emotional reactions) are ensured by the constant circulation of tears along the lacrimal ducts. Excess fluid enters the lacrimal sac through the lacrimal openings, located at the inner upper and lower parts of the eye, and from there through the nasolacrimal canal into the nasal cavity.

The above causes of the disease lead to lag of the ciliary edge (usually the lower one), drying out and irritation of the conjunctiva, which in turn causes additional production of tear fluid and its accumulation due to displacement of the lacrimal punctum or cicatricial deformation of the outflow tract. The prolonged existence of an eversion of the eyelid gradually leads to keratinization and thickening of that part of the conjunctiva that is tightly fused to the cartilage of the eyelid. At the border between them there are additional lacrimal glands.

The outflow of 90% of the tear fluid passes through the lacrimal punctum located on the lower eyelid, which is what causes the main clinical manifestations of ectropion in these areas:

1. Continuous tearing.
2. Frequent blinking due to a constant sensation of a foreign body, “sand” in the eye.
3. The symptoms of conjunctivitis are the presence of injected (dilated) vessels, redness of the eye and a moderate burning sensation associated with irritation during constant mechanical removal of tears and the development of infection.
4. Redness and maceration of the skin under the eye.
5. Further development of symptoms of keratitis with subsequent clouding of the cornea and a significant decrease in visual acuity.

The severity of symptoms depends on the above reasons that caused the pathological condition and its severity. The latter is characterized as weakly expressed if there is only a loose fit to the conjunctiva of the eyeball, and significant - with a visually noticeable eversion of the mucous membrane, which can be approximately 1/3 of the eyelid (partial eversion) or along its entire length (complete eversion).

Infectious diseases

Inflammation of the eyelids almost always accompanies eye diseases, since these formations are connected through a common conjunctiva and have a common innervation and blood supply system.

The subcutaneous tissue of the eyelids is very loose, and it is penetrated by a large number of capillaries, so swelling easily forms here, and redness is clearly visible. These phenomena accompany bacterial, viral and allergic conjunctivitis.

However, the tissue of the eyelids can become inflamed in isolation from eye diseases in humans.

Formation of boils

Most often, various types of staphylococci provoke purulent inflammation of the hair follicle or sebaceous glands. A painful nodule full of purulent contents forms on the eyelid in the area of ​​the eyebrows. Inflammation covers adjacent tissues, they turn red and swell. After some time, a purulent tip appears on the nodule. It can be of different colors - from white to yellow-green. A person feels a pulsation around the boil, local and general body temperature may increase, headache and weakness may appear. When the boil spontaneously breaks out, these symptoms quickly disappear, and scars form in the place of the former abscess. Furunculosis of the century requires the use of antibacterial drugs, since it is a dangerous source of bacteria and their toxins near the brain. When several abscesses accumulate, they speak of a carbuncle of the century. Since their healing also occurs with scarring of necrotic areas, as a result, eversion of the eyelid or its shortening may occur.

Barley

Gordelum is similar to a boil, but is localized in the hair follicles of the eyelashes and the adjacent sebaceous glands, and therefore is found on the edge of the eyelid. There is also an internal form of the disease, in which the meibomian glands on the inner surface of the eyelids become inflamed. In any case, the disease is characterized by the formation of a purulent head surrounded by a zone of hyperemia. The edge of the eyelid is swollen and painful.

Since the disease is caused by bacteria (Staphylococcus aureus), treatment is carried out with ophthalmic forms of antibiotics - drops or ointments.

Abscess

This is the name for the melting of tissue in purulent diseases, while the abscess has clear boundaries. This extensive infectious process occurs when penetrating wounds of the eyelids become infected, infection spreads from a boil or barley, or sinus empyema. The eyelid swells significantly, the skin is hot to the touch, the formation is dense and painful. Often the swelling affects the surrounding areas, and the nearest lymph nodes become painful. An abscess may rupture spontaneously. This is a dangerous condition because infection of the retrobulbar space and cerebral sepsis can occur.

Phlegmon

This is an extreme degree of purulent inflammation, which is diffuse in nature. This condition is caused by an increase in the infectious process from boils, barley, insect bites, and lacerations.

The easy formation of phlegmon on the eyelids is facilitated by loose subcutaneous tissue. The symptoms are pronounced. This is pain, skin flushing, fever, chills, the eyelid is dense and hard to the touch. The transition of the inflammatory process to neighboring areas threatens them with sepsis. Medical assistance is required.

Erysipelas of the eyelids

This infection is caused by group A beta-hemolytic streptococcus, but rarely occurs primarily on the eyelids.

Erysipelas on the eyelids usually spreads from the scalp or face

At the site of inflammation, a feeling of itching and burning appears, bright redness with torn edges. This area is painful, the skin is tense and hot to the touch. The disease leaves behind pigmentation, peeling, and dry, dense crusts. The eyelid may remain swollen for a long time due to lymphostasis. The general condition is disturbed: the temperature rises, the head hurts and is dizzy, the lymph nodes are inflamed. Complications of a septic nature are possible - the formation of ulcers, abscesses, and areas of necrosis on the skin. The infection can go further and cause conjunctivitis, keratitis, optic neuritis, periostitis of the orbit, and inflammation of the meninges.

Shingles

This disease, caused by the varicella zoster virus, affects nerve and epithelial skin cells anywhere in the human body. Regarding eyelid disease, we are interested in herpes zoster ophthalmicus - a lesion of the superior branch of the trigeminal nerve. Initially, pinkish spots appear along its course, then bubbles, which, after opening, leave behind scabs. Skin rashes can also be located on the eyelids, causing secondary infection with bacteria or fungi, and causing deformities. But the greatest threat is hidden, of course, inside - shingles is dangerous due to damage to the cornea, retina, postherpetic neuralgia of the oculomotor and optic nerve.

Molluscum contagiosum

Another viral disease that affects the skin of the eyelids. Characteristic is the formation of small nodules that rise slightly above the skin. They are smooth and have a color similar to the color of the skin or a little more pink. When the nodule “ripens”, a small depression appears in the center, and when pressed, a loose whitish rod, similar to wax, emerges from it. These formations are painless and disappear on their own within six months.

The infection is contact, so the disease, having occurred in one eyelid, can spread to the other if they are rubbed or scratched. The tubercles must not be damaged. If touched, the skin area must be disinfected and hands washed with soap. If the contents of the nodule suddenly fall on the eyeball, it can cause keratitis or conjunctivitis.

Actinomycosis

In addition to bacteria and viruses, fungus radiata can cause damage to the eyelids. Usually it is present in the human oral cavity and does not harm him, but when the immune system is weakened, actinomycetes can give rise to the development of the disease. Fungal infection occurs not only of the eyelids, but also of other auxiliary structures of the eye, especially the lacrimal canals. In a humid environment (in the corner of the eye), the fungus is especially active. Here its colony can form, which provokes tissue necrosis and fistulas. Fungi weaken local protective factors, and actinomycosis is often accompanied by a bacterial infection.

Chalazion

This is the name for hardening that occurs as a result of proliferative inflammation at the edge of the eyelid around the meibian glands or cartilaginous framework. The reason for this formation is the obstruction of the mouth of the gland and the retention of its secretion inside.

The chalazion is painless; upon palpation, it is felt as an elastic round formation that is not fused to the skin.

Blockage of the gland is possible due to hypothermia, poor hygiene, decreased immunity, as well as increased production of secretions from these glands.

Under unfavorable conditions, the chalazion can fester, which will lead to pain, swelling, and a local increase in temperature.

Treatment of ectropion of the eyelid

Treatment may be:

1. Conservative or symptomatic.
2. In the form of a full-fledged surgical correction - blepharoplasty for eversion of the eyelid.

Conservative therapy

It is shown only when:

• weak severity of the defect;
• presence of contraindications for surgical treatment;
• the need to treat the underlying disease (paralysis or paresis of the facial nerve, damage to connective tissue due to systemic autoimmune diseases, tumors in the orbital area, etc.), which is the cause of ectropion; in this case, the result of treatment of the underlying pathology is the spontaneous elimination of eversion of the mucous membrane.

Treatment

The type of treatment for eyelid inversion depends on the cause of the pathology and the stage of its severity. All treatment methods can be divided into three groups:

• Combating the factor that provoked the appearance of ectropion;
• Symptomatic therapy;
• Surgical intervention.

When surgery is not needed

Not in all cases, it is necessary to go under the surgeon’s knife to eliminate an eversion. You can cope with conservative therapy. Indications for such treatment are the following factors:

• The clinical picture is weak;
• There are contraindications for surgical intervention;
• To get rid of ectropion, it is enough to cure the underlying pathology.

Conservative therapy also includes taking medications aimed at alleviating the patient’s condition. Medicines minimize the risk of complications.

Additionally, the following methods are used:

• Gluing a patch at night that facilitates the process of closing the eyelids;
• Using moisturizing drops throughout the day to moisturize the mucous membrane;
• In advanced stages of pathology, the edges of the eyelids are sutured to protect the conjunctiva from drying out.

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Surgical treatment of eyelid inversion

Surgical intervention is prescribed for senile, cicatricial and mechanical (after removal of the tumor that caused the inversion) ectropion. The technique of the procedure depends on the age of the patient and the condition of the tissues of the organ of vision.

During surgical intervention, the main attention is paid to a number of points:

• Presence of scars;
• The reason for the development of pathology;
• The level of flexibility of the ligaments that support the corners of the organ of vision;
• The condition of soft tissues, their redundancy or deficiency.

The correction is carried out by an ophthalmologist-surgeon or a specialist in the field of plastic surgery. The main purpose of the operation is to return the deformed eyelid to its correct position and fix it. Before the intervention, a consultation with a doctor is required, and you will also need to undergo a number of diagnostic measures:

• Blood and urine analysis;
• Electrocardiogram;
• Chest X-ray.

Medicines to relieve symptoms

Additionally, in order to alleviate the unpleasant symptoms of entropion, the doctor may prescribe the following medications:

• Moisturizing drops: Visine, Systane, Lacrisify, Vidisic, Hilo-Komodo, Lacrisin, natural tear. They restore the integrity of the tear film and eliminate irritation of the mucous membrane. Usually available in the form of eye drops.
• Keratoprotectors: emoxipin, Korneregel, blepharogel. Prevents the development of dry eye symptoms and restores damage to the surface of the cornea.
• Gels with dexpanthenol. Accelerates the healing of postoperative wounds.

The patient's condition can be temporarily alleviated by special patches that are glued to the skin and pull back the rolled-up eyelid. Most often they are used in the case of senile entropion.

Some patients with entropion prefer to use soft contact lenses because they prevent eyelashes from damaging the cornea.

How is diagnosis carried out?

Some patients may need additional consultation with a neurologist.
An ophthalmologist diagnoses an entropion in a person. Depending on the etiology, consultation with a neurologist may be required. The doctor listens to complaints and studies the medical history for possible provoking factors and prescribes diagnostic methods, such as:

• biomicroscopy using a contrast agent;
• visometry;
• Norn test to determine the strength of the tear film.

Is surgery necessary?

Surgery is the only treatment for entropion that can eliminate entropion.

There are a number of methods for treating different stages of entropion, all of which are surgical. This can be the application of sutures that pull the eyelid to its natural anatomical position, excision of a small strip of skin on the eyelids, changing the shape of the orbicularis muscle of the eyeball, etc. In each case, the technology is determined individually, depending on the form of the disease, its severity, and medical history.

There is only one radical way - surgery. Without it, you can relieve symptoms and slow down the development of entropion, but these are temporary measures.

It is impossible to cure eyelid entropion with medication: there are simply no drugs that will “force” the eyelash edge to take the correct position. Medicines make it easier to prepare for surgery and speed up recovery after it, but without surgery you will not be able to recover.

In order for the surgical intervention to be as effective as possible and recovery after it to be quick, it is worth using auxiliary methods (on the recommendation of an ophthalmologist):

• medications whose action is aimed at restoring the cornea. They form a natural protective film, which allows you to quickly restore all functions of the eyelids after surgery;
• patches used to mechanically move the eyelid into the correct position. They simply fix the tissue so that the eyelashes cannot come into contact with the eyeball. Physically it is not very comfortable and looks rather strange, but the method shows good effectiveness, especially in childhood;
• contact lenses-films allow you to create an additional barrier between the eyelids and the mucous membrane. The lenses are soft enough not to damage or irritate the cornea, but at the same time dense enough to prevent eyelashes from injuring the eyeball.

Reasons why the eyelids become inflamed

First of all, it is worth noting that there are a huge number of reasons why eyelid inflammation occurs, but most often such a defect is provoked by the following factors:

• Micromite bite. These insects are mainly located in human hair or skin. And this can happen due to a decrease in human immunity.
• Human sensitivity to various environmental factors. The overwhelming majority of irritants are: low-quality decorative cosmetics, animal hair and even house dust.
• If a person has a defect such as farsightedness and does not use glasses, then in such a situation the eye muscles will be constantly in a tense state. As a result, the person will begin to suffer from constant itching, which will make him want to rub his tired eyes. And when you rub your eyes, there is a high probability of getting an infection, which provokes an acute form of blepharitis.

In these cases, the eyelids also suffer. Eyelid diseases can be caused by other factors.

Defects in the digestive system provoke metabolic failure. Therefore, in the vast majority of cases, blepharitis is detected against the background of diabetes mellitus, colitis and gastritis. And the whole point is that due to these ailments, a person experiences disruptions in the normal functioning of the sebaceous glands located between the eyelashes, which increases the risk of developing inflammation of the eyelids.

But at the same time, the above list will be incomplete if we do not indicate the following defects, which in the overwhelming majority become the culprits of inflammation of the eyelids, namely:

• failure in the lacrimal layer of the cornea;

• the presence of viral infectious diseases of a chronic nature;

• staphylococcus or streptococcus of the ocular membrane;

• an infection in body fluids or teeth that can penetrate the eyes and cause inflammation of the eyelids;

• eye burn of chemical origin;

• sustained eye injury;

• a progressive inflammatory process in the nasopharynx or nasal sinuses.

In these cases, the eyelids become inflamed. Diseases of the eyelids can appear as a result of overstrain due to prolonged reading or prolonged work at the computer.

Surgical correction of lower eyelid inversion

Surgical treatment is indicated for age-related changes, the presence of post-traumatic, thermal or chemical post-burn scars, complications of blepharoplasty performed previously (for aesthetic purposes), or the introduction of cheek implants, etc.

The operation for inversion of the lower eyelid consists mainly of removing scars, strengthening the muscular-ligamentous apparatus and/or restoring an area of ​​tissue with a skin flap in case of its deficiency. For these purposes, various techniques and their modifications are used - operations according to Kunt-Szymanovsky, Blashkovich, Imre, Filatov, Ficke and others.

The choice of technique is made based on taking into account the degree of eversion of the mucous membrane, the area of ​​excess skin, as well as on the basis of determining the degree of such signs as:

• horizontal weakness of the eye tissues, which is characterized by their failure to return to their original position after the central part has shifted from the eyeball by 0.8 cm or more;
• tendinous weakness of the medial canthus, which is determined by pulling the lower eyelid outward. In this case, the location of the lowest point is recorded. In the absence of pathology, the latter moves no more than 2 mm; with moderate weakness it reaches the edge of the cornea, with severe weakness - the pupil;
• tendinous weakness of the lateral canthus is characterized by its rounded shape, while it is possible to displace the lower soft tissues of the lower parts of the periorbital region in the medial direction (toward the nose) by more than 2 mm.

Classification. What can be ptosis of the upper eyelid?

So, as we found out above, ptosis of the upper eyelid can be unilateral or bilateral, complete or partial, congenital or acquired. The last two characteristics indicate the cause of the pathology. Thus, the factor due to which ptosis appeared from birth may be underdevelopment of the eye muscles or even the absence of the muscle responsible for raising the eyelid. There are many reasons for the acquired type. Ptosis of the upper eyelid is divided into the following types: Aponeurotic ptosis, the development of which is caused by stretching or weakening of the aponeurosis - a connective tissue plate that lifts the muscles of the upper eyelid.

• Mechanical ptosis that occurs during the deformation of the eyelid due to ruptures, the presence of a foreign body or scar.
• False ptosis is a form that is observed with significant hypotonia of the eyeball or strabismus, as well as due to the presence of excessive skin folds in the upper eyelid.
• Age-related ptosis of the upper eyelid is considered a natural physiological process, since as a result of aging of the body, both muscles and ligaments weaken.

• Neurogenic ptosis, the development of which is caused by diseases such as encephalitis, stroke, multiple sclerosis and other pathologies of the nervous system.

We will focus our attention on pathology of the neurological type and understand the characteristics of the type and methods of its treatment.

If lower eyelid entropion occurs in a child

In infants under 1 year of age, bloat occurs quite often, and this does not always mean the presence of a genetic predisposition.

Due to age, the muscles that hold the eyelid in its normal position may simply not be fully developed. This does not mean that you will necessarily have to “cut”; you can often get by with a set of conservative methods:

• use a patch that will fix the eyelid in the correct position. The difficulty is that small children (this method is best used before reaching 1 year old) simply do not allow it to stick;
• use a special gel that will protect the cornea and minimize its damage by the deformed ciliary edge;
• use antiseptics that help maintain eye hygiene when they become sour. For this, herbal decoctions (pharmaceutical) or a weak solution of baby shampoo that does not irritate the mucous membranes are used.

The combination of these techniques in many cases gives positive results - the position of the eyelid is completely normalized, and surgery to remove the entropion is not required. In this case, a systematic approach and implementation of all the ophthalmologist’s recommendations play a key role.

The effectiveness of the measures taken (or ineffectiveness) appears at approximately 11-12 months of age, and the ophthalmologist makes a decision on the need and extent of surgical intervention.

Inversion of the lower eyelid in a child can also appear at an older age. It is important to diagnose entropion in time to avoid problems with vision, which develops in childhood.

One of the clearest characteristic signs of entropion is that the child begins to pull his chin up and raise his head to see some object (the field of view is significantly reduced due to interfering eyelashes).

Rehabilitation after blepharoplasty for ectropion of the eyelid

Rehabilitation measures coincide with the general instructions for the patient after blepharoplasty: instillation of eye drops with a moisturizing and antiseptic effect; wearing sunglasses and using sunscreen cosmetics; performing gymnastics for the eye muscles. Do not wear contact lenses. You need to sleep on high pillows.

Visiting a bathhouse, sauna, or solarium is contraindicated. Alcohol, cigarettes, coffee are excluded. Physical activity is limited.

These prohibitions and restrictions must be observed for two months.

Blepharoplasty for the treatment of ectropion

The intervention takes from one to three hours, the duration depends on the form of the disease and the type of technique used. In addition to correcting the cosmetic defect, the process of tear drainage is corrected and the visible consequences of dislocation (hernia, excess epidermis) are eliminated.

Excision is carried out in places where natural folds of the skin form; special sutures are used, so the scars after surgery are practically invisible. Swelling and bruising persist for several weeks. To reduce negative symptoms, it is recommended to use cooling compresses.

The patient is left in the hospital for a day so that the doctor can monitor his condition. After discharge, you must visit the doctor on the specified days, he will monitor the process of tissue regeneration.

Contraindications for surgery

Surgical intervention has a number of limitations. Very often, correction is not possible in elderly patients. Also contraindications to blepharoplasty are:

• Diseases of the cardiovascular system;
• High blood pressure with frequent crises;
• Severe diabetes mellitus;
• Thyroid pathologies;
• Detachment of the retina;
• Dry eye syndrome.

If contraindications are identified, doctors select an alternative treatment option. Return to contents

Postoperative complications

In some cases, even surgery will not help to completely get rid of the inversion. After correction, a slight gap remains between the eyeball and the edge of the eyelid. This maintains the risk of developing ectropion again.

Patients may also encounter a number of negative manifestations after blepharoplasty:

• Penetration of infection into the wound;
• Seams coming apart;
• Formation of cysts in the skin area;
• Impaired functioning of the lacrimal glands;
• Drooping of the upper eyelid;
• Inability to completely close the eye;
• Bleeding from a postoperative wound.

In most cases, repeated surgery is required to eliminate complications.

Memo for the patient after ectropion surgery

To eliminate the risk of developing negative consequences during the rehabilitation period, it is important to follow some rules:

• Avoid visiting baths, saunas and other thermal procedures on your face for two weeks after surgery. This will help reduce swelling and bruising;
• Limit physical activity and bending for one month. Necessary for favorable resorption of swelling and tissue regeneration;
• Avoid direct contact of the organ of vision and sunlight for six months. It is also prohibited to visit the solarium. This will help eliminate the risk of pigmentation on the eye.

Forecast

With timely initiation of therapy or early blepharoplasty, provided that all postoperative recommendations are followed, the prognosis of the disease is quite favorable. The cosmetic defect is eliminated, visual acuity is restored, and the patient returns to a normal quality of life. However, in the case of severe pathology, the risk of relapse cannot be excluded.

Ectropion of the eyelid is a pathology that is not only a cosmetic defect, but also causes severe discomfort and can lead to partial or complete loss of vision. Modern treatment methods are effective and can prevent dangerous complications. Sometimes ectropion of the eyelid goes away on its own after treatment of the underlying disease. However, in most cases, patients require surgery.

Ectropion correction (video)

Treatment of entropion

Treatment for bloat can only be surgical . The main goal of the intervention is to ensure correct and complete closure of the eye during the blinking process. In addition, entropion is a noticeable cosmetic defect.

During the operation, the doctor cuts and sutures the necessary part of the skin flap or muscle fiber. The intervention is performed on an outpatient basis under local anesthesia.

LASIK - surgery to restore vision Why one eye is watering Fighting puffiness under the eyes

After surgery, a prophylactic course of antibiotic therapy is prescribed to prevent infection of the surgical wound. The following drugs are prescribed: erythromycin and tetracycline ointments, kolbiocin (a complex drug containing two antibiotics - chloramphenicol and rolatetracycline).

Prevention and prognosis

If the treatment was timely, the lower eyelid inversion goes away without aggravating consequences, so the prognosis is favorable. The addition of a secondary infection can lead to deterioration of vision, pathological changes in the iris, conjunctiva, and cornea. To prevent ectropion from occurring, you should eat properly, including foods containing collagen in your menu, and do exercises for the eye structures. It is not recommended to overuse cosmetic procedures, and before manipulating the eyelids, you should consult a doctor. It is also necessary to thoroughly clean the visual organs.