William L. White, MD
Blepharoplasty is a surgery typically done to remove redundant skin on the upper eyelid, which is referred to as dermatochalasia. Such changes are typically the normal result of aging, but can have a hereditary component. If the excess skin obstructs vision, which typically occurs when the excess upper lid skin rests on the eyelashes, a upper blepharoplasty will normally improve overhead vision significantly.
Blepharoptosis is the medical term for drooping of the upper eyelid, a condition that may affect one or both eyes. (This is different than dermatochalasia.) When the edge of the upper eyelid falls, it may block the upper field of your vision. The drooping may be mild, with the lid only partially covering the eye, or severe, with the lid completely covering the pupil. Ptosis can present at any time in life, from birth through senescence. Since it is noted at birth, it is referred to as congenital ptosis.
In children, the most common cause is improper development of the levator muscle, the major muscle responsible for elevating the upper eyelid. With adults, it may occur as a result of aging, trauma or muscular or neurologic disease.
As you get older, the tendon that attaches the levator muscle to the eyelid can stretch and allow the eyelid margin to fall and cover part of the eye. It may become bothersome enough to warrant surgical repair. The goals of ptosis surgery are elevation of the upper eyelid to improve the field of vision, permit full visual development in children, and to establish more symmetry with the opposite upper eyelid.
Ectropion is an outwardly turned or loose eyelid. The sagging lower eyelid leaves the eye exposed and dry. As a result, excessive tearing and early morning discharge from the eye is common with ectropion.
The surgery to repair ectropion is usually performed as an outpatient procedure under local anesthesia. Most patients will feel that their lower lids are too tight immediately after repair, but they typically will loosen significantly over the first few weeks following the procedure.
Entropion occurs when the eyelid turns inward, with the lashes rubbing against the eye. This can cause the eye to become irritated, red, and sensitive to light and wind. Left untreated, this can cause irreversible loss of vision. There are some eyelid problems that only need to be corrected if they bother the patient. This is a problem that always has to be corrected because of the risk of vision loss that will not be regained with delayed intervention.
The surgery to repair entropion is most commonly performed as an outpatient procedure under local anesthesia. Most patients will feel that their eyelid has been rolled out too far immediately following the surgery, but the eyelid has a tendency to roll back in as it heals.