Lower Lid Malposition

What Is Lower Lid Malposition?

Lower lid malposition is a relatively common condition that refers to abnormal positioning of the lower eyelids. This condition can create noticeable cosmetic issues and also lead to a number of different visual problems that can become serious as time progresses. Lower lid malpositions can cause decreased vision due to tearing, pain, or infection.

There are distinct types of lower eyelid malposition. The two most common forms are entropion and ectropion. With entropion, the eyelid turns inwards and causes the eyelashes to brush against the cornea, which can damage it. An ectropion lower eyelid turns outward, causing irritation and affecting the eye’s ability to remain lubricated.

Lower lid retraction is a downward pulling of the lid that exposes more of the white portion of the eye (sclera). When severe, the eyes have trouble closing, called lagophthalmos, and may be chronically irritated due to dryness.

What Causes Lower Eyelid Malposition?

Relaxation of tissue from aging is the primary cause of malpositions with the lower eyelid. Over time, the skin can begin to sag and pull the eyelids away from the eye. Paralysis of the facial nerve from conditions such as Bell’s palsy can also cause the eyelid to sag, as can facial trauma, scarring, and complication from certain surgeries.

Symptoms of Lower Eyelid Malposition

Symptoms and signs include:

• The feeling of something being stuck in the eye
• Tearing
• Breakdown of the cornea
• Mucous secretions
• Crusting around the eyelid
• Poor distribution of tears over the cornea
• Burning sensations
• A feeling of grit in the eye
• Reddening of the eyelid and the conjunctiva
• Increased white showing between the iris (colored part of the eye) and eyelid margin

What Are the Treatment Options for Lower Eyelid Malposition?

Eyelid malposition is typically treated with reconstructive surgery in order to reposition and/or anatomically and functionally reconstruct the eyelid. This is often achieved with an outpatient procedure that tightens the eyelid and returns it back to its normal positioning. In some cases, implanting skin grafts to cover areas of the eye that are left exposed as a result of retraction may be required as well.

When surgery is not considered a viable option, lubricating drops and ointments may be prescribed instead. Botulinum toxin can treat certain spastic conditions and temporary sutures are an additional option that may be effective in some instances.