Eyelid malposition: causes, symptoms and treatment
Written in association with:
Ophthalmologist
Published: 16/08/2021
Edited by: Conor Lynch
Eyelid malposition is the medical term used to refer to an abnormal or incorrect alignment of one or both eyelids. If left untreated, the condition may lead to serious eye consequences such as corneal ulceration.
Top Doctors recently spoke with highly esteemed ophthalmologist, Mr Colin Vize, to learn more about the condition, its various different causes and symptoms, and how best to treat it.
What is eyelid malposition?
Eyelid malposition is a general term for any condition where the eyelid itself is in the wrong place. It can either be droopy, turning in or turning out. As a consequence, the patient can be symptomatic due to ocular discomfort.
The eyelids are designed to protect the eye, and so, if they are in the incorrect place, they are not going to be able to serve the purpose for which they were designed.
Why and how does eyelid malposition occur?
Sometimes, patients can find themselves in a situation where they have become uncomfortable due to a weakness of one of the eyelid muscles or tendons. It is particularly common in the elderly when gravity takes its toll and things tend to consequently sag.
The upper eyelid can droop and cause ptosis. The lower eyelid, which acts as a gutter, can become lax which leads to tears rolling down one’s face. Some children are born with the eyelids in the wrong place, which may cause problems and ultimately require surgical correction.
What are the main symptoms of eyelid malposition?
The most common symptoms that patients report are watery eyes, foreign body sensation and blurred vision.
Another issue is a feeling of embarrassment due to people experiencing watery eyes and non-emotional tears, especially in breezy environments.
How common is the condition?
An element of eyelid malposition is very common in the elderly but is relatively rare in younger people apart from congenital defects.
What are the different types of eyelid malposition?
The main types would be either if the eyelid is turning out, which is known as an ectropion, or if the eyelid is turning inwards, which is an entropion. The other condition that is commonly associated with eyelid malposition is ptosis, where the upper eyelid has a malposition, resulting in it being lower than it should be.
The upper lid acts as a shutter, and opens and closes on a very regular basis, in order for our eyes to blink. Sometimes, however, the muscle that lifts the eyelid can become a little weaker, or indeed the tendon could perhaps stretch. As a result, the lid itself sits in a lower position and can cause a bit of blurred vision as a result.
What are the main causes?
Eyelid malposition can be caused due to age-related issues, as previously mentioned, and can also occur due to scarring.
The other main cause is mechanical eye malposition, whereby, if you had a growth, it pulls the eyelid downwards due to gravity, and so the lid can sit in the wrong position as a result.
What is the most severe form of eyelid malposition?
One of the worst, most severe eyelid malpositions is an entropion (the eyelid turning inwards) because the eyelashes are turned inwards as well as the eyelid itself.
The eyelashes, in this case, then rub against the eye and cause constant eye irritation. It’s like having a rough wind-screen wiper rubbing against your eyeball all the time.
If left untreated long enough, it could cause an ulcer on the cornea, which would require immediate and intensive treatment.
How should it be treated?
Conservative measures are always an option, as a temporary solution, such as giving artificial tears as a barrier and to keep the eye comfortable. In general, the solution for the majority of eyelid malposition is oculoplastic surgery.
The eyelid will often require tightening or turning in or out, or lifting, depending on the underlying pathology.
Mr Colin Vize is a highly experienced ophthalmologist who specialises in eye conditions and eyelid malposition. If you are concerned in any way with regards to the health of your eye(s), you can book a consultation with him by visiting his Top Doctors profile.