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Eyelid Malposition

What are the causes of eyelid malposition?

Patients born with normal eyelids may, over time, experience a change in the position of their eyelids that affects their appearance or function and even causes vision problems. For example, the eyelid can turn inwards and cause the eyelashes to rub against the eye, a condition called entropion. The eyelid can also turn outwards and cause the eye to be irritated or tear excessively, a condition known as ectropion. 

One of the most common eyelid malpositions occurs when the eyelids become droopy or heavy. This can be due to excess eyelid skin (dermatochalasis), sagging eyebrows (brow ptosis) or weak eyelid muscles (blepharo-ptosis, also known as ptosis, pronounced TOE-sis). This condition occurs when muscles that open the eyelid become weak or stretched, causing the upper eyelid to sag. It can affect one or both eyes. While some people are born with ptosis, others develop ptosis with age, after injury, or as a result of neurological or muscular disorders. People with ptosis may develop headaches from straining to keep their eyes open, and in more serious cases, find that their vision is blocked.

How are droopy eyelids treated?

The first step to correcting droopy eyelids is a thorough evaluation to determine the factor(s) causing droopy eyelids including, dermatochalasis, brow ptosis, and blepharoptosis. A patient can have one or multiple conditions, which contribute to droopy eyelids. While each condition requires a different surgical treatment, the oculoplastic surgeons at New York Eye and Ear Infirmary of Mount Sinai (NYEE) may treat multiple conditions at the same time.

  • A blepharoplasty, surgical removal of excess eyelid skin and fat, is the name for the surgery to treat dermatochalasis.
  • In contrast, ptosis cannot be corrected simply by plastic surgery that removes excess eyelid skin. The eyelid muscles must be re-connected during surgery to raise the eyelids.
  • Similarly, a browlift may be necessary when brow ptosis is the main factor causing eyelid heaviness.

Only oculoplastic surgeons have the extensive training required to recognize and surgically correct all of the various causes of a “droopy lid.” 

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