If eyes are windows to the soul, then eyelids may be considered their guardians. Eyelids protect the eyes from dust and dirt and their blinking action prevents the eyes from drying out. There are various eyelid problems commonly encountered, both in the young and old. These problems include ptosis, entropion, ectropion and epiblepharon as well as a variety of lumps and bumps.
What is Ptosis?
In this condition, the upper eyelid is droopy and is in an abnormally low position. Most commonly, this occurs as a change related to ageing, or as a congenital problem present at birth. In senile ptosis, surgery may be considered when it blocks vision significantly. Congenital ptosis surgery should be considered if it causes problems like amblyopia (lazy eye) or significant astigmatism. Surgery can also be considered for cosmetic improvement.
What is Entropion?
This is a condition where the eyelid is turned inwards abnormally, causing the eyelashes to rub against the delicate cornea. The common causes include senile changes (usually involving the lower lids) due to old age and eyelid scarring resulting from certain infections or burns (usually affecting the upper lids). Entropion causes the eyes to become red, irritated and teary. If neglected, it can be predisposed to infections of the cornea and cause irreversible scarring to the cornea. Various surgical procedures are available to correct both upper and lower lid entropion conditions.
What is Ectropion?
Usually affecting the lower lids, ectropion is a problem where the eyelid margin turns outwards, preventing proper closure of the eye. It may cause symptoms of redness, tearing and irritation. This is commonly associated with a stroke or weakness of the facial nerve (e.g. Bell's palsy). Eyelid laxity as a result of ageing can also cause ectropion. Surgery to correct the laxity and inward turning may be performed, with good cosmetic results.
What is Epiblepharon?
Often affecting young children of Chinese descent, epiblepharon is an abnormality of the eyelids consisting of an excessive fold of eyelid skin physically pushing the eyelashes inwards. It may irritate the cornea, giving rise to symptoms of tearing, redness and even itching in some patients. As it may naturally resolve itself when the child grows older, surgery is usually not done till the child is 7 or 8 years old, unless it is very severe.
What are "lumps and bumps"?
These are common features and they could be either cancerous or harmless. Frequently seen lumps and bumps include styes, cysts and moles which can be easily treated. For the elderly, a recent appearance or recent progression of an existing lump should be taken seriously as it may indicate a malignant cancer.
Surgery for eyelid problems
Most eyelid surgery can be performed as day surgery under local anaesthesia for adults and general anaesthesia for children. Minimal care is required after surgery, usually gentle cleansing of the operation wound once a day and an antibiotic ointment two to three times a day will be sufficient. The operation wound may be slightly swollen and red for a few days but usually little pain is expected. Most patients can return to work within a week or two. Stitches are taken out generally five to seven days after surgery.