Rolled up eyelids. Lower eyelid inversion: effective treatment methods. Types and causes of extropion

A pathology of the adnexal apparatus of the eye, leading to incorrect positioning of the ciliary edge, is called eversion of the eyelid - ectropion. A disease affecting the lower or upper eyelid prevents it from adjoining the eyeball. As a result of this, it turns outward.

In the vast majority of cases, the disease affects the lower eyelid. This is due to the presence of thinner cartilage tissue. Pathological inversion of the lower or upper eyelid is possible after unsuccessful blepharoplasty.

The disease is divided into the following forms:

The rarest type is congenital. A child is born with a short musculocutaneous plate of the eyelid.
Spastic eversion. Spasm of the orbicularis muscles caused by an inflammatory disease.
Mechanical ectropion. The presence of neoplasms leading to eversion.
Scar form. Exposure to various external factors (burn, injury or surgery).
Paralytic form. Paralysis of the facial nerves, or an unsuccessful Botox injection.
Senile inversion of the upper and lower eyelids. Age-related muscle atrophy, weakening of tendons and thinning of fatty tissue.

There are two main diagnosable forms: mild (the eyelid moves slightly away from the edge) and severe (the eyelid turns out completely).

Unsuccessful blepharoplasty can cause ectropion.

Symptoms of the disease

The disease can be identified by characteristic changes in the shape of the lower eyelid. The patient exhibits the following symptoms:

uncontrollable lacrimation. Tear production is carried out by the lacrimal glands, which are also located in the lower eyelid. Eversion prevents the eyelid from joining the eyeball, so secreted tears do not enter the lacrimal sac, but flow out of the eyes;
redness is observed in severe form and appears against the background of conjunctivitis. As a result of this disease, the conjunctiva is deprived of protection and is susceptible to drying out. Insufficiently moistened mucous membranes are an excellent target for infections and inflammations;
the sensation of a foreign body or sand in the eye causes dryness and increased irritation of the membrane;
eroded area of skin. Appears when the patient constantly rubs his eyes with his hand or with a cloth of the upper eyelid;
inflamed cornea. In the absence of timely treatment, blurred vision and deterioration may occur;
Maceration of the eyelid occurs due to continuous lacrimation. A constantly wet eyelid becomes less durable and elastic.

With ectropion, a secondary infection may occur.

Diagnostic methods

Ectropion of the eyelid can be diagnosed independently. An examination by an ophthalmologist will help confirm the diagnosis, recognize complications, identify the cause and determine the form.

The diagnosis is established through visual analysis and certain actions (it is enough to return the skin to the correct position to determine the scar defect).

In the paralytic form, there is no sensation around the eyes. To identify horizontal weakness, the doctor pulls the skin from the center of the eyelid away from the eyeball by 8 mm. The skin will return to normal after blinking.

If the outer corner of the eye is retracted by no more than 2 mm, and the palpebral fissure has a rounded shape, this indicates its weakening. With a weakened inner corner, the eyelid pulled outward will touch its lowest point with the limbus or pupil.

Do not confuse lower eyelid inversion with inversion of the eyelid. These are two different pathologies.

Treatment options

In mild cases, to correct eversion of the eyelid, treatment may consist of compresses and ointments with an antibacterial effect. To avoid infection, the eyelid is fixed in its normal position using a patch. Often these are not long-term measures that precede surgery.

Atonic volvulus is eliminated by surgery. During the procedure, the surgeon normalizes the contact of the eyelid with the eyeball and restores eye closure during blinking. In a similar way, they get rid of the scar form of ectropion.

Correction of the paralytic type of eversion of the eyelid should begin with a consultation with a neurologist. In the process of getting rid of neuralgia, the function of the facial nerve is restored, and then the position of the skin.

In the mechanical form, the first step is to get rid of the tumor, and then normalize the position of the eyelid. The feeling that there is a foreign object in the eye can be removed with the help of eye drops prescribed by a specialist.

During surgery the following can be used:

Blepharoplasty (using a laser or scalpel).
Surgitron device. High-frequency radio waves dissolve damaged cells without damaging surrounding areas.

Possible complications

Mistakes made during surgery or improper further care can lead to unpleasant consequences:

scars and cicatrices;
hematomas;
bleeding;
infection;
itching at the site of the postoperative scar;
impaired functioning of the lacrimal gland;
burning sensation in the eyes.

If one of the above symptoms appears, you should immediately see an ophthalmologist.

Blepharoplasty should be performed by a professional and experienced doctor. Otherwise, complications may develop.

Traditional medicine recipes

Elderly people should take special care of their eyes. To do this, you can regularly do therapeutic massage and use traditional medicine recipes:

A daily exercise will help strengthen the eyelid and improve the health of the mucous membrane: fill a container with clean water at room temperature and dip your face in it. Then open your eyes and blink quickly a few times. Raising your face, blink a few more times. This manipulation is performed three times.
After washing your face after a night's sleep, prepare an infusion for lotions from 1 tbsp. linden blossom and a glass of hot water. Cool the broth, moisten a double cotton pad and place it on your eyelids for 5 minutes.

Rehabilitation measures

In order for the rehabilitation period to be favorable, certain indications should be observed:

instill eye drops prescribed by your doctor;
wear sunglasses;
perform a set of gymnastic exercises for the eyes daily;
use high pillows for sleeping;
do not use contact lenses;
eliminate bad habits and caffeine;
limit physical activity.

During the recovery period, it is strictly forbidden to visit the bathhouse, sauna and solarium. The duration of rehabilitation is two months.

The symptoms of ectropion are similar to entropion.

Forecast

Timely treatment, surgery and compliance with doctor's instructions can give a favorable prognosis. The cosmetic defect will disappear, sharp vision will return, and the patient will resume his usual lifestyle. However, in the presence of a severe pathological ocular form, relapse is possible.

Prevention measures

To prevent the disease, you should adhere to certain rules: periodically visit an ophthalmologist, promptly eliminate inflammatory processes, protect your eyes from mechanical damage and monitor hygiene.

If you follow preventive measures and consult a specialist at the first signs of the disease, you can avoid many problems caused by ectropion of the eyelid.

Sep 25, 2017 Anastasia Tabalina

Conjunctivitis is an ophthalmological disease in which the conjunctiva (mucous membrane of the eye) suffers from inflammation, swelling and hyperemia (severe redness). About 30% of all ophthalmologist patients consult doctors with such symptoms. In most cases, these patients are children, because they often rub their eyes with unwashed hands and suffer from colds. In both cases, bacteria and viruses enter the mucous membrane of the eye. Middle-aged people can also “catch” conjunctivitis, but their etiology of the disease is somewhat different, as are the symptoms.

Types of conjunctivitis

In ophthalmology, the term “conjunctivitis” refers to many different diseases that occur with inflammation of the eye mucosa.

“Rabbit eyes,” as conjunctivitis is popularly called, is a common ophthalmological disease.

So, all conjunctivitis is divided into

- depending on origin:

for endogenous (accompanying other diseases);
exogenous (arising after contact with a pathogen).

- depending on the current:

spicy;
subacute;
chronic.

- depending on the clinical form:

purulent;
catarrhal;
follicular;
filmy.

- depending on the etiology:

bacterial;
chlamydial;
viral;
fungal;
allergic and autoimmune;
for general diseases.

Let's look at the symptoms of individual types in detail.

Bacterial

Acute conjunctivitis alternately affects two eyes, and the disease occurs suddenly with sharp pain in the eyes.

Symptoms:

Sticking of eyelashes in the morning (explained by copious secretion, the nature of which quickly changes: first mucus, then mucus and pus, only pus);
Conjunctival hyperemia (redness);
Swelling of the eyelids;
Burning sensation;
Tearing.

The symptoms of chronic conjunctivitis do not appear as brightly as in the acute form, but they always increase in the evening. It is characterized by a long course with periods of improvement. Hypovitaminosis, diseases of the oral cavity, impaired outflow of tears, and inflammation of the nasal sinuses can contribute to the activation of the “dormant” disease.

Symptoms:

Burning, itching;
Sensation of the presence of a foreign body;
Increased visual fatigue;
Moderate redness of the eye mucosa;
The edge of the eyelid is framed by crusts (dried discharge).

Pneumococcal conjunctivitis is transmitted through household contact, so if a child attending a children's group gets sick, an epidemic begins. After the end of the incubation period (1-2 days), the acute phase begins.

Symptoms:

Swelling of the eyelids;
The presence of whitish-gray films on the mucous membrane of the eyelids and on the lower fornix (they are easily removed with a cotton swab).

Diphtheria conjunctivitis is a rather rare type of disease (occurs in unvaccinated children and adults). It is often combined with diphtheria of the upper respiratory tract.

Symptoms:

Severe swelling;
Sealing of the eyelids and their pain (it is almost impossible to turn the eyelids out);
When the eyelids are opened, a cloudy liquid interspersed with flakes is released;
Gray plaque-film on the edges of the eyelids (it is very difficult to remove them; they disappear on their own after 7-10 days).

The species is fraught with damage to the sclera and the possibility of the formation of star-shaped scars.

Gonococcal conjunctivitis develops in adults suffering from gonorrhea (through the introduction of the pathogen into the eyes), in persons in contact with a patient with gonorrhea and in newborns (infected at the time of birth if the mother has gonorrhea). The disease progresses rapidly and without treatment leads to corneal perforation.

Symptoms:

Swelling of the eyelids;
Bright red conjunctiva;
Copious discharge from the eye;
The conjunctiva gathers into protruding folds.

In newborns, the symptoms are somewhat different: gonoblennorrhea develops on days 2-5; bloody-purulent discharge pours out of the eye when pressing on the palpebral fissure, the eyelids are swollen. A dangerous complication of this type is damage to the cornea and the formation of a cataract.

Acute epidemic conjunctivitis affects entire families and children's groups, and it occurs in all countries with warm climates. You can become infected through dirty hands, clothes, etc. Even flies can carry pathogenic bacteria.

Symptoms:

The duration of the disease is 5-6 days.

Angular conjunctivitis is transmitted through household contact and is distinguished from others by frequent painful blinking. Patients are also concerned about discharge in small volumes, reminiscent of stringy mucus. It accumulates in the corners of the eye, forming waxy crusts.

Chlamydial

Trachoma is considered a social disease and today it is found only in countries where people live overcrowded and poor. Paratrachoma, the second type, is diagnosed much more often. Both children (infection occurs at the time of childbirth from a sick mother) and adults can suffer from it, and the routes of infection can be very different. This includes infected water in swimming pools and dirty hands.

It occurs more often in young women (20 to 30 years old). In most cases, chlamydial conjunctivitis affects one eye.

Symptoms:

Redness and swelling of the eyelids;
Enlargement of the parotid glands (appears after 3-5 days);
The mucous discharge is scanty at first, then the purulent is abundant;
At 2-3 weeks, numerous non-scarring follicles form on the conjunctiva;
Hearing loss and ear pain may be bothersome.

Viral

Experts suggest that more than half of cases of inflammation are caused by viruses. Among eye infections, the leading positions are occupied by adenoviral and herpetic infections, which often occur in the form of epidemic outbreaks.

Adenoviral conjunctivitis has two viral forms.

Pharyngoconjunctival fever (incubation period 7-8 days). An acute viral disease, often found among preschoolers and primary schoolchildren. For the first 2-4 days, only general clinical manifestations bother you: rhinitis, fever, enlarged lymph nodes.

Then conjunctivitis occurs - one- or two-sided with characteristic symptoms: swelling of the eyelids, light mucous or mucopurulent discharge. In the membranous form, grayish-white films may form; in the follicular form, small or large follicles appear on the mucous membrane of the eyelids.

Epidemic keratoconjunctivitis (incubation period 4-7 days). Mostly adults suffer from this contagious disease. Distinctive features of this type of conjunctivitis: duration is up to 2 months, after recovery immunity remains. Symptoms: general malaise, enlarged lymph nodes, sharp redness of the eyelids, pinpoint hemorrhages, multiple small follicles on the conjunctiva, non-purulent discharge, possibly temporary decreased vision, a feeling of clogged eyes.

Herpetic conjunctivitis, often detected in childhood, is characterized by a sluggish and prolonged course, with frequent relapses. In most cases, one eye is affected. There are three clinical forms. The symptoms of the catarrhal form are similar to acute conjunctivitis, the follicular form is characterized by rashes on the conjunctiva of the lower eyelid, and with the vesicular-ulcerative form, tender films are formed that cover erosions, lacrimation and photophobia are noted.

Fungal

About 50 species of fungi pose a danger to the human eye, including yeast-like fungi, dermatophytes and mold mycetes. They migrate to the mucous membrane of the eye from mycotic foci on the skin, damaging the conjunctiva and cornea.

Conjunctivitis of fungal etiology often occurs in people with weakened immune systems. There are two subtypes of the disease:

Granulomatous conjunctivitis is characterized by hyperemia of the conjunctiva, the appearance of dense yellowish grains or superficial ulcers with a greenish coating on the mucosa. Lymph nodes with this type of conjunctiva always enlarge (pus accumulates in them).

Exudative conjunctivitis is caused by yeast-like fungi Candida. The main symptom of the disease is pseudomembranous plaque on the hyperemic conjunctiva.

Allergic

They occur due to genetically determined sensitivity to certain allergens. Allergic conjunctivitis can be combined with atopic dermatitis, bronchial asthma, and allergic rhinitis.

Variations of allergic conjunctivitis:

Spring catarrh. Often develops in boys 5-12 years old due to increased sensitivity to ultraviolet rays. Symptoms are most pronounced in the summer, regressing in the fall: foreign body sensation, photophobia, pale upper eyelid interspersed with dense large papillae.
Drug-induced conjunctivitis can occur due to the use of eye drops and systemic medications. It can manifest itself either acutely (immediately after using the medicine) or subacutely (during long-term treatment). Main symptoms: severe itching, burning, erosions on the conjunctival mucosa, copious mucous or filmy discharge, subconjunctival hemorrhages may occur.
Hay fever is a seasonal manifestation of allergies caused by flowering grasses and other natural phenomena. Hay fever is combined with damage to the skin and upper respiratory tract. The onset of the disease is acute, there is unbearable itching, severe swelling of the conjunctiva, and a clear, thick discharge.
Hyperpapillary conjunctivitis occurs with prolonged contact of the conjunctiva with a foreign object, including contact lenses. The symptoms of the disease are similar to those of spring catarrh.

Treatment

Depending on the causes of the occurrence, ophthalmologists use various medications. However, it is not therapy that is initially prescribed, but the pathology that provoked conjunctivitis is eliminated (first the direct causative agent of the infection is eliminated, and then its painful consequences).

In general, treatment of conjunctivitis involves frequent eye rinsing with medicinal solutions and the use of eye ointments and drops.

Stye on the eye and methods of its treatment

Barley is a limited purulent inflammatory process of an infectious nature in the eyelid area. The official name of this disease is hordeolum, but the term “stye”, associated with the appearance of the inflamed eyelid, is no less widespread in the medical literature, and is also much more commonly used and familiar among the people.

Symptoms and types

Typically, the first symptoms of stye are:

slight burning sensation;
redness in the eyelid area;
discomfort when blinking.

These phenomena progress quite quickly, and within a short time other signs of the disease begin to appear. The most typical of them:

the presence of a cone-shaped abscess in the form of a swelling with a yellow spot on the eyelid;
pain when touched;
severe redness and significant local swelling of the eyelid;
lacrimation is common;
feeling of a foreign body in the eye.

Barley is classified according to its location:

outer;
interior.

With external barley, the abscess is located on the outside of the eyelid, and is usually caused by inflammation of the ciliary hair follicles, less often of the small sebaceous glands of Zeiss.

With internal barley, the so-called meibomian glands and the cartilaginous plate of the eyelid become inflamed. In this case, the abscess with a yellow spot is located on the inner surface, and in order to see it, you need to turn the eyelid outward (it is clear that this can be difficult due to pain and swelling).

External stye is much more common than internal stye. Internal stye is characterized by greater pain and slower development of symptoms.

According to the number of ulcers, barley can be:

single;
multiple;
occur in one eye;
or be two-sided.

According to the nature of the course, this disease can be:

sharp;
recurrent;
chronic.

Related material: How to avoid styes

Reasons for appearance

The immediate cause of stye is an infection, most often bacterial, and more than 90% of all cases of the disease are due to Staphylococcus aureus.

Staphylococcus aureus often causes barley.

Much less often the disease is caused by:

streptococci or other bacteria;
fungi;
microscopic demodex mites.

In addition to infection, a weakening of the body's immune system plays a major role in the development of the disease. This factor is especially important in cases of multiple styes, as well as in chronic or recurrent course of the disease.

Material on the topic: Barley during pregnancy

Predisposing factors for the development of this pathology may be diseases such as:

diabetes;
vitamin deficiencies;
HIV infection;
seborrheic dermatitis;
furunculosis;
stress;
general exhaustion of the body;
eye diseases similar in localization: conjunctivitis, blepharitis, etc.

Possible complications

Complications with barley occur quite rarely and are usually associated with:

the presence of concomitant diseases;
weakened immune system;
with poor eye hygiene;
illiterate self-medication.

Regarding the last point, it should be especially noted that in no case should you squeeze out the stye with your hands - otherwise this can lead to the spread of infection and the occurrence of severe complications, such as:

phlegmon of the orbit:
thrombosis of the cerebral sinuses;
purulent meningitis;
sepsis, etc. - up to death.

Other possible consequences include:

chronicity and relapse of the disease;
transfer of infection to the other eye;
chalazion - a painless swelling on the eyelid, sometimes requiring surgical removal.

Treatment at home

In many cases, stye goes away without drug treatment - it is enough to maintain eye hygiene:

do not wipe the sore eye with your hands, so as not to spread the infection to other areas;
do not use makeup until complete recovery;
clean purulent discharge and dry crusts that form with a cotton swab dipped in water.

You can also lubricate the problem area of the skin of the eyelids with ordinary brilliant green. However, if there is no improvement within 3-5 days, or, on the contrary, the barley increases in size, then it is necessary to begin treatment to avoid complications.

The term eversion of the eyelid defines its incomplete adherence to the eyeball. In the literature, the name of the condition ectropion of the eyelid is also found. The pathological condition occurs in people of all ages, including children. It is most often registered in people over 45 years of age. Eversion is not only a cause of cosmetic defect and psychological discomfort, but can also lead to the development of complications, including visual impairment.

Ectropion of the lower eyelid is accompanied by the appearance of several characteristic symptoms, which include:

Lacrimation caused by irritation of the mucous membrane of the conjunctiva and sclera in the area of incomplete closure. Also, the appearance of the symptom is due to the fact that normally in a person, tear fluid washes the eye and forms a “stream” that flows between the lower eyelid and the eye. The fluid accumulates below in the inner (medial) corner of the eye, where it is absorbed in the lacrimal openings. If there is insufficient adhesion, the tear fluid “leaks out” in the outer (lateral) angle.
Skin irritation resulting from systematic exposure to tear fluid against the background of increased lacrimation.
Subjective sensation of the presence of a foreign body in the eye (“grain of sand”).
Hyperemia (redness) of the conjunctiva of the eye, the appearance of (injections) of blood vessels on the sclera, which indicates blood stagnation and the development of an inflammatory reaction.

The change is often accompanied by a noticeable cosmetic defect, which is characterized by a loose junction and an “everted” lower eyelid.

Causes

The main function of the eyelids is to protect the eye from the negative effects of various environmental factors. Due to the tight fit and blinking, uniform hydration of the eyeball is maintained. The fit is ensured by the presence of a cartilaginous frame, which is more pronounced in the upper eyelid. Ectropion of the century is a polyetiological condition. This means that its development occurs due to the influence of several reasons, which include:

Age-related changes that often develop in the lower eyelid, which is associated with fewer cartilaginous structures. This is also affected by a decrease in muscle tone and a decrease in the number of elastic fibers in the skin. Age-related changes lead to the gradual development and intensification of eversion of the eyelids of both eyes over a long period of time.
Scar changes are the formation of connective tissue cords that have less elasticity compared to surrounding tissues after injuries (cuts, chemical or thermal burns), surgical interventions (blepharoplasty). Scars can cause the formation of not only eversion, but also volvulus.
Paralysis of the muscles that maintain tissue tone, which occurs as a result of impaired innervation - the condition often develops after a cerebral stroke or optic neuritis.
Mechanical impact - the formation of a tumor formation (benign or malignant tumor) in the eyelid area leads to their stretching and loose fit to the eye.
Systematic inflammatory processes in the structures of the eye, leading to changes in the condition of the tissues of the appendages.
Hereditary predisposition - the condition of the tissues, tone, and rate of destruction of the cartilaginous frame are determined by the corresponding genes, which are inherited from parents to children. This factor predetermines the development of the condition in an elderly person.

Due to the anatomical features, as well as the presence of a more developed cartilaginous frame, inversion of the upper eyelid develops very rarely.

Knowing the causes allows the doctor to select effective treatment and preventive measures.

Diagnostics

Ectropion of the eyelid can be suspected based on the appearance of characteristic changes and clinical symptoms. The severity of changes is assessed by an ophthalmologist during an examination. It also establishes or excludes the development of relevant complications. To determine the cause of the changes, an additional examination is prescribed, which may include various methods of laboratory, instrumental and functional research.

Based on all the results of the diagnosis of the pathological condition, the doctor makes a conclusion and selects the most optimal treatment.

Classification

Depending on the group of reasons that led to the changes, eyelid inversion includes the following types:

Congenital type.
Post-traumatic or cicatricial eversion.
Age (senile) type.
Paralytic type (the condition is caused by a violation of the innervation of the branches of the facial nerve).

Depending on the severity of the pathological condition, lower eyelid inversion is divided into 4 degrees:

the eversion affects only the lacrimal openings in the medial corner of the eye;
the lower eyelid partially moves away along its entire length, and the lower strip of the sclera becomes noticeable;
changes are characterized by the development of inflammation of the conjunctiva in the area of eversion with redness of the mucous membrane and its thickening in the form of a shaft;
eroded ectropion, accompanied by the fact that against the background of an inflammatory reaction, small areas of integrity are formed in the conjunctiva, which do not heal for a long time.

Based on the clinical classification, the attending physician has the opportunity to quickly establish a diagnosis, as well as select adequate therapeutic measures.

Eversion after blepharoplasty

Blepharoplasty is a surgical intervention, the purpose of which is to change the shape of the eyelids, the shape of the eyes, and remove excess fatty tissue. After an operation accompanied by traumatization of a large volume of tissue, complications may develop in the form of scar formation. This can lead to loose closure, resulting in the formation of eyelid inversion after blepharoplasty. Scar complications after blepharoplasty develop relatively infrequently and require appropriate correction.

How to correct lower eyelid inversion after blepharoplasty?

The choice of therapeutic measures depends on the length of time that has passed since the blepharoplasty operation:

If a little time has passed after the surgical intervention and the doctor detects an emerging inversion, then fixation of the eyelid with an adhesive plaster is prescribed. This makes it possible to level out the emerging changes.
If a lot of time has passed after the operation, then repeated surgery is prescribed. The attending physician selects the technique for correcting changes individually.

Treatment of ectropion

Correcting an inversion or ectropion of the eyelid is a complex undertaking. The choice of methodology and direction of therapeutic measures is carried out by the ophthalmologist individually. For minor changes, or if the patient refuses surgery, conservative therapy is prescribed. Radical treatment involves blepharoplasty - surgical correction of changes in tissues.

Conservative therapy

Conservative treatment involves the appointment of several therapeutic measures:

The use of artificial tears eye drops, which provide sufficient hydration of the sclera and conjunctiva, as well as preventing the development of related complications.
The use of eye drops with antiseptic and antibacterial effects, which help prevent the development of infectious complications and reduce the severity of the inflammatory reaction.
Normalization of the functional state of the facial nerve in case of neuritis. It involves the prescription of drugs from various pharmacological groups, the choice of which depends on the cause of nerve inflammation (anti-inflammatory, antiviral drugs, B vitamins).

Eversion of the eyelid (also known as ectropion) is a condition characterized by a change in the normal position of the edges of the folds of skin around the organs of vision. The problem manifests itself as a loose fit of the edge of the eyelid (usually the lower one) from the surface of the eyeball.

If only the inner third of the eyelid is deformed, then eversion of the lacrimal punctum is diagnosed. Treatment in most cases consists of surgical correction, which is determined in accordance with clinical data.

Ectropion after blepharoplasty

Eversion is the most important side effect of blepharoplasty. Ectropion is determined by curling the eyelid or pulling the conjunctiva away from the eye. This leads to constant watering, thereby causing continuous moisture and irritation of the skin in the eye area.

Ectropion (inversion of the upper eyelid) is much less common than the lower eyelid and occurs early after surgery due to swelling. The problem is temporary and improves as the density of the swelling decreases. Prolonged eversion is caused by the removal of excessive skin volume or complications in the form of scars in the ligaments and muscles.

In order to avoid ectropion after blepharoplasty, it is important to follow certain rules. The attending physician, before sending the patient home, must familiarize him with how to behave and what to do in the coming days. As a rule, after blepharoplasty, it is recommended to keep your head elevated while sleeping.

For at least a week after the procedure, it is necessary to avoid excessive physical activity, which causes an increase in blood pressure, which is undesirable after plastic surgery. The pitfalls of blepharoplasty include possible swelling of the eyelids in the first days after surgery.

Even some minor hematomas on the lower eyelid should be kept in mind, which disappear within a short period of time.

Ectropion - clinical picture

As a rule, at the first stage, eyelid eversion is manifested by significant lacrimation, the cause of which is considered to be a tear aspiration disorder caused by eversion of the lower lacrimal punctum. The person wipes away the secreted fluid, stretches the eyelid, as a result of which the condition worsens.

In the case of prolonged ectropion, hyperemia and thickening of the conjunctiva gradually develops, sometimes its metaplasia (this condition is usually defined as the final stage of untreated peripheral paresis, when, after the initial lagophthalmos, it reaches the weakening of the muscles around the eyes). Sometimes during the examination exposure keratopathy and even keratitis in the lower half of the cornea are determined.

The main symptoms of eyelid inversion can be summarized in the following points:

loose fit up to the inversion of the eyelid from the surface of the eyeball;
the problem mainly affects the lower eyelid;
in the case of a loose fit of only the inner ⅓ of the eyelid, this indicates eversion of the lacrimal punctum;
A mandatory sign is excessive tearing.

The symptoms of ectropion can vary widely, depending, first of all, on the intensity of changes in the eyelid: if it is slightly drooping, as a rule, clinical signs are absent or appear minimally. The most commonly observed and only symptom of eyelid inversion is chronic conjunctivitis.

Due to inflammation, the connective tissue is red, and sometimes strong discharge appears. With significant exposure to pollen, dust and wind, symptoms become more severe and progressive in nature.

In many cases, it comes to the development of keratitis and horny skin, which, if left untreated, can lead to blindness.

Classification of the disease

Eversion of the eyelid is divided into several types, depending on the etiology. More precise symptoms are also associated with the species, on the basis of which the doctor makes a diagnosis:

Congenital ectropion. This type of disease is autosomal hereditary and rarely occurs on its own (for example, the pathology is often associated with ptosis, or blepharophimosis). Disappears spontaneously as the face grows. Relatively often affects the upper eyelids. The therapy consists of suturing the lateral edges of the eyelids and moving or transferring the skin.
Involutional (atonic) eversion of the eyelid. It is the most common form of the disease. It is especially common in the lower eyelid in elderly patients, in whom the problem is caused by weakening of the tissue and paralysis of the pretarsal part of the orbicularis oculi muscle. The disease is accompanied by significant lacrimation, hyperemia and hypertrophy of the conjunctiva. The therapy consists of horizontal shortening of the eyelid at the site of the temporal (motor) edge, as a result of which re-adhesion (sufficient adherence) of the eyelid to the eyeball is achieved.
Paralytic ectropion. As a result of reduced function of the circular eye muscle (m. orbicularis oculi), a person cannot completely close the eyelids, which often causes the development of lagophthalmos. The cause is often considered to be paresis of the facial nerve n.VII. Therapeutic methods include suturing the edges of the eyelid, that is, tarsography.
Cicatricial ectropion. Occurs, in particular, as a result of tension caused by scars on the skin of the eyelids and around them (often these are formed as a result of burns, including chemical burns, trauma or cancer of the eyelids). The treatment is quite complex: Z-plasty is performed on the site of traction scars. In the case of extensive processes, the cords are excised and the skin is covered plastically from the second eyelid or from the mastoid area (processus mastoideus).

Is it possible to use compresses or not?

If the symptoms of the disease are minor, proven therapy is used, which involves the use of suitable ophthalmic ointments containing antibiotics and corticoids. In addition, subconjunctival injection is possible.

In long-term conditions, surgery is required. Surgical methods vary and depend on the choice of specialist. All of them are aimed at strengthening the lower/upper eyelid, which makes it possible to remove ectropion.

Traditional medicine advice recommends cool compresses or lotions made from a decoction of eyebright to treat ectropion. Are they able to help? In some cases, yes. However, these compresses do not have any effect on the elasticity of the skin; they only reduce swelling of the eyelids.

The use of tonic cosmetics has a similar effect. But in the case of herbal compresses, it is necessary to take into account the risk of allergic skin reactions.

Thus, the swelling does not decrease and such self-medication can only worsen the condition. A similar “disservice” can be provided, for example, by using compresses from chamomile decoction.

Fat pads on the upper and lower eyelids, as well as excess folds of skin in this area, can be removed through surgery. For milder forms of lesions, laser surgery is used, but classical surgical techniques are usually preferred.

As a rule, women come to the doctor at an early age, who are primarily concerned about the aesthetic side of the problem. Men tend to put off resolving the issue until drooping eyelids begin to interfere with vision.

The question of when is the right time for surgery is not so easy to answer. Loss of elasticity of the skin of the eyelid leads to wrinkles. Undesirable “corrugations” are compensated by tightening the skin of the forehead and eyebrows upward.

Over time, such compensation leads to a constant forced “surprised” facial expression and the appearance of deep wrinkles on the forehead. A minor primary problem subsequently causes a larger secondary one. Therefore, in terms of aesthetics, the earlier solution is better.

Plastic treatment

Regarding the prompt solution of the problem, there are a number of questions:

What are the indications for surgery? All types of eyelid malposition or adhesions to the ocular surface must be corrected. The skin must optimally adhere to the eyeball of the eye, otherwise the eyelid cannot properly perform its functions and becomes a source of constant eye irritation. The expected benefit is the restoration of normal skin fold function.
What is the preparation for the procedure? In healthy patients there is no need for special preparation. Only in people taking drugs that affect blood clotting are treatment adjustments sometimes necessary over a short period of time. The decision to discontinue therapy or consider substituting it should always be made by the attending physician or cardiologist. In addition, it is necessary to notify the specialist of any allergies (especially to disinfectants, medications, eye ointments, drops or local anesthetics).
How is the operation performed? The procedure is performed under local anesthesia. The principle is based on plastic correction of the eyelid and its immediate area, possibly using the skin of the armpits, the oral mucosa or the cartilage of the earlobe (this is done in order to create the correct position and shape). The effect depends on the operation itself.
What are the possible complications and risks? Skin bleeding, especially in patients using drugs that affect blood clotting, imperfect healing or dehiscence of the wound, subsequent infection in the wound, incomplete closure of the palpebral fissure, insufficient correction of the position of the skin fold, allergic reactions to disinfection, ointment or local anesthesia, anaphylactic reactions are rare.

This pathology (usually ectropion of the lower eyelid) can only be treated surgically and cannot be cured on its own.