Case Study: Condition of the Lower Eyelid
Dr Charles Su
What is this condition of the lower eyelid called?
Lower eyelid ectropion
What are the physical changes in the lower eyelid which can lead to such a malposition?
Commonly, laxity of the lower eyelid tissues and shrinkage of the thin eyelid skin are two major factors which lead to lower eyelid ectropion. These are generally involutional changes, aided by the action of gravity over years. Solar exposure to the thin lower lid skin over time leads to its contraction.
What are two important sinister underlying causes to look out specifically for?
Remember that lower lid laxity can be caused by weakness of the orbicularis oculi muscle, whose action is to close the eyelids. This is innervated by the 7th Cranial nerve. Hence it is always important to formally test facial nerve function through assessing the power of the muscles of facial expression. This is particularly relevant in a unilateral case of lower lid ectropion. Also, skin cancers, most typically basal cell carcinomas, can shrink the skin and cause it to tighten, pulling the lower lid down in this way. It is therefore important to inspect and palpate the lower lid skin carefully for any suspicious lesion. An eyelid malposition can also be contributed to by a deeper lesion or mass.