Ptosis - is a drooping or lowered position of the upper eyelid margin or edge (where the lashes come out), as opposed to drooping of excess skin over the lashes (dermatochalasis- see blepharoplasty).  It is pronounced toe-sis (silent “p” as in ptarmigan). When the lid margin/edge begins to cross the pupil with eyes open, vision can become obstructed.

There are a variety of causes for this condition. Most commonly, there is a slippage or dis-insertion of the muscle that elevates the upper eyelid (called the levator). This can occur with age, stretching of the eyelid after swelling, contact lens wear or ocular surgery. The correction of this type of ptosis involves a delicate outpatient surgery.

Patients born with ptosis (other than that caused by birth trauma to the eyelid) can have what is termed congenital ptosis.  In this condition, the muscle that elevates the eyelid (levator) is not formed normally.  This can be an urgent problem if the eyelid covers the pupil while the child is awake as visual input through both eyes is necessary for the development of the visual system in the brain.  Failure to achieve visual input to each eye can lead to permanent poor vision in the occluded eye (amblyopia).

Other causes of ptosis include neurologic problems such as third cranial nerve palsy or Horner’s syndrome, eyelid trauma, Myasthenia gravis (ocular or systemic), inadvertent Botox placement and orbital tumors.  Clinical evaluation is necessary to determine the cause of the ptosis and choose the appropriate treatment.

Entropion - is a turning or rolling in of the eyelid edge or margin towards the eyeball.  This may be noted initially only in the mornings on awakening and then become more constant over time. In this condition the eyelashes and even the eyelid skin can rub on the eyeball causing irritation, pain, redness and even infection. The common cause is a  looseness of particular eyelid muscles. Other causes includes scarring from surgery, tumors, and autoimmune conditions (ocular cicatricial pemphigoid or OCP). Surgical correction, again, depends on the cause.

Retraction - is a shortening of the vertical position of the eyelid, such that its edge or margin rests too high (upper lid) or too low (lower lid) on the eyeball in relation to the pupil. This can even be severe enough that the eyelids to not close when sleeping (lagophthalmos). Causes include thyroid related eye disease, prior eyelid surgery (overzealous cosmetic surgery) or trauma, and skin cancers.

Laxity - occurs with stretching or weakness of the tendons holding the eyelid in place. The tension of the eyelid on the eyeball plays an important role in getting the tears to go into the tear drain ducts and into the nose.

Ectropion - is a turning or rolling out of the eyelid edge or margin away from the eyeball. This can lead to tearing, red irritated and inflamed eyes and even eye infections. Causes include age-associated looseness, tightness of facial skin from sun-damage or scarring from burns/trauma/prior eyelid surgery/skin cancer excision. Other causes include paralysis of the facial nerve, and repeated rubbing or stretching of the eyelid. Surgical correction technique depends on the cause, and commonly involves tightening of loose eyelid tendons, but may require skin grafting or more extensive surgery.