Lower Eyelids

Ectropion

Eyelid Retraction Treatment | Eyelid SurgeryA lower eyelid ectropion is where the lower eyelid turns out and away from the eye, causing exposure of the eye. This can cause redness, discomfort and tearing. There are many types of lower eyelid ectropions including involutional ectropion, cicatricial ectropion, mechanical ectropion, and paralytic ectropion. In some cases, more white of the eye is seen. This is called “scleral show”. It can create a “round eyed” appearance. Treatment is lower eyelid surgery to restore the eyelid to an appropriate position. Most often this involves tightening a loose eyelid but it may require a skin graft and or canthoplasty. Dr. Palu performs ectropion repair surgery as an outpatient under local or sedation anesthesia.


Entropion

A lower eyelid entropion is where the lower eyelid turns in and towards the eye, scratching the eye. This can cause redness, discomfort and tearing. There are many types of lower eyelid entropions including involutional entropion, cicatricial entropion, mechanical entropion, and paralytic entropion. Treatment is lower eyelid surgery to restore the eyelid to an appropriate position. Most often this involves tightening a loose eyelid and repositioning supporting tissue. Dr. Palu performs entropion repair surgery as an outpatient under local or sedation anesthesia.


Eyelid Retraction

Lower eyelid retraction is where the lower eyelid is pulled downward, exposing the lower part of the eye. More white of the eye is seen. This is called “scleral show”. It can create a “round eyed” appearance. This exposure of the eye can cause redness, discomfort and tearing. Lower eyelid retraction is usually due to scarring of the eyelid skin or of the inner layer of the eyelid. This is called cicatricial retraction. It is seen in conditions where the eyelid has sustained inflammation or trauma and in thyroid disease when it affects the eyelids. Treatment is lower eyelid surgery to restore the eyelid to an appropriate position. Most often this involves surgery directed at the tissue causing the pulling down of the eyelid. This usually is done by releasing the scarred tissue and repositioning the eyelid but it may require a skin graft, free tarsal grafts, or a hard palate graft. Dr. Palu was among the first surgeons in the area at use hard palate grafts in lower eyelid reconstruction. Dr. Palu performs surgery to repair lower eyelid retraction as an outpatient under local or sedation anesthesia.


Facial Paralysis / Bell’s Palsy

Facial Paralysis and Bell’s Palsy result in an inability of the eyelids to close. There is incomplete protection of the eye and exposure of the eye. In the upper eyelid, this results in lagophthalmos, or incomplete downward movement of the upper eyelid. In the lower eyelid this results in a paralytic ectropion, the eyelid is turned out, down and away from the eye. These result in exposure of the eye. This can cause redness, discomfort and tearing. Treatment is directed at both the upper eyelid and the lower eyelid. It involves placing a gold weight in the upper eyelid to help the upper eyelid move downward during a blink and during closure. It also involves raising and tightening the lower eyelid surgery to restore the eyelid to an appropriate position. Most often this involves tightening a loose eyelid but it may require a skin graft and or canthoplasty. Dr. Palu was among the first surgeons in New York to use gold weights in the treatment of ocular exposure due to facial paralysis during his work with neurosurgeons at NYU over 20 years ago. Dr. Palu performs gold weight and canthoplasty surgery for facial paralysis and Bell’s Palsy as an outpatient under local or sedation anesthesia.


Ocular Exposure

Eyelid Retraction Treatment | Eyelid SurgeryOcular exposure, exposure conjunctivitis and exposure keratoconjunctivitis refer to conditions where the eye is not protected. This is often due to a lower eyelid problem such as ectropion, retraction, facial paralysis or Bell’s Palsy. This can cause redness, discomfort and tearing. Treatment is lower eyelid surgery to restore the eyelid to an appropriate position. Most often this involves raising and tightening the lower eyelid but it may require a skin graft, free tarsal grafts, or a hard palate graft. Dr. Palu was among the first surgeons in the area at use hard palate grafts in lower eyelid reconstruction. In certain cases, an aesthetic tarsorrhaphy may be performed to treat ocular exposure. Dr. Palu has published his technique in the journal Laryngoscope. Dr. Palu performs surgery to address ocular exposure as an outpatient under local or sedation anesthesia.

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