Fig. 6.1
Entropion with trichiasis
Fig. 6.2
Entropion with trichiasis
Lagophthalmos (Figs. 6.4)
Lid retraction (Figs. 6.5–6.9)
Fig. 6.5
Retraction side view
Fig. 6.6
Retraction and ectropion
Fig. 6.7
Retraction margin ectropion and punctal eversion
Fig. 6.9
Bells palsy
Floppy eyelid syndrome
Traumatic injury
Botox injections with resultant orbicularis weakness.
Entropion which denotes in turning of the lid margin toward the eye can occur with or without trichiasis. Trichiasis would be where the lashes are rubbing on the eye. Different forms of entropion include senile, mechanical, spastic, and cicatricial.
Ectropion which is the converse of entropion where the lid margin is turned away from the eye also adversely affects to pump function. Different subtypes include senile, mechanical, spastic, and cicatricial.
Lagophthalmos which is due to an incomplete closure of the eyelids has paralytic, mechanical, and cicatricial forms. Examples of paralytic lagophthalmos would be from a Bell’s palsy or facial palsy and even iatrogenically from Botox injections.
Lid retraction is often referred to as a pulling down of the lower lid or up of the upper lid. Often times with facial aging changes the lid can sag down and increase the scleral show of the eye. This might preclude adequate tear pumping function. Additionally with canthal tendon laxity, whether lateral canthal, medial canthal, or both, canthal laxity compromises pump function.
Floppy eyelid syndrome could be considered a form of laxity associated with sleep apnea affecting the lacrimal pump function.
Trauma, including that induced by surgery, cannot only affect the tear pump function by affecting a component or multiple components of the tear drainage system but any irregularities created from the trauma in the lids itself can adversely affect this function.
All of these pathological conditions of the lids affect the blink of the lid not allowing for the proper pumping of the tears into the drainage system.
Additional Dysfunctions
The tear pump function can also be affected by position of the punctum. Most commonly punctal eversion can occur where the punctum is not facing the tear lake. This may be an isolated problem or part of an malposition of the lid. This more commonly affects the lower lid punctum. The upper lid can also slip behind the lower lid and push it out. This condition has been referred to as imbrication.
The punctum can also be affected stenosis by thereby decreasing the openness of the punctum, diminishing the ability of the tears to enter into the drainage system. Similarly canalicular stenosis can also preclude the flow of tears within the tear drainage system affecting the pumping function. Obstructions of the nasolacrimal sac and duct similarly have an adverse effect. These issues are covered in other chapters of this book.
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