Eyelid Surgery (Blepharoplasty), Entropion, Ectropion & Ptosis: Symptoms, Causes & Treatment Options

What Is Blepharoplasty?

Blepharoplasty, or eyelid surgery, is a procedure that corrects droopy or sagging eyelids by removing excess skin, muscle, and fat. As we age, the eyelid tissues stretch and the muscles that support them become weaker, leading to a tired, heavy appearance or even reduced vision.

request an appointment

Upper Eyelid Blepharoplasty

Upper eyelid surgery involves making small incisions to remove excess skin and fat. A fine suture is used to close the incision and recreate a natural eyelid crease.

Lower Eyelid Blepharoplasty

Lower eyelid surgery may include:

  • An external incision just beneath the lash line
  • An internal incision on the inside of the eyelid (transconjunctival approach)

Both approaches help reduce puffiness, smooth the under-eye area, and restore a more youthful appearance.

Why Is Eyelid Surgery Performed?

Excess eyelid skin and fat can cause:

  • A heavy, drooping eyelid
  • Puffy or tired-looking eyes
  • An aged appearance
  • Obstruction of the upper field of vision

Upper blepharoplasty can significantly improve peripheral vision in patients whose eyelids block their line of sight.

Insurance Coverage for Blepharoplasty

Insurance may cover medically necessary upper eyelid surgery when vision is impaired. Requirements often include:

  • Documented visual field obstruction
  • Clinical photography
  • Formal visual field testing

Some insurance providers require pre-authorization before approving eyelid surgery.

Entropion

Entropion is a condition where the eyelid turns inward, causing the eyelashes and skin to rub against the surface of the eye. It usually affects the lower eyelid and is more common in older adults.

Symptoms of Entropion

  • Feeling like something is in the eye
  • Redness or irritation
  • Eye pain
  • Sensitivity to light or wind
  • Excessive tearing
  • Mucous discharge or eyelid crusting

Causes of Entropion

  • Age-related muscle weakness
  • Trauma or burns
  • Previous eyelid surgery
  • Increased risk with age

Treatment for Entropion

Non-surgical relief:

  • Artificial tears
  • Lubricating ointments

Surgical treatment:

  • Quickert Sutures: In-office sutures reposition the eyelid.
  • Incisional Surgery: Performed in an outpatient center to tighten eyelid muscles and restore normal positioning.

Ectropion

Ectropion is a condition where the eyelid turns outward, exposing the inner eyelid and interfering with normal tear drainage. It most often affects older adults.

Symptoms of Ectropion

  • Excessive tearing due to poor tear drainage
  • Dry, gritty, or sandy sensation
  • Irritation or burning
  • Redness of the eyelids and eyes
  • Sensitivity to light

Causes of Ectropion

  • Age-related muscle weakness
  • Facial paralysis (e.g., Bell’s palsy)
  • Scarring or previous eyelid surgery
  • Benign or cancerous eyelid growths

Treatment for Ectropion

Non-surgical relief: Artificial tears, ointments, and eyelid taping.

Surgical repair: Outpatient surgery to reposition and tighten the eyelid.

Ptosis

Ptosis is a condition where the upper eyelid droops over the eye. In severe cases, ptosis can block part or all of the upper visual field. Children and adults may develop ptosis.

Causes of Ptosis

  • Stretching of the levator muscle
  • Aging
  • Eye trauma
  • Side effects after certain eye surgeries
  • Neurological or muscular disorders
  • Tumors affecting eyelid muscles

Treatment for Ptosis

Non-surgical option: Upneeq eye drops may help lift the eyelid in some adults but must be used daily.

Surgical option: Outpatient ptosis surgery under local anesthesia. The levator muscle is tightened or repositioned to elevate the eyelid. Blood thinners are typically stopped prior to surgery, and recovery takes about one week.

Dermatochalasis

Dermatochalasis refers to redundant skin of the eyelids, often accompanied by bulging orbital fat. This may lead to:

  • A heavy feeling around the eyes
  • Brow ache
  • Eyelashes obstructing the visual axis
  • Reduced superior visual field

Indications for Upper Eyelid Blepharoplasty

  • Redundant or lax eyelid skin
  • Fat herniation
  • Functional visual symptoms
  • Skin irritation or dermatitis from excess skin

Risk Factors for Eyelid Conditions

  • Aging
  • Inflammatory eyelid diseases
  • Chronic lid swelling or edema
  • Systemic disease or allergy
  • Family history

Diagnosis of Eyelid Conditions

Patient History

Doctor evaluation typically reviews:

  • Impact on daily activities
  • Previous eye conditions or surgeries
  • Systemic diseases (e.g., diabetes, rheumatologic disorders)
  • Cosmetic treatment history
  • Dry eye symptoms
  • Medication list, including supplements and blood thinners

Physical Examination

  • Quantity and symmetry of excess skin
  • Eyelid crease position
  • Fat pad herniation
  • Presence of ptosis
  • Brow position

Ocular Evaluation

  • Visual acuity
  • Pupil exam
  • Eye movement testing
  • Intraocular pressure
  • Corneal exam
  • Tear film evaluation

Diagnostic Procedures

Visual field testing—performed with eyelids taped and untaped—is used to measure how much excess skin obstructs vision. This test is especially important when determining medical necessity for insurance coverage.