Types of Eyelid Malpositions & Repair

Eyelid positioning can become disordered with age. The eyelid may roll inward or outward as a result of stretching in the tendon that supports it. Corrective treatment involves surgical intervention to repair the eyelid malpositioning.

Types of Eyelid Malpositions

Eyelid malposition is when the upper or lower eyelid is not in its normal position, leading to a range of issues such as sagging, drooping, turning inward (entropion), or outward (ectropion). These malpositions can result in discomfort, irritation, dryness, and even impaired vision if left untreated.

There are four primary types of eyelid malpositions that can occur:


This is when the lower eyelid rolls outward, turning the eyelashes toward the cheek. It is caused by relaxation of eyelid tissues over time or past surgery/trauma. 

The outward rolling prevents the eyelid from effectively sweeping tears into the tear ducts, causing excess tearing and dryness as well as irritation and damage to the cornea.


The inward rolling of the lower eyelid, directing eyelashes into the eye. Entropion develops as eyelid muscles relax over time. Ingrowth rubs the delicate eye surface, resulting in tearing, scratches, scarring or discharge from the cornea.


In retraction, the upper or lower eyelid pulls away from the eye surface. Retraction stems from relaxation of eyelid muscles, leaving the eyes susceptible to irritation from impaired lubrication and cleaning by the eyelids.


Excess sagging skin and muscle in the upper or lower eyelid causes a “baggy eyes” appearance along with heavy lids, bags under the eyes, and eyelid wrinkles. 

In addition to cosmetic issues, dermatochalasis can lead to ectropion, entropion, eyelid infections and eye irritation due to impaired vision from excess eyelid tissue.


Epiblepharon is a condition where the inner part of the eyelid rolls backward, causing the eyelashes to rub against the eyeball. It usually affects both the upper and lower eyelids.

When the eyelashes are pulled upward and backward in this way, it causes them to constantly rub against the delicate surface of the eye. This repeated rubbing and irritation leads to symptoms like redness, watering, swelling, and discomfort.

Symptoms of Eyelid Malpositions

It is advised to seek medical advice if you experience any persistent eyelid or eye symptoms occur. Early treatment can correct the condition and even prevent complications.

Treating Eyelid Malpositions

The good news is there are effective treatments available to correct eyelid positioning.

The most common treatment is a brief surgical procedure. For ectropion or entropion, the doctor will make small internal adjustments to tighten weakened eyelid tissues and muscles back to their normal orientation. Retraction may be treated by sutures that gently pull the eyelid forward.

Dermatochalasis, or excessive eyelid skin and muscle laxity, can present more complexly. A blepharoplasty is a surgical procedure to remove extra fatty tissues and tighten muscle. It restores a more youthful contour and lift.

When surgery is not suitable, lubricating drops and ointments may be prescribed instead. Injectables and temporary sutures are also options that may be effective in some instances.

If your eyes are looking tired and old, or if they are constantly dry, scratchy, irritated or painful, do not hesitate to reach out to our team at Eagle Aesthetics & Surgery to assess your condition.

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