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Sensory disorder of eyelid — Clinical Guidelines

Overview

Sensory disorders of the eyelid encompass conditions affecting eyelid structure and function, including congenital imbrication, entropion, and complications from medications like bortezomib. These disorders can lead to functional impairment and aesthetic concerns requiring specific diagnostic and therapeutic approaches.

Diagnosis

Clinical Presentation: Evaluate for overlapping eyelids (imbrication), inward turning of the eyelid margin (entropion), or eyelid swelling/chalazia 1 4.

Physical Examination: Detailed inspection of eyelid margins, tarsal plates, and surrounding structures 1 9.

Imaging: Not typically required for diagnosis but may be used in complex cases to assess underlying anatomy 7.

Grading: Severity grading for entropion and imbrication based on clinical findings and functional impact 1.

Management

Congenital Eyelid Imbrication:

- Temporary Measures: Tarsorraphies for mild cases 1. - Surgical Interventions: Lateral tarsal strip procedures for severe cases 1.

Entropion:

- Surgical Treatments: Tarsal stabilization, orbicularis oculi weakening, and lid margin shortening 2. - Temporary Measures: Eyelid taping or sutures for acute management 2.

Bortezomib-Associated Chalazia:

- Surgical Excision: Removal of chalazia, often involving upper eyelid 4. - Monitoring: Regular follow-up to assess recurrence and manage with antibiotics or steroids if necessary 4.

Special Populations

Pediatrics: Voluntary entropion reported in a 12-year-old, suggesting selective innervation issues 9.

Comorbidities: Patients on bortezomib should be monitored for ocular side effects, particularly chalazia 4.

Key Recommendations

Surgical Intervention for Severe Congenital Eyelid Imbrication: Consider lateral tarsal strip surgery for irreversible cases 1 (Evidence: Moderate).

Primary Treatment for Entropion: Prioritize surgical stabilization techniques over conservative measures for definitive correction 2 (Evidence: Moderate).

Monitoring Patients on Bortezomib: Regular ophthalmic evaluations to detect and manage potential chalazia early 4 (Evidence: Weak).

References

1 Mgaya E, Brennan R. Congenital Eyelid Imbrication Syndrome: Two Case Reports and Management Review. Journal of pediatric ophthalmology and strabismus 2025. link 2 Custer PL. Treatment of Eyelid Entropion: A Historical Review. Ophthalmic plastic and reconstructive surgery 2025. link 3 Rootman DB, Bokman CL, Katsev B, Rafaelof M, Ip M, Manoukian N et al.. Crowdsourcing Morphology Assessments in Oculoplastic Surgery: Reliability and Validity of Lay People Relative to Professional Image Analysts and Experts. Ophthalmic plastic and reconstructive surgery 2020. link 4 Fraunfelder FW, Yang HK. Association Between Bortezomib Therapy and Eyelid Chalazia. JAMA ophthalmology 2016. link 5 . Laser blepharoplasty and skin resurfacing. American Academy of Ophthalmology. Ophthalmology 1998. link 6 Small RG, Fransen SR, Adams R, Owen WL, Taylor RB. The effect of phenylephrine on Müller muscle. A blepharogram study of eyelid motion. Ophthalmology 1995. link30978-5) 7 Perlstein SH, Chubak GS, Edelstein MS. A microsurgical approach to eyelid surgery. Annals of ophthalmology 1993. link 8 Jelks GW, Jelks EB. Preoperative evaluation of the blepharoplasty patient. Bypassing the pitfalls. Clinics in plastic surgery 1993. link 9 Harvey JT. Voluntary entropion. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 1985. link

Sensory disorder of eyelid