Although eyelid malpositions are usually caused by involutional soft tissue changes, it is perilous to make that diagnosis without considering the rarer causes.
Eyelid malpositions can cause cosmetic problems and threaten vision. They can also point to a sinister underlying process.
Eyelid malpositions, such as upper lid ptosis or lower lid ectropion, are very common, especially in the elderly (see Table). They present an obvious cosmetic problem and have effects on the health of the ocular surface and may interfere with the visual axis. However, it is crucial to look beyond the eyelid to avoid missing more serious underlying causes.