Entropion and Ectropion

A 72-year-old woman from Delhi presents with bilateral lower eyelid malposition, chronic tearing, and conjunctival injection. On examination, both lower eyelids are everted with exposed palpebral conjunctiva, and the lacrimal puncta are displaced inferiorly and laterally. She reports difficulty with eye closure and a sensation of dryness despite excessive tearing. What is the primary underlying pathophysiology?

A 68-year-old man from rural India presents with a 6-month history of progressive eye irritation, foreign body sensation, and tearing in the left eye. On examination, the lower eyelid margin is turned inward, with the lashes rubbing against the cornea. Corneal abrasion is noted on fluorescein staining. The patient reports the symptoms worsen when he squints or during windy conditions. What is the most likely diagnosis?

A 68-year-old woman presents with progressive drooping and eversion of the lower eyelid bilaterally over the past 2 years. She reports chronic tearing, mild conjunctival injection, and occasional mucoid discharge. On examination, the lower eyelid is everted, exposing the palpebral conjunctiva. The eyelid margin is lax and separated from the globe. Horizontal lid laxity is confirmed with a positive snap test. There is no history of facial trauma, surgery, or systemic disease. What is the most likely diagnosis?

A 68-year-old man from rural Maharashtra presents with a 6-month history of progressive redness, irritation, and tearing of the left eye. On examination, the lower eyelid margin is turned inward toward the globe, and the lashes are in contact with the cornea. Corneal abrasion is noted on fluorescein staining. The patient reports the symptoms worsen when he squints or closes his eyes tightly. What is the most likely diagnosis?

A 72-year-old woman from Delhi presents with a 3-month history of lower eyelid drooping, loss of eyelid tone, and chronic epiphora (excessive tearing). On examination, the lower eyelid is everted and separated from the globe, exposing the palpebral conjunctiva. The lacrimal punctum is displaced inferiorly and laterally. She denies pain or photophobia. What is the most appropriate initial management?