Ageing is a natural, irreversible and intensifying process of changes in the metabolism and physicochemical properties of cells, which leads to an inhibition of autoregulation and regeneration of the body and to morphological and functional changes of its tissues and organs (according to the PWN Encyclopedia).

Eye adnexa is a group of tissues and anatomical structures which cover the eyeball and enable proper functioning of the eye. The eye adnexa consists of eyelids along with superciliary arches, palpebral and bulbar conjunctivae and lacrimal apparatus. The eyelids provide mechanical protection to the anterior part of the eyeball. Eyelashes and hair on the superciliary arch protect the eye from sweat and small particles. Apart from that, the eyelashes serve as sensors which trigger the eye-closing reflex. Blinking spreads tears across the anterior surface of the eye, moisturizing it. During blinking, a thin layer of tears is moved across the anterior surface of the cornea and the eyeball conjunctiva, washing any potential foreign bodies to the lower fold of lid conjunctiva and to the eyeball. Tear film creates a very smooth surface of the eyeball which allows the light to be properly refracted by the cornea, supplies the superficial layers of the cornea with oxygen as it does not have its own vessels. Tears have a slightly higher concentration of sodium chloride than other tissue fluids and, additionally. They contain small amounts of protein bodies with buffer capacity, as well as certain amount of lysozyme of antibacterial properties. Mechanical rinsing and the lysozyme protect the eye against infections.

The eyelid skin of elderly people is wrinkled. It is a result of dermis thinning, subcutaneous tissue atrophy, lowered elasticity and excessive skin dryness. The amount of lipids on the surface of skin is lowered parallel to the atrophy of lipids in the skin itself, which is caused by a significant drop in the number of fibroblasts synthesising and accumulating skin cholesterol. A lowered activity of sebaceous glands, especially in women, also takes place. In some people, a gland overgrowth occurs, which can lead to a formation of senile sebaceous adenomas.

A decrease in the skin’s elasticity and a lowered immunity of capillaries leads to their dilation (telangiectasia). A tendency to focal, brown discolourations (senile lentigines) occurs. In the case of both dry skin and seborrhoea, an increased tendency to inflammatory reactions occurs as a result of chemical, physical, thermal and bacterial factors.

The orbital fatty tissue atrophies in elderly people. The eyeball collapses and the palpebral fissure appears to be narrowed. A slow atrophy of the orbital septum can take place and the orbital fat can move forward (baggy eyelids). The eyeball sheath and palpebral ligaments become less elastic. The tarsus and eyelid muscles slowly atrophy which leads to a senile ptosis of the upper eyelid and to lower eyelid ectropion (fig. 1) (1). The treatment of the upper eyelid ptosis is based on a surgical correction under local anaesthesia and consists of cutting the palpebral sulcus, dissecting free the aponeurosis of the levator palpebrae superioris, suspending it to the tarsus and layer suturing.

Eyelid ectropion causes the palpebral conjunctiva to become exposed. This leads to its hyperaemia, inflammatory overgrowth and epiphora. The latter is a consequence of lacrimation being increased by inflammation as well as by an impairment of the outflow of tears, which is a result of the lacrimal point (the first step of draining the tears) protruding out of the eyeball (2). The senile eyelid ectropion requires surgical correction which can be performed in 4 ways:

– tarsal-conjunctival resection: rhombus of approx. 3-4 mm vertically and 6-8 mm horizontally below the lacrimal point,

– “T” plastics: additional resection of a full-thickness pentagonal fragment of the eyelid, lateral from the lacrimal point,

– horizontal shortening of the eyelid: by resecting a proper, full-thickness fragment of the eyelid with an optional blepharoplasty of the lower eyelid,