Lower eyelid atony: pathogenesis, clinical significance and possibilities of correction. Literature review

Lower eyelid atony is a common cause of ocular prosthetic complications in patients with anophthalmos. Decreased eyelid tone results in prosthesis instability, eyelid eversion, excessive tearing, and inflammatory changes. These manifestations greatly compromise both rehabilitation outcomes and patients’ quality of life. The condition gains particular clinical importance in individuals who have undergone oncological surgery or radiation therapy, where marked scarring and tissue fibrosis often occur in the orbit. This review article provides an overview of current knowledge regarding the anatomy and physiology of the lower eyelid, the mechanisms underlying atony development, its clinical features, and diagnostic methods. Various surgical correction techniques are discussed — ranging from traditional canthoplasty to the application of synthetic implants and skin–mucosal grafts. The review also addresses specific aspects of ocular prosthesis fitting in patients with eyelid atony, emphasizing the need for individualized design in terms of shape and weight. Particular attention is devoted to the challenges of ophthalmic rehabilitation in patients post-radiation therapy for retinoblastoma and other malignant tumors. The article highlights the importance of an interdisciplinary approach and underscores early detection of eyelid atony as a key factor for successful ocular prosthetic rehabilitation.