Surgical-Procedures

Eyelid Surgery

Ptosis

Ptosis is the medical term for drooping of the upper eyelids. This lowering of the eyelids may cause a reduction in the field of vision when the eyelid either partially or completely obstructs the pupil. Patients with ptosis often have difficulty keeping their eyelids open. To compensate, they will often arch their eyebrows in an effort to raise the drooping eyelids. In severe cases, people with ptosis may need to lift their eyelids with their fingers in order to see. Children with ptosis may develop amblyopia (“lazy eye”) or developmental delay from limitation of their vision.

There are many causes of ptosis including age related weakening of the muscle, congenital weakness, trauma, or sometimes neurologic disease. As we age, the tendon that attaches the levator muscle, the major muscle that lifts the eyelid can stretch and cause the eyelid to fall. This represents the most common cause of a droopy eyelid.

Ptosis can be corrected surgically and usually involves tightening the levator muscle to elevate the eyelid. In severe ptosis, when the muscle is extremely weak, a “sling” operation may be performed, enabling the forehead muscles to elevate the eyelid. Other types of repair may include surgery on the muscle on the inside of the lid in cases of small amounts of ptosis. The goal is to elevate the eyelid to permit a full l field of vision and to achieve symmetry with the opposite upper eyelid.

Ectropion & Entropion

Ectropion (Turned-out Eyelid)

Ectropion means that the lower eyelid is “rolled out” or sagging away from the eye. The sagging lower eyelid leaves the eye exposed and dry. If ectropion is not treated, the condition can lead to chronic tearing, eye irritation, redness, pain, crusting of the eyelid, mucous discharge, and breakdown of the cornea due to exposure.

Generally the condition is the result of tissue relaxation associated with aging, although it may also occur as a result of facial nerve paralysis (due to Bell’s palsy, stroke or other neurologic conditions), trauma, scarring, previous surgeries or skin cancer.

With an ectropion, the wet, inner, surface of the eye, called the conjunctiva is exposed and visible. Normally, the upper and lower eyelids close tightly, protecting the eye from damage and preventing tear evaporation. If the edge of one eyelid turns outward, the two eyelids cannot meet properly and tears are not spread evenly over the eye.

Ectropion is repaired surgically. Most patients experience immediate resolution of the problem once surgery is completed with little, if any, post-operative discomfort. After your eyelid heals, your eye will feel comfortable and be protected from corneal scarring, infection, and loss of vision.

Entropion (Turned-in Eyelid)

Entropion is a condition in which the eyelid is rolled inward toward the eye. It can occur as a result of advancing age and weakening of certain eyelid muscles. Entropion may also occur as a result of trauma, scarring, or previous surgeries.

A turned in eyelid rubs the eyelashes against the eye, making it red, irritated, painful, and sensitive to light and wind. If it is not treated the condition can lead to excessive tearing, mucous discharge and scratching or scarring of the cornea. A chronically turned in eyelid can result in light sensitivity and may lead to eye infections, corneal abrasions, or corneal ulcers. If entropion exists, it is important to have it repaired before permanent damage to the eye occurs.

There are a number of surgical techniques for successfully treating entropion. The most common surgical treatment involves tightening of the eyelid to restore the lid to its normal position. The surgery to repair entropion is usually performed as an outpatient procedure under local anesthesia. Patients recovery quickly and experience immediate resolution of the problem following surgery. A non-incision entropion repair may be performed as an in-office procedure under local anesthesia. This procedure requires several strategically placed sutures which evert the eyelid. The procedure is an excellent treatment for patients who are not suitable for surgery, or until more definitive surgery can be performed.

Skin Cancer

Several types of skin cancer affect the eyelids and face. Basal cell carcinoma is the most common type, while squamous cell carcinoma, sebaceous cell carcinoma, and melanoma are less common.

Treatment usually involves a biopsy of suspicious skin lesions. Once a diagnosis is made, several options exist for cancer removal. The usual treatment method is removal of the skin cancer by a dermatologist who performs Moh’s surgery.

This surgical technique allows for complete removal of the skin cancer while preserving unaffected tissue.

This combined approach to skin cancer removal allows for the best chance of complete cancer removal, reduced rate of recurrence at the site of removal, an optimal reconstructive result.
Reducing your exposure to the sun’s harmful UV rays is the best prevention. Speak to our Doctors about the sunscreens he recommends.

Tearing

The tear film on the surface of the eye is a critical component of maintaining vision. Tears nourish and lubricate the surface of the eye as well as wash away debris. A smooth, balanced tear film also allows light to enter the eye in an optimal fashion. If there is a disturbance of the tear film, patients will often experience tearing, burning, irritation and most importantly blurred vision. Patients who experience tearing either have a problem with tear production or tear drainage.

Unfortunately, inflammatory conditions like rheumatoid arthritis, Sjogrens disease as well as aging and menopause lead to decreased tear production. As tear production diminishes, the surface of the eye starts to dry out. Some patients with dry eyes note tearing of the eyes during activities like reading, driving, watching TV, using a computer or going outside on a windy day. The treatment for dry eyes includes replacing tears with artificial lubricants which can be bought over the counter, medications that decrease inflammation in tear glands and encourages natural tear production to resume and finally a simple procedure to plug the tear drain. Other causes of increased tear production exist like allergies, infections and eyelashes poking the eye.

An obstruction of the tear ducts may occur due to numerous reasons (aging, trauma, inflammatory conditions, medications and tumors) and cause numerous signs and symptoms ranging from wateriness or tearing to discharge, swelling, pain and infection. These signs and symptoms may result from the tear drainage system becoming obstructed at any point from the tear passageway to the nasal cavity.

If the tear passageways become blocked, tears cannot drain properly and may overflow from the eyelids onto the face as if you were crying. In addition to excessive tearing you may also experience blurred vision, mucous discharge, eye irritation, and painful swelling in the inner corner of the eyelids.

Depending on the cause of your symptoms and their severity, we will suggest an appropriate course of treatment. In mild cases, warm compresses and antibiotics may be recommended. In other cases, surgery to bypass the tear duct obstruction, called a dacryocystorhinostomy (DCR ) may be recommended.

A DCR is performed by creating a new tear passageway from the corner of the eye to the nose, bypassing the obstruction. A small silicone tube called a stent may temporarily be placed in the new passageway to keep it open during the healing process. In a small percentage of cases, the obstruction is between the eyelid and the nose In these cases, in addition to the DCR procedure, it may be necessary to insert a tiny artificial tear drain called a Jones Tube. A Jones Tube is made of Pyrex glass and allows tears to drain directly from the eye into the nose.