Eyelid plastic

Eyelid plastic, Tear Drainage, Orbital Surgery

Oculopastics

Eyelid problems

Blepharoplasty - As people age they tend to get sagging of their upper and/or lower eyelids. The excess tissue can block the vision and can cause chronic fatigue with trying to keep the eyelids open. The excess tissue can be removed with a surgery called blepharoplasty. It can be done in the office under local anesthesia and is one of the more common plastic surgeries performed.

Blepharospasm - Spasm of the eyelid muscles can make it difficult to open the eyelids and keep them open. It is an often under diagnosed condition and can be treated with Botox injections into the muscles around the eyelids. The Botox temporarily relieves the muscle spasms.

Eyelid tumors

Styes – chalazion - A stye or chalazion is the most common benign growth on the eyelid. It is caused by a blocked oil (Meibomian) gland. These glands produce the oily part of the tear film which helps prevent the tears from evaporating too quickly. A chronic condition known as blepharitis can include inflammation of these glands and cause the glands to become blocked, swollen, and inflamed. Styes can be treated medically, and if they do not resolve can be removed surgically.

Cancers - The eyelids are one of the most common locations for skin cancer to occur. These can include basal cell carcinoma, squamous cell carcinoma, malignant melanoma, or other more rare tumors. The success rate for cure of skin cancers is very high if diagnosed early and removed completely. Oculoplastic surgery includes reconstructing eyelids after tumor removal.

Eyelid position

Ptosis - Ptosis is drooping of the eyelid. It can occur on one or both sides. A person can have it at birth or can develop it later on. The eyelid can be raised by surgically shortening the muscles which elevate the eyelid.

Lid retraction - Lid retraction is when the upper or lower eyelid is pulled farther away from the pupil than normal. It can have a number of etiologies, including thyroid eye disease, tumors, muscle paralysis or scarring. It can be repaired surgically. If there is paralysis of the eye closure muscles, a gold weight can be placed in the upper lid to help it close.

Entropion - Entropion is the turning inward of the eyelid against the eye. It causes rubbing of the lashes and lid skin against the eye with constant irritation. It can be caused by aging, scarring from previous infections, and occasionally occurs at birth. It can be repaired as an outpatient surgery.

Ectropion - Ectropion is the turning outward of the eyelid away from the eye. It causes chronic tearing of the eye and irritation because the lid is not properly protecting the eye. It can occur from aging, from scarring, or from tumors and can also be repaired as an outpatient surgery.

Abnormal eye lashes - When eye lashes turn inward, they cause chronic pain and foreign body sensation because they rub against the eye. This is called trichiasis. If the abnormal lashes recur after just pulling them, then electroepilation or cryoepilation (freezing) can be done to eliminate them.

Tear Drainage problems - Tears normally drain from the eye through small openings in the inside corner of the eyelids. The tears then flow through the tear drainage system into the nose. When the tear duct becomes obstructed, the tears will drain down the face instead. This can be very annoying, but can also lead to infection. Children can be born with an obstructed tear duct. It is usually caused by a thin membrane at the bottom of the tear duct that fails to open. If it does not resolve spontaneously, it is treated with probing and possible tube placement. A probing can be done in the office until about age 12 months. After that it is done under general anesthesia in the operating room.

When the obstruction occurs later in life, it usually requires more extensive reconstruction of the tear drainage system. This is called a dacryocystorhinostomy or DCR. If there is significant scarring in the upper part of the tear duct which may occur from injury or infection, a permanent Pyrex glass tube may be required.

Dry eyes - When a person develops severe dryness of the eyes because not enough tears are being produced, then the tear drainage system can be closed with plugs or cautery to help keep more tears on the eye. Usually, drops, gels, and ointments are tried first.

Orbit

Tumors - The orbit is the tissue between the bony eye socket and the eye itself. Benign or cancerous tumors can occur in this tissue. Inflammation can also occur here causing forward displacement of the eye and sometimes double vision with difficulty moving the eyes. The most common cause of this is thyroid eye disease, also called Graves’ eye disease.

Removal of the eye - Sometimes the eye itself may need to be removed. Some reasons include severe injury, cancer, and a blind painful eye. When the eye is removed, a motility implant is placed in the orbital tissues to replace the volume removed. A prosthesis or artificial eye is then fit to match the appearance of the remaining eye.

www.countryhillseyecenter.eyemd.org