Eye Lids

Blepharoplasty

As we age, the delicate skin around the eyes can appear puffy or saggy. Eyelid skin stretches, muscles weaken, and the normal deposits of protective fat around the eye bulge. The surgical procedure to remove excess eyelid tissues (skin, muscle, or fat) is called blepharoplasty.

Blepharoplasty can be performed on the upper eyelid, lower eyelid, or both. The surgery is performed for either cosmetic or functional reasons. Sometimes excess upper eyelid tissue obstructs the upper visual field or can weigh down the eyelid and produce tired-feeling eyes. Most often, people choose blepharoplasty to improve their appearance by making the area around their eyes firmer. When blepharoplasty is performed to improve vision, rather than for cosmetic reasons only, it may be covered by insurance.

Botox can also be used to reduce fine facial wrinkles. Botox is an injectable medication that is used in the office to reduce facial muscle spasm. It is most effective for "crow's feet", brow furrows, and "smile lines."

Blepharoplasty for the lower lid removes the large bags under the eyes. It is unusual for third party payers to cover lower lid blepharoplasty.

The surgery is usually performed on an outpatient basis and can take one to three hours. Upper lid incisions are made in the natural crease of the lid, and lower lid incisions are made just below the lash line. A procedure for lower lid blepharoplasty, called transconjunctival blepharoplasty, removes excess fat through an incision inside the lower lid. Incisions are closed with fine sutures.

Swelling, bruising and blurry vision are common after blepharoplasty. Stitches are removed senses days after surgery, except in the case of transconjunctival blepharoplasty where the self-dissolving sutures require no removal.

Rare complications associated with blepharoplasty include bleeding and swelling, delayed healing, infection, drooping of upper or lower eyelid, asymmetry, double vision, vision loss, and dry eye. It is important to note that the puffiness of the fat pockets may not return, but normal wrinkling and aging of the eye area will continue.

Below is a patient who had a blepharoplasty procedure done at Missouri Eye Institute. Click the before and after pictures for larger views.

*Images used with patients permission

Ectropion

Ectropion is an outward turning of the lower eyelid, most commonly caused by aging, although eyelid burns or skin disease may also be responsible.

Normally, the eyelids help lubricate and cleanse the eye during blinking. An eyelid that is drooping and has lost contact with the eye can cause dry eyes, excessive tearing, redness and sensitivity to light and wind.

Surgery can be performed to tighten the eyelid and return it to its normal position. The eyelid can then protect and lubricate the eye properly, so that irritation and other symptoms subside.

Eyelid surgery to repair ectropion is usually performed as an outpatient procedure using local anesthesia. After surgery, an eye patch is usually not worn and antibiotic ointment is prescribed.

Entropion

Entropion is an inward turning of the eyelid and lashes toward the eye, usually caused by relaxation of the eye muscles and tissue due to aging.

Entropion usually affects the lower lid. The skin and eyelashes rub against the eye and cause discomfort and tearing. The irritated eye can produce mucous, and become red and sensitive to light and wind. If entropion is not treated, rubbing of the skin and eyelashes can cause infection or scarring of the eye, which can cause vision loss.

Surgery can be performed to tighten the eyelid and return it to its normal position. The eyelid then protects the eye properly, and irritation and other symptoms subside.

Eyelid surgery to repair entropion is usually performed as an outpatient procedure using local anesthesia. After surgery, an eye patch is usually not worn and antibiotic ointment is prescribed.

Eyelid Surgery

Basal Cell Carcinoma

Eyelid surgery is a common method of treatment for entropion (inward turning of the eyelid), ectropion (outward turning of the eyelid), ptosis (drooping of the eyelid), and some eyelid tumors. Our doctor's treat skin cancers of the eyelid.

Eyelid surgery is usually an outpatient procedure with local anesthesia. Risks of surgery are rare, but include asymmetry of the eyelids. Differences in healing between the eyes may cause some unevenness after surgery.

After eyelid surgery, a black eye is common but goes away quickly. It may be difficult to close your eyelids completely, making the eyes feel dry. This irritation generally disappears as the surgery heals. Serious complications are rare but include vision loss, scarring, and infection. To most people, the improvement in vision, comfort and appearance after eyelid surgery is very gratifying.

Ptosis

Ptosis is drooping of the upper eyelid. The lid may droop only slightly or it may cover the pupil entirely. In some cases ptosis can restrict and even block normal vision.

Congenital ptosis, or ptosis that is present at birth, requires treatment for normal visual development. Uncorrected congenital ptosis can cause amblyopia, or lazy eye. If left untreated, amblyopia can lead to permanently poor vision.

Except in mild cases, the treatment for childhood ptosis is usually surgery to tighten the levator muscle that lifts the eyelid. In severe ptosis, when the levator muscle is extremely weak, the lid can be attached or suspended from under the eyebrow so the forehead muscles do the lifting. Children with ptosis, whether they have had surgery or not, should be examined annually by an ophthalmologist for amblyopia, refractive disorders, and associated conditions.

Ptosis in adults is commonly caused by separation of the levator muscle from the eyelid as a result of aging, cataract or other eye surgery, an injury, or an eye tumor. Adult ptosis may also occur as a complication of other diseases involving the levator muscle or its nerve supply, such as diabetes.

If treatment is necessary, it is usually surgical. Sometimes a small tuck in the levator muscle and eyelid can raise the lid sufficiently. More severe ptosis requires reattachment and strengthening of the levator muscle.

The risks of ptosis surgery include infection, bleeding, and reduced vision, but these complications occur very infrequently. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return.

Chalazion

A chalazion is a swelling in the eyelid caused by inflammation of one of the small oil producing glands located in the upper and lower eyelids. A chalazion is sometimes confused with a stye, which also appears as a lump in the eyelid, but is an infection of a lash follicle that forms a red, sore lump. Chalazions tend to occur farther from the edge of the eyelid than styes and tend to "point" toward the inside of the eyelid. Sometimes a chalazion can cause the entire eyelid to swell suddenly, but usually there is a definite tender point.

When a chalazion is small and without symptoms, it may disappear on its own. If the chalazion is large, it may cause blurred vision. Chalazions are treated with any or a combination of the following methods:

· Warm compresses can be applied. The simplest way is to hold a clean washcloth, soaked in hot water, against the closed lid. Do this for five to ten minutes, three or four times a day. Repeatedly soak the washcloth in hot water to maintain adequate heat. The majority of chalazions will disappear within a few weeks. Sometimes antibiotic ointments are used in combination with warm compresses.

Surgical incision or excision may be used to remove large chalazions which do not respond to other treatments.

Chalazions usually respond well to treatment, although some people are prone to recurrences. If a chalazion recurs in the same place, your ophthalmologist or optometrist may suggest a biopsy to rule out more serious problems.

Blephartis

Blepharitis is inflammation of the eyelids, usually with redness, swelling, and itching. Blepharitis can be caused by bacteria on the eyelids or the skin around the eyes. Dandruff or oily skin can also cause it. To treat this problem, you need to keep your eyelids clean. Your eye doctor may also give you medication if it is severe enough.

 

To reduce the redness and swelling you can use warm compresses.
1. You must first wash your hands with soap and warm water
2. Then get a clean washcloth with warm water. Wring out the wash cloth.
3. To loosen the scales or crusts close your eyes and place the washcloth over your eyelids for 3 to 5 minutes.
4. Keep the washcloth warm.
5. Repeat 2 or more times a day. Use a clean washcloth each time.

To use an eyelid scrub:
1. Wash your hands with soap and warm water.
2. Use a ready-made eyelid scrub. You can mix a scrub by mixing 3 drops of baby shampoo in ¼ cup warm water.
3. Dip a lint-free pad, cotton swab, or clean washcloth in the scrub.
4. Close one eye and scrub the base of the eyelid.
5. Rinse the lid in cool water and dry with a clean towel.
6. Repeat on the other eye.

Botox Injections

Botox is the trade name for botulinum toxin. In its pure form, botulinum toxin is a type of food poisoning that causes muscle weakness. It acts as a nerve impulse blocker, preventing muscles from contracting. In an extremely dilute form, botulinum toxin has many medical applications.

Botulinum toxin can be injected directly into muscles of the face or eye when facial muscles are overactive. Botox causes the overactive muscles to relax. It usually takes a few days for the therapeutic effect to be noticeable. The injections may need to be repeated every 4 to 6 months.

Botulinum toxin is used in ocular conditions such as blepharospasm, an excessive contraction of the eyelid muscles that forces the eyelids closed, and hemifacial spasm, an excessive contraction of the facial muscles on just one side of the face. For certain types of double vision, botulinum toxin can be injected directly into the eye muscle opposite the paralyzed eye muscle. Some wrinkles also become less prominent if injected with botulinum.

Side effects of the injection are temporary. They can include a droopy upper eyelid, double vision, and inability to close the eyelids.