As we age, the tone and shape of our eyelids, eyebrows, forehead and the tissue around our eyes become slack. This results in excess, puffy, or lax skin that can make us appear more tired or older than we are.
If you’re considering reconstructive or cosmetic eyelid surgery, you should decide what physical attributes you want to refresh. Is there too much skin? Does it hang over the lashes? Are the wrinkles too excessive? Are the eyelids unequal in appearance? Do the lower lids have heavy bags? You may simply look at your eyes and decide you want a more youthful look. During your initial consultation, our oculoplastic specialist can explain what can be surgically enhanced in order to accomplish your desired look.
Ptosis- This is a drooping of the upper eyelids or eyebrows, which can cause a decrease in peripheral vision. It may be present at birth. It can occur after trauma or other eye surgeries. Most commonly, it is due to gravitational changes associated with aging.
Eyelid Retraction- The upper or lower eyelids may appear as if they open too widely. A significant amount of the white part of the eye (sclera) is visible, giving the person a staring appearance. Sometimes the eyelids cannot close completely. This condition is often associated with thyroid disease but may have other causes.
Entropion- This is a condition in which the eyelid, usually the lower lid, is turned inward toward the eye. The lashes rub on the eyeball causing discomfort. Entropion commonly occurs in older people but it may be seen in children.
Ectropion- In this condition, the eyelid, usually the lower lid, is turned outward away from the eyeball. The back surface of the eyelid which normally rests on the eyeball becomes exposed to the air. This results in a red and painful eye and eyelid. Ectropion can also cause excess tearing.
Trichiasis- The eyelid is in a normal position, but the eyelashes grow toward the eyeball instead of away from it. The eye is often uncomfortable, red, and filled with tears. One or more lashes may be involved.
All of these conditions can be corrected with “outpatient” surgery under a local anesthetic. IV sedation is used to prevent anxiety and pain during surgical procedures. The goal of the final reconstruction is to make the eyelid appear and function as close to normal as possible.
Cosmetic eyelid surgery is performed to improve the appearance of the eyes and face. The cosmetic surgical procedure most often performed to improve the appearance of the eyelids is a blepharoplasty.
Blepharoplasty refers to the cosmetic or aesthetic procedure performed to remove excess skin, fat, and muscle from the upper and lower eyelids. Sometimes, eyebrow elevation surgery is indicated instead of eyelid surgery. Drooping lids, brows, bags, and wrinkles can give a tired or older look to an otherwise youthful and energetic person. Cosmetic eyelid surgery can give the eye a more open appearance and generally give the face a more youthful, rested look.
Reconstructive eyelid surgery is performed when the eyelid inhibits good vision due to age, an accident, or a medical problem. Patients who experience eyelid reconstruction may also benefit from the improved appearance of the eyes and face.
The same surgical procedure can be done for reconstructive purposes in cases where upper eyelid excess skin is so extensive that it causes difficulty with vision or chronic irritation of the eyelids.
This is a condition in which the eyelids close or spasm involuntarily and the patient is unable to open them for a period of time. When Blepharospasm is severe, the patient may be incapacitated due to an inability to see through the tightly closed eyelid. The cause of this condition is unknown, but treatments are available. The current treatment of choice is injections, which can be done in the office in about 10 minutes. Repeat injections are usually required.
The eyes are constantly lubricated by tears which are produced by the lacrimal (tear) gland located near the outer portion of the upper eyelid.
The tears flow across the eye and enter the tear ducts which are located in the inner corners of both eyelids. From these ducts, the tears collect in the tear sac and eventually drain into the nose. Any obstruction in the ducts that drain the tears will cause overflow tearing. This is called epiphora.
Tear duct obstruction can occur as a birth defect or as part of the aging process. Tear duct surgery is performed to allow tears to flow normally from the eye into the nose. Dry eyes, allergies, infections, and eyelid mal-positions can also cause tearing. Dr. Goldey can usually determine the cause of tearing by a routine exam, although sometimes supplemental tests are required. Treatments of excessive tearing can be accomplished by medication or surgery once the cause is identified.
Treatments of excessive tearing can be accomplished by medication or surgery once the cause is identified.
The eyelids, like other parts of the body, can develop lumps or bumps which are not considered a normal part of the eyelid. They are referred to as eyelid lesions or tumors. Most of these lesions are benign and are not a threat to one’s general health. These can be removed at any time.
A small percentage of eyelid lesions, however, are malignant. These are skin cancers that must be removed before they enlarge and spread. Some malignant lesions have a similar appearance to benign lesions. It is important that most lesions which are surgically removed be sent to a laboratory for evaluation. After removal, reconstructive surgery must be performed to repair the defect that remains. Small lesions may be removed without stitches to close the defect. Large tumors, however, may require removal of the entire eyelid to ensure that the whole tumor is removed.
When an eye must be removed due to injury or disease, special techniques are used to give patients the most natural appearance possible, including the fitting of a prosthesis (artificial eye). For some patients who have had previous surgeries, reconstruction of the socket may also enhance the fit and movement of the prosthesis.
