Eyelid Surgery Cosmetic & Reconstructive
You may not think about tears until you're sad, hurt yourself or are laughing out loud with good friends, but, actually, your eyes produce tears all the time.
Healthy eyes are continuously covered by fluid — a tear film which allows you to maintain clear vision and comfortable eyes.
Decreased production of fluids from your tear glands can destabilize that tear film and create dry spots on the surface of your eyes. An imbalance in the substances that make up the tear film can also cause dry eyes.
What causes dry eyes?
Tears are made up of a complex mixture of water, fatty oils, proteins, electrolytes, bacteria-fighting substances and growth factors that regulate various cell processes. This mixture helps make the surface of your eyes smooth and clear. Without tears, good vision is impossible.
The tear film has three basic layers: oil, water and mucus. Problems with any of these layers can cause dry eye symptoms.
For some people, the cause of dry eyes is an imbalance in the composition of their tears. Other people don't produce enough tears to keep their eyes comfortably lubricated. Eyelid problems, medications including certain antidepressants, antihistamines, cold medicines, and birth control pills, as well as environmental factors such as cold, dry, sunny or windy conditions can lead to dry eyes.
Although dry eyes can affect both men and women at any age, the condition is more common among women, especially after menopause. This may be due in part to hormonal changes.
Damage to the tear glands from inflammation or radiation can also hamper tear production.”
Dry eyes are also associated with some medical conditions such as hyperthyroidism, diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren's syndrome and vitamin A deficiency.
Regardless, when you're unable to produce enough tears, your eyes become dry and easily irritated. Dry eyes are a common source of discomfort, especially in people over 40, as tear production tends to diminish as you get older.
No two people experience dry eyes exactly the same way. You may experience a stinging, burning or scratchy sensation in your eyes, stringy mucus in or around your eyes, increased eye irritation from smoke or wind, eye fatigue after short periods of reading or sitting in front of a computer, increased sensitivity to sunlight and situations with bright lighting, and “stickiness” when wearing contact lenses.
Surprisingly, you may have dry eyes and still at times find yourself with tears streaming down your cheeks. You may also experience blurred vision, often worsening at the end of the day.
Diagnosing dry eyes
Those with severe or chronic dry eyes should be examined. We can test the quantity and quality of your tears. We’ll perform simple tests to look at how your eyelid functions. Problems with eyelid function can impair the complex blinking motion required to spread your tear film across your eye, or if your eyelid doesn’t close properly, this can contribute to the problem.
We’ll also check for inflammation along the edge of the eyelids, which can cause your eyes to feel dry and scratchy.
For mild dryness, preservative-free, over-the-counter artificial tears can help lubricate and protect the eyes. Ointments, like Refresh PM, can be used at night. It’s important not to use drops that are specifically for reducing redness. You want to be certain you’re getting drops to enhance your natural tears.
Wearing UV-blocking sunglasses in the cold or wind, is also helpful, and don’t point fans and car air-conditioner vents directly at your eyes.
Prescription eyedrops may be needed. The goal of treatment is to keep your eyes moist. If you have an eyelid condition, such as an anatomic abnormality or an incomplete blink that aggravates your dry eyes, we can help you. If your eyelids are inflamed, we may recommend a special cleansing routine or short-term, nightly treatment with antibiotic drops or ointment or treatment with an oral antibiotic, such as tetracycline or doxycycline.
We can also partially or completely close your tear ducts with tiny silicone plugs, to keep tears from draining. Severe dry eyes require more aggressive treatment.
As we age, the tone and shape of our eyelids, eyebrows, forehead and the tissue around our eyes becomes slack. This results in excess, puffy or lax skin that can make us appear more tired or older than we are.
Traditional or laser eyelid surgery can correct sagging eyelids, remove fatty pouches beneath the eyes and remove excess skin in the upper eyelids. It can be done alone, or in conjunction with other facial surgery procedures such as laser skin resurfacing, a facelift, forehead lift or eyebrow lift.
Cosmetic eyelid surgery is performed to improve the appearance of the eyes and face. The cosmetic surgical procedure most often performed to improve 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 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.
If you’re considering 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, Dr. Goldey can explain what can be surgically enhanced in order to accomplish your desired look.
Other Eyelid Surgery
Abnormal conditions of the eyelid, caused by trauma, disease, or by the normal aging process that can be corrected by surgery. The surgical reconstruction of these abnormal conditions requires special surgical techniques. Some of these abnormal conditions are as follows:
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 local anesthetic. IV sedation is used to prevent anxiety and pain during surgical procedure.
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 Botulinum Toxin injections (BOTOX®), 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, therefore, 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.
At Mid-Florida Eye Center, the goal of the final reconstruction is to make the eyelid appear and function as close to normal as possible.
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.