Functional & Reconstructive Surgery
Excess skin of the upper and lower eyelids tends to occur with age and is a medical condition called Dermatochalasis. If the upper eyelid excess skin is significant enough, it can interfere with a person's peripheral or central vision. In many of these cases, insurance will cover the costs involved with the surgical removal of the excess skin, known as a blepharoplasty. Or it can be done as a cosmetic surgery if the excess skin is not visually significant.
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With age, the eyelid structures change, allowing fat pads to become more pronounced, worsening the appearance of upper excess skin and of the lower eyelids causing a baggy appearance. Unfortunately, dermatochalasis of the lower eyelids are never covered by insurance and is always considered a cosmetic procedure.
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Ptosis is the drooping of the upper eyelid(s) that can be caused by different reasons but the most common cause is due to stretching or dehiscense of the eyelid muscle that pulls the eyelid up and open, called the levator aponeurosis. Patients are often told by others that they look tired or sleepy.
Age, genetics, chronic eye rubbing or other environmental factors can be contribute to this condition. In rarer cases, there can be a more serious neurological or vascular cause for ptosis. For these reasons, its important to have an urgent evaluation by an eye doctor and/or eyelid specialist, especially if the onset of ptosis is sudden.
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If the condition is significant enough to interfere with vision, insurance will often cover the ptosis repair. There are different ways to surgically correct this condition therefore it is best to have an thorough evaluation by a fellowship trained oculoplastic surgeon.
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After ptosis repair, because the eyelids become more open, patients often complain about the appearance of excess skin after the surgery. It's like vertical curtains that bunch up when you open them. As seen in the photos below, pre-existing excess skin becomes bunched up and more apparent as the eyelids become more open after ptosis repair. Patients will often have a cosmetic blepharoplasty (an out of pocket expense) at the same time as a ptosis repair for achieve a more youthful appearance.
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With age, the eyebrows can droop, pushing the upper eyelid skin down and exaggerating the hooding and excess skin appearance of the upper eyelids. A person can often have both brow ptosis and dermatochalasis at the same time. If the brow ptosis is significant enough and interfering with one's vision, insurance will often cover this surgery.
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Depending on factors such as the severity of the brow ptosis, heaviness of the brows and hair line position, the eyebrows can be elevated using different surgical methods either through an incision in the crease, by endoscopic means or an incision above the eyebrows. Because everyone's condition is unique, it is best to have an evaluation by a fellowship trained oculoplastic surgeon.
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Ectropion is where the lower eyelid(s) turn or sag outwards leaving the eyeball and inner surface of the eyelid exposed to the air to dry out. Eyeball irritation can cause tearing, redness, burning, gritty, sandy feeling, crusting and discharge. Without treatment, the eyeball can become inflamed and result in corneal/eye damage, recurrent infections and corneal ulcers.
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Ectropion is often associated with age and laxity in the eyelid but it can also be caused by facial nerve paralysis, scarring or complications from other eyelid surgeries.
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Surgical treatment would depend on the underlying cause and the severity of the ectropion.
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Entropion is where the eyelid(s) turn or fold inwards, causing the eyelashes to roll in and rub up against the eyeball or cornea, causing irritation. Patients often experience tearing, redness, burning, gritty, sandy feeling, crusting and discharge. Without treatment, the eyeball can become very inflamed and result in corneal/eye damage, recurrent infections and corneal ulcers.
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Entropion is commonly associated with age and loosening or laxity of the eyelid however it can also be congenital, caused by scarring or complications from other eyelid surgeries.
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This condition can be corrected successfully with surgery.
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Most skin cancers of the eyelids are due to basal cell carcinomas (BCC) which almost never spread (or metastasize) to the rest of the body. However if large enough, BCC can cause distortion and disfigurement of the eyelids.
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Sqaumous cell carcinoma (SCC) accounts for a smaller number of eyelid cancers, however SCC carries an increased risk compared to BCC of spreading to deeper tissues like the orbit, brain and sinuses. Although rare, SCC tends to have an increased risk compared to BCC of metastasizes.
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Melanoma of the skin around the eyelids is rare but has an even higher risk of metastasis than BCC or SCC.
Skin cancer around the eyelids can be diagnosed with a biopsy performed in the office. Treatment usually involves Mohs surgical removal of the cancer, and reconstruction of the eyelid defect by a fellowship trained oculoplastic surgeon.
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Any lesions, bumps or growths should be evaluated by a qualified professional. With early detection and diagnosis, the prognosis is often much better than if left to grow and invade large areas of the eyelid.
Blockage anywhere along the tear duct will prevent your tears from draining normally. Patients can have watery eyes throughout the day with tears running down their cheek, recurrent pink eye, blurred vision and a painful swollen area near the inside corner of the eye.
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Tear duct blockage in adults can be associated with age, chronic inflammation, infection, history of radiation or chemotherapy treatments, trauma, tumor or other unknown causes.
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Tear duct blockage can be diagnosed by probing and irrigating the tear duct system with saline solution. Surgical correction would depend on the location and extent of the blockage. Treatment can include probing with stent placement, endoscopic or external dacryocystorhinostomy (DCR) or conjunctivodacryocystorhinostomy with a glass tube, also known as Jones tube placement.
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An evaluation by a fellowship trained oculoplastic surgeon can help determine the type of treatment that is needed.
A stye or hordeolum usually starts off as a painful lump on the eyelid that becomes painless over time. It is due to a localized infection of the meibomian gland (oil gland) located within the eyelids. A chalazion is due to a blocked meibomian gland and is generally not painful but can start off as a hordeolum.
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Sometimes hot compresses four times per day for ten minutes each session helps resolve this condition. But if it persists or the chalazion/stye is very large, surgical incision and drainage of the lesion can help speed up its resolution.
Enucleation is the removal of the entire eyeball (globe) and can be done with or without re-attachment of the eye muscles to the spherical implant that is put into place to fill the missing volume in the eye socket.
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Evisceration is where the cornea and inner contents of the eye are removed, leaving the white scleral outside shell. And implant is placed inside the eyeball shell and stitched into place.
These procedures are necessary when a patient experiences severe eye trauma, an intraocular tumor, severe infection in the eye or a blind, painful eye.
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After the eye socket is healed (6-8 weeks), a patient can be fit with a prosthesis to match the other eye and often results in a good cosmetic outcome. The prosthesis is made by an ocularist.
Eyelid lacerations can be partial or full thickness defects in the eyelid that can be caused by trauma such as from falling on a sharp object, a dog bite or blunt trauma. They can involve the tear duct, which then requires repair of the tear duct and placement of a stent to allow the tear drainage system to stay open as it heals rather than scar down and close off.
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An orbital fracture occurs when there's a break in one or more of the bones surrounding the eyeball and is often caused by blunt force trauma such as being hit with a fist or a car accident.
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Depending on the severity and location of the fracture, surgical treatment may or may not be necessary and can be determined by a fellowship trained oculoplastic surgeon. In some cases, surgical intervention is needed urgently before any permanent damage occurs to the muscles controlling the eyeball.
An orbital tumor is a tumor that is located within the orbit or the space within the bony structures that surround and protect the eyeball. In many cases, these tumors cannot be detected unless they start creating symptoms such as blurred vision, visual disturbances, numbness, pain, restricted eye movements or displacement of the eyeball forward, causing "proptosis" or a bulging appearance of the affected eye.
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These tumors can be benign or malignant and can be either primary (tumor originate here) or metatstatic (tumor has spread for cancer elsewhere in the body).
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MRIs, CT scans and surgical biopsies can help with the diagnosis of these tumors. Depending on the type of tumor, they can either be surgically removed or treated medically or/radiologically by an oncologist.