Ocuplastic Eyelid Surgery

What is oculoplastic surgery?

Oculoplastic surgery is a specialised surgery that aims to treat problems with the eyelids, tear drainage system and eye socket.

Someone with functional eyelid problems may struggle with their vision or field of vision, experience excessive tearing, pain or discomfort. Oculoplastic surgery can either be reconstructive or cosmetic.

Reconstructive or functional oculoplastic surgery can improve the function of the structure surrounding the eye.

Types of oculoplastic surgery

The scope of oculoplastic surgeries designed to address eyelid conditions or cosmetic concerns is extensive, however the most common include:

Blepharoplasty (Eyelid Surgery)

As you age, your eyelids stretch which causes the supporting muscles to weaken resulting in sagging skin around the eyes. Besides making you look older, this could reduce your peripheral vision quite significantly especially the upper and outer parts of your field of vision. Blepharoplasty (pronounced “blef-a-ro-plasty”) is a type of eyelid surgery involving the repairing of droopy eyelids which may include the removal of excess skin, muscle and fat.

Undergoing this procedure may reduce or eliminate your vision problems, and make your eyes appear younger and more alert.

Blepharoplasty may be an option if you have:

• Baggy or droopy upper eyelids
• Excess skin of the upper eyelids that interferes with your peripheral vision
• Excess skin on the lower eyelids
• Bags under your eyes

Types of blepharoplasty procedures:

Upper blepharoplasty: a surgical procedure that removes excess skin and fat in the upper eyelids.

Lower blepharoplasty: a surgical procedure that removes excess skin, muscle and fat from the lower eyelids.

Possible risks of eyelid surgery include:

• Infection and bleeding
• Dry, irritated eyes
• Difficulty closing your eyes or other eyelid problems
• Noticeable scarring
• Injury to eye muscles
• Skin discolouration
• The need for a follow-up surgery
• Temporarily blurred vision or, rarely, loss of eyesight
• Risks associated with surgery in general, including reaction to anaesthesia and blood clots

Ptosis Repair

What is ptosis?

Ptosis, also known as blepharoptosis, is the medical term for the drooping or falling of the upper eyelid.

The lowering of the upper eyelid may cause a reduction in the field of vision, partially or completely obstructing the pupil. Patients with ptosis might experience difficulty with keeping their eyelids open and will often arch their eyebrows in an attempt to raise their eyelids. In extreme cases, some people may actually need to lift their eyelids with their fingers in order to see.

What causes ptosis?

In some cases, a person can be born with ptosis but it is usually the result of the loosening or stretching of the muscle and tendon that lifts the eyelid. This can be from an injury or disease, or it can come with age. Symptoms may worsen towards the end of the day or when tired.

Why do you need surgery?

Ptosis can cause problems when you drive, read, or even walk up and downstairs. Surgical repair is needed to reattach or shorten these muscles or tendons in order to elevate the eyelid again and restore a normal field of vision.

Eyelid malposition

What is eyelid malposition?

Sometimes our eyelids can become positioned incorrectly. There are two conditions that describe their position, entropion and ectropion

Entropion

Entropion is when the eyelid turns inward and usually occurs on the lower eyelids. The eyelid can either be rolled inward on a continuous basis or only when the eyelids are closed tightly. This causes the skin and eyelashes to rub against the cornea which can be painful for some.

Entropion is usually the result of aging, but there are other causes:

• Injury
• Congenital defect
• Muscle weakness
• Prior surgery
• Inflammation
• Skin diseases

Symptoms of Entropion

• Redness
• Irritation
• Dry eyes
• Excessive tearing
• Sensitivity to light
• Reduced vision
• Discharge from the eye
• A feeling that there is something in the eye.

Untreated entropion can lead to corneal abrasions, ulcers and infections

Treatment for Entropion

Although Botox injections are effective in relaxing the muscle spasms that can cause the eyelid to roll inward, surgery is proven to be the best solution. If the condition is caused by muscle weakness around the eye, a small section of the eyelid will be removed in order to tighten the muscles in the area.

Ectropion

Opposite to Entropion, ectropion is when the eyelid turns outward and typically affects the lower lid. Ectropion exposes one section of the lid or the entire eyelid.

This condition is common in older adults as the muscles, tendons and connective tissue around our eyes get weaker as we age. However, if a person has had trauma to their face or eyes, the possibility of developing ectropion is greater.

Other possible causes of entropion are:

• Eyelid growths
• Previous eyelid cosmetic surgery
• Facial scarring from trauma
• Excessive sun exposure
• Cosmetic laser skin resurfacing
• Use of certain medical eye drops to treat glaucoma

Symptoms of Ectropion

Ectropion inhibits proper tear drainage from the eye so as a result, someone who has this condition may experience similar symptoms to Entropion. These symptoms include eye irritation and redness, excessive tearing, pain, sensitivity to light, inflammation, and a gritty feeling in the eye.

In severe cases, ectropion may cause corneal abrasions, corneal ulcers and eye infections.

Treatment for Ectropion

Much like entropion, surgery is the best option for treating this eye condition. The surgery will involve stretching of scar tissue, the removal of a small section of the eyelid, or a skin graft to reposition the eyelid.

Tearing Disorders

In order for the eye to function properly and retain its health, it needs to remain moist. The lacrimal gland is a specialised gland that produces tears that spread over the surface of the eye. Any excess tears will drain into the tear drainage system. This process maintains the delicate balance of too little or too much fluid surrounding the eye.

If there is too much fluid, the eye might be dry or there could be an obstruction in the tear drainage system. If there is not enough fluid, the surface of the eye will dry out and result in burning, tearing or irritation.

There are medications that can help the lacrimal glands produce more tears, however, if the increased lubrication still doesn’t relieve any discomfort, surgery might be required. Surgery may also be required if an obstruction is blocking the outflow of tears in the tear drainage system. In some cases, the tear drainage system may just need to be corrected or in more complex cases, an entirely new drainage path needs to be created.