Dermatochalasis refers to excess eyelid skin. Upper lid dermatochalasis can sometimes lead to visual field obstruction. Blepharoplasty is a surgical procedure designed to remove redundant eyelid skin and fat. This can be performed on the upper and lower eyelids.
Ectropion refers to an outward rotation of the eyelid margin. This is often combined with eyelid laxity or retraction, contributing to eye irritation. Surgical correction is sometimes needed to reposition the lid and protect the surface of the eye.
Entropion refers to an inward rotation of the eyelid margin. Eyelashes can rub against the cornea, causing eye irritation or infection. Entropion can appear on the upper or lower eyelids and lead to significant discomfort. Surgical correction often provides much relief.
Eyelid retraction is seen when the upper lid is too high or the lower lid is too low. This can cause lagopthalmos (difficulty with eyelid closure), dry eyes, and corneal problems. Eyelid retraction can be a normal anatomic variant or due to thyroid eye disease, trauma, surgery, and rarely other causes. Upper lid retraction correction can be performed from an incision underneath the lid or on the outside at the lid crease. Correction of lower lid retraction can include lower lid tightening, skin graft placement, and spacers, to achieve an improved lid height and contour.
Epiblepharon is a condition commonly seen in Asian children. The lower eyelid skin and muscle causes the lashes to rotate inwards, causing eye irritation. When causing persistent discomfort or corneal changes, surgical correction is needed in order to alleviate symptoms and protect the surface of the eye from further damage.
Trichiasis refers to misdirected eyelashes that can cause significant eye irritation. Several treatments aim to remove the lashes: including epilation (pulling the lash), freezing the lash follicles with cryotherapy, and electrolysis. These procedures are typically performed in the office under local anesthesia.
Facial paralysis can lead to many eyelid issues causing ocular exposure, corneal problems, and lagophthalmos (inability to close the eye). Management of this complex problem can range from conservative measures to multiple modalities of surgical correction. Facial palsy may cause a drooping brow on the affected side which can interfere with peripheral vision and lead to facial asymmetry requiring a brow lift. Repositioning of the upper and lower lids may be necessary in order to protect the eye and restore the lids to their natural anatomic position. This can be done by placing a gold weight in the upper lid to assist with eyelid closure as well as tightening the lower lid.
There are many different kinds of orbital tumors of various origins. They can sometimes lead to changes in eyelid or eye position, diplopia (double vision), pain, and even vision loss. It is important to obtain a thorough evaluation in order to determine proper treatment and management.
Thyroid Eye Disease
Thyroid eye disease is a common autoimmune inflammatory condition most frequently associated with Grave's disease. Clinical signs can include eyelid retraction, proptosis (bulging of the eye), eyelid and conjunctival inflammation, diplopia (double vision), and decline in vision. Treatment requires a multidisciplinary approach, often including systemic medications in conjunction with management by an oculofacial plastic and reconstructive surgeon.