Reconstructive Surgery
and Management

Dermatochalasis

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.

Ptosis

Eyelid ptosis describes drooping of the upper eyelid margin. This can commonly cause upper peripheral vision loss. Several surgical procedures for ptosis can elevate the eyelid margin to the desired height.

Eyelid Malpostions

Ectropion

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

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

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

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.

Eyelid, Brow, and Midface Lesions

There are many varieties of eyelid lesions, including benign and malignant neoplasms, that can develop around the forehead, eyelids, and midface areas. Some examples are sun related changes, styes (chalazion), skin tags, moles, and skin cancers. Various treatments include observation, topical medications, cryotherapy, laser, and excision. Examination of the tissue by a pathologist is often indicated in order to determine the diagnosis and further management. 

Trichiasis

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.

Tearing

Tearing can not only be a nuisance, but it can interfere with daily activities and become a chronic issue if not treated appropriately. There are many causes of tearing including dry eyes, chronic inflammation, eyelid malpositions, and various degrees of nasolacrimal duct obstruction (blockage of the drainage system). There are various surgical treatments for nasolacrimal duct obstruction, including irrigation with saline in the office, temporary stenting, and establishment of a new passageway for tear drainage (dacryocystorhinostomy). A thorough evaluation in the office can help determine the cause of tearing and establish a plan for treatment.

Facial Palsy

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.

Skin Cancer

Sun exposure can lead to various forms of skin cancer on the eyelid, brow, and mid-face, including basal cell carcinoma, squamous cell carcinoma, and melanoma. It is imperative to treat these in a timely manner. Various treatments include topical creams, surgical excision and reconstruction. Advanced cases may also require oral medications or radiation.

Orbit Tumors

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.

Enucleation and Evisceration

In some circumstances such as a blind and painful eye, trauma, or tumors, removal of the eye is necessary. Enucleation refers to removal of the eye, while evisceration refers to removal of the contents inside the eye. A spherical implant is often placed to restore volume, and a prosthesis can be placed over the area in order to reestablish a normal appearance.

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.