Eyelid | Eye
Dermatochalasis (Excess Upper Eyelid Skin)
Dermatochalasis refers to excess eyelid skin. Upper lid dermatochalasis can sometimes lead to visual field obstruction. Blepharoplasty surgery is a procedure designed to remove redundant eyelid skin and fat. Depending on various factors, upper eyelid blepharoplasty can be a functional or cosmetic concern. Lower eyelid blepharoplasty is not covered by insurance.
Ptosis (Droopy Upper Eyelid)
Eyelid ptosis refers to “droopy upper eyelid(s)”, and can occur on one or both sides. Ptosis can cause difficulty with peripheral vision, and aesthetically, can cause someone to look inadvertently inattentive or sleepy. The most common cause of ptosis is weakness of the levator muscle, which is the main muscle responsible for opening the eyelid. Ptosis can also be present from birth (congenital ptosis), or be caused by various neurologic disorders, muscular conditions, surgery, or trauma. The surgical correction of ptosis typically requires tightening of the muscles that open the eyelid, either through an incision along the upper eyelid crease, or through a hidden incision on the back surface of the eyelid.
Ectropion (Eyelid turning out)
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 (Eyelid turning in)
Entropion refers to an inward rotation of the eyelid margin. Eyelashes can rub against the cornea, causing eye irritation and even lead to infection. Although entropion can occur on the upper or lower eyelids, it more commonly affects the lower eyelids. Surgical correction often provides significant relief.
Eyelid retraction is seen when the upper lid is too high or the lower lid is too low. This can cause lagophthalmos (difficulty with eyelid closure), dry eyes and corneal problems. Eyelid retraction can be a normal anatomic variant or can be due to thyroid eye disease, trauma, surgery, and rarely other causes. The correction of upper lid retraction can be performed from an incision underneath the lid or with an incision along the upper eyelid crease. Lower eyelid retraction can be corrected with lower eyelid tightening, placement of a skin graft and/or spacer, which typically achieves an improved lid height and contour.
Trichiasis refers to the misdirection of eyelashes, and can cause significant eye irritation. Several treatments can be performed in attempt to remove the lashes including epilation (pulling the lash or lashes), cryotherapy (freezing of the lash follicles), and electrolysis (damaging the lash follicles with radiofrequency or electrocautery). These procedures are typically performed in the office under local anesthesia.
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 this condition is present and causing persistent discomfort and/or corneal changes, surgical correction is recommended to alleviate the symptoms and protect the surface of the eye from further damage.
A chalazion is a small, typically non-infectious bump on the upper or lower eyelid that occurs due to a blockage of the oil glands on the eyelid. They typically occur in those with blepharitis, or inflammation of the eyelid margin, and can be treated with conservative management in addition to steroid injection and/or drainage.
Eyelid twitching is a common condition. Occasional twitching is typically due to lack of sleep, excessive caffeine intake and/or stress, and can be alleviated by increasing sleep, decreasing caffeine and stress. Another common cause of blepharospasm is dryness of the eyes. Some patients with eyelid twitching have a condition known as benign essential blepharospasm (BEB). BEB is a condition caused by abnormal contraction of the muscles in the eyelids causing involuntary eyelid closure and excessive blinking. Although vision may be normal, visual perception can be severely impacted. in which the eyelids have abnormal contractions close involuntarily and blink excessively. If persistent, blepharospasm can be treated with neuromodulator injections and/or surgical intervention.
Hemifacial spasm (HFS) causes twitching and spasm of the muscles on one side of the face, including the eyelids, cheek and mouth. HFS can be due to compression of the facial nerve (nerve that moves the muscles of the face), so it is important to see a specialist and obtain baseline imaging. Like BEB, HFS can be treated with neuromodulator injections, and sometimes requires surgical intervention.
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 of 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.
Congenital and gravitational settling of the brows (brow ptosis) causes forehead lines, low or asymmetric brows, and redundancy in skin of the upper eyelids. With age, the temporal, or outermost, aspect of the brow is the first to succumb to weakness and brow ptosis, leaving heavier skin sagging on the outside of the upper eyelids. This can also create deep wrinkles at the outside corner of the eyelids. Brow ptosis can cause impairment of the peripheral vision and may require surgical correction.
Eyelid, Eyebrow and Facial Lesions
There are many varieties of eyelid lesions, including benign and malignant neoplasms, that can develop on the forehead, eyelids, and midface areas. Some examples are sun related changes, cysts, 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.
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 cream and surgical excision with reconstruction. Advanced cases may also require oral medications and/or radiation.
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 of the eyebrow 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 weight in the upper lid to assist with eyelid closure, as well as tightening the lower lid.
Temporal Artery Biopsy
Giant Cell Arteritis, also known as temporal arteritis, is a very serious condition that can present with headache, jaw claudication, double vision, and/or irreversible vision loss. It is critical to seek medical care, as laboratory testing and treatment with steroids may be necessary. Biopsy of the temporal artery can be performed in the hospital or as an in-office procedure, and is important in confirming the diagnosis of this condition.
Facial Trauma / Facial Fractures
Facial trauma can result in a variety of injuries including eyelid and/or facial lacerations and facial fractures (including fractures of the bones of the eye socket). A CT scan is recommended following any significant facial trauma to assess for fractures. Although fractures are serious and should be managed by an experienced and specialized physician, not all fractures require surgical repair. The repair of any lacerations of the eyelid is a delicate procedure that should be performed by a specialist to optimize the outcome.
Lacrimal (Tear Drainage System)
Epiphora (excessive tearing)
Persistent and excessive tearing can be a nuisance, and can interfere with daily activities. There are many causes of tearing, including dry eyes, chronic inflammation, eyelid malpositions, prior trauma, prior or current chemotherapy medications, and various degrees of blockage of the tear drainage system (nasolacrimal duct obstruction). Depending on the cause of tearing, there are various treatments that range from conservative management with over the counter artificial tears to surgical intervention. Tearing will be evaluated in the office to assess the patency of the tear drainage system, and plan for the best mode of treatment that addresses the cause(s).
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.