RECONSTRUCTIVE

Your eyes communicate more than you think. The eyes have long been recognized as the center of facial expression and provide important cues about thoughts and emotions. These expressions facilitate human connection and contribute to first impressions.  It is well known, that first impressions are formed in a fraction of a second, often before you have a chance to open your mouth. 

Entropion

Ectropion is a condition in which an eyelid tissue is loose and turns outward, away from the eye.  In some cases of ectropion, the eyelids may not close tightly which can cause the feeling of foreign body sensation and mucous discharge.   Ectropion leaves the surface of the eye dry and exposed which can also cause tearing, redness, and irritation.

Aging is a common cause of ectropion; however, it can also occur as a result of facial nerve paralysis (Bell’s palsy), trauma, scarring or other surgeries.

Treatment of ectropion requires surgery.  The specific approach to repair is determined by the underlying cause of ectropion.  However, generally speaking surgery is performed to tighten the eyelid and bring it closer to the eye. If ectropion is left untreated or severe, the condition can lead to an irregular ocular surface, infections, and decreased vision. 

Ectropion

Entropion is a condition in which an eyelid turns inward, rubbing against the eye, making it red, irritated and sensitive to light.  It often causes the feeling of foreign body sensation and may cause excessive tearing. Entropion is most commonly caused by advancing age and weakening of eyelid muscles.  Entropion may also occur as a result of trauma, scarring or other surgeries.

Definitive treatment of entropion requires surgery.  Prior to surgery, the eye can be protected by taping the eyelid down and using lubricating drops and ointment.  In the office a non-incisional procedure may be performed as a temporary treatment or for patients who are unable to have surgery.  

If entropion is left untreated the condition can lead to excessive   tearing, crusting with mucous discharge and eye irritation.  In severe or longstanding cases, it can cause infection and serious damage to the eye.

Eyelid Ptosis

Ptosis is the medical term for drooping of the upper eyelid.  It may affect one or both eyes. When the edge of the upper eyelid droops it may block your peripheral vision. When the drooping is mild it may be very close to or partially cover the pupil.  If it is severe the eyelid may completely cover the pupil.

With age related changes the tendon that attached the muscle to the eyelid can stretch and allow the eyelid margin to drop and cover part of the eye.  It may also be present at birth or be caused by injury or certain neurological conditions.

If eyelid ptosis is bothersome enough and affects your vision, insurance may cover surgical repair. The main goals of ptosis surgery are elevation of the upper eyelid to improve the field of vision and to obtain more symmetry with the other upper eyelid.

Eyelid Reconstruction

Eyelid reconstruction is commonly performed to correct defects after skin cancer removal. Another common indication for reconstruction is trauma. In both upper and lower eyelid reconstruction, an in-depth knowledge of the anatomy, structure and function of the eye and surrounding structures is an absolute requirement for success. Eyelid tissue is very complex and the goals of reconstruction are to achieve proper eyelid function, protect the eye and to achieve an aesthetic result. Therefore, reconstruction by an oculoplastic trained ophthalmologist is recommended. 

Dermatochalasis

Dermatochalasis is a term used to describe the presence of loose and excess skin around the eye.  Dermatochalasis is commonly due to age related changes which causes loose connective tissue and loss of skin elasticity. It can also occur with prominent fat pads and drooping of the upper eyelid (ptosis).  Additionally, the skin is weighed down by the effect of gravity. 

Dermatochalasis is typically more dramatic in the upper eyelids.   If dermatochalasis is severe enough to affects your vision peripheral vision, insurance may cover surgical repair which is called a blepharoplasty.  The main goals of a reconstructive blepharoplasty to remove the excess skin and to improve peripheral vision.

Thyroid Eye Disease

Thyroid eye disease (TED) is an autoimmune, inflammatory eye condition most commonly seen in patients with Graves’ disease. In the majority of thyroid patients, no disease or mild TED is detected.  However, TED may present with a wide variety of signs and symptoms ranging from tearing, dryness and irritation to swelling, double vision, loss of vision and eye bulging. 

 

TED requires close and often frequent follow-up due to the severe and sight threatening complications that are associated with the disease.  A wide variety treatment options are available ranging from supportive measures like over-the-counter lubricating drops to orbital (eye socket) surgery.  If you have been diagnosed with thyroid disease and notice eye dryness or irritation, changes in your appearance or vision you should be evaluated by an ophthalmologist for an individualized treatment plan.

 
 

Eyelid Retraction

Eyelid retraction can occur in both the upper and lower eyelids and is most commonly caused by thyroid eye disease.  Eyelid retraction can also be caused by genetic factors. Lower eyelid retraction can also result from scar tissue associated with previous lower eyelid surgery, commonly a lower lid blepharoplasty.  Regardless of the cause, eyelid retraction can cause exposure, dry eyes, blurred vision and tearing.  

 

Surgical intervention provides the best treatment for correction of eyelid retraction and is based on an individualized approach that considers both the cause and severity of the problem.

Lacrimal Duct Surgery

Tears made naturally by the lacrimal gland drain from the surface of the eye from the through the lacrimal duct.  The drainage process starts with a blink which pushes the tears into two small openings called the punctum.  Punctum are located in the upper and lower eyelid.  Each punctum drains into a small tube which leads to the lacrimal sac.  The lacrimal sac is leads to the lacrimal duct which is surrounded by bones inside your nose.  Blockage of this normal pathway may cause tearing, watering and mucous discharge in the inside corner of the eye.  This excess tearing often spill onto your cheeks.  In some cases, tears become stagnant due to blockage of the lacrimal sac and may lead to an infection.

A blockage may occur almost anywhere along the pathway.  Definitive treatment of the blockage requires surgery.  The surgical approach is determined by the cause and location of the blockage.  The most common surgery performed for blocked tear ducts is the dacryocystorhinostomy (DCR).  During a DCR a new drainage pathway is created to bypass the blockage.  Next a silicone stent is placed in the new pathway temporarily while the area heals.  The stent is later removed in the office.

Thyroid Eye Disease 

Thyroid eye disease (TED) is an autoimmune, inflammatory eye condition most commonly seen in patients with Graves’ disease. In the majority of thyroid patients, no disease or mild TED is detected.  However, TED may present with a wide variety of signs and symptoms ranging from tearing, dryness and irritation to swelling, double vision, loss of vision and eye bulging.  

 

TED requires close and often frequent follow-up due to the severe and sight threatening complications that are associated with the disease.  A wide variety of treatment options are available   ranging from supportive measures like over-the-counter lubricating drops to orbital (eye socket) surgery.  If you have been diagnosed with thyroid disease and notice eye dryness or irritation, changes in your appearance or vision you should be evaluated by an ophthalmologist for an individualized treatment plan.