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Eyelid Surgery

Ptosis (droopy eyelid) Repair

Ptosis (droopy eyelid) is condition in which the upper eyelid is abnormally low. Normally, the upper eyelid is kept in position by the levator, a muscle that pulls the eyelid up, against gravity. When the levator is affected, the upper eyelid drops and leads to ptosis. Ptosis can affect one upper eyelid or both. The common causes of ptosis include:

  • Age-related ptosis, in which the levator becomes overly stretched and loses elasticity due to gravity and age. This is the most common form of ptosis
  • Congenital ptosis, in which the levator muscle has developed abnormally and is present from birth.
  • Myasthenia gravis, in which the levator muscle is weakened due to impaired transmission of nerve impulse to the levator. In myasthenia gravis, ptosis varies from time to time and worsens with fatigue
  • Neurogenic ptosis, in which the levator cannot function properly due to damage to the nerve that controls the levator muscle. Neurogenic ptosis is usually due to a damaged third cranial nerve caused by diabetes mellitus, high blood pressure, or brain aneurysms.

The treatment of ptosis depends on its underlying cause. Surgery is usually reserved for congenital and age-related ptosis. If the levator can contract normally, surgery is performed to repoistion the levator in order to return the upper eyelid to a better position. If the levator cannot contract normally, then the upper eyelid is suspended artificially by attaching the levator to the forehead muscles with a sling.

Repair of Lid Malposition

In order for the eyelids to function properly, they are normally held in proper positions by eyelid muscles. Normally the upper and lower eyelid margins gently hug the eyeball and help to protect the surface of the eye.

  • Ectropion - When the margin of lower eyelid is turned out, the condition is called ectropion. Ectropion of the lower eyelid can lead to chronic eye irritation due to over-exposure of the lower portion of the eye.
  • Entropion - When the margin of the lower eyelid is turned in, the condition is called entropion. Entropion causes the eyelashes to rub against the eye, damaging the ocular surface.

The most common cause of ectropion and entropion of the lower eyelid is age. With age, the eyelid muscles that control the position of eyelid margins can atrophy or become stretched, leading to imbalance in the forces that normally keep the eyelid margin in the correct position. Many surgical approaches are available depending on the eyelid malposition. If the eyelid is too loose, it can be shortened and tightened. If one of the eyelid muscles is out of position, it can be re-attached surgically back to its normal position. If there is excessive scarring of the skin (which turns the eyelid margin out), the skin grafts is used to return the eyelid back to its normal position.

Floppy eyelid syndrome is a condition, in which the upper eyelid has become overly stretched and loose such that it would turn inside out spontaneously. This usually occurs when patient is asleep, leading to chronic eye irritation. When severely enough, the floppy eyelid can be tightened surgically. Since sleep apnea is commonly associated with floppy eyelid syndrome, patients with floppy eyelid syndrome should also be evaluated for sleep apnea.

Tarsorrhaphy

Tarsorrhaphy is procedure to fuse the margins of upper and lower eyelids. Tarsorrhaphy is performed to protect the ocular surface or to promote healing of the ocular surface, such as in ocular chemical burn, chronic breakdown of the corneal surface, and over-exposure of the ocular surface due to facial paralysis (Bell’s Palsy). Tarsorrhaphy can be temporary or permanent depending on the severity and the chronicity of patient’s eye condition. Tarsorrhaphy is reversible. Tarsorrhaphy is a short surgical procedure that can be performed in office or in a minor operation room.

Chalazion Incision and Drainage

Chalazion developes when the opening to one of the oily glands in the eyelid margin is blocked, leading to swelling and inflammation of the eyelid. Chalazion typically appears lumpy and is tender to touch during the acute stage. If chalazion does not respond to medical therapy (warm compresses; topical and oral antibiotics), chalazion can be incised and drained. The procedure is frequently performed in office under local anesthesia. Once drained, chalazion resolves usually within a week.

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