Oculoplastic Surgery

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Corrective Surgery

Ptosis is a drooping upper eyelid that is often treated with a corrective procedure. In this condition, the border of the eyelid (part that contains the lashes) falls too low and may partially block vision. In severe cases, the lid may completely cover the pupil and the patient has to tilt his or her head back to see. Mild ptosis does not always require treatment. However, it seldom improves over time and usually requires corrective surgery.

Ptosis may be a congenital condition (present at birth) or the result of an injury or neuromuscular disease (e.g., myasthenia gravis). Ptosis that develops in adults is usually related to the long-term effects of gravity and aging, which cause the tendon that attaches the levator (lifting) muscle to the eyelid to lose elasticity.

In adults, the underlying cause is determined and treated, if possible. Corrective surgery shortens or tightens the levator muscle and lifts the upper eyelid. In cases where the levator muscle is especially weak, the eyelid and the eyebrow may be lifted. The procedure is usually performed under local anesthesia that numbs the area around the eye. It is preferable for the patient to be awake to help the surgeon gauge how high to lift the lid.

Young children are usually given general anesthesia. If ptosis is not too severe, surgical correction is generally performed between the ages of 3 and 5. Ptosis that interferes with vision is corrected at a younger age to help avoid amblyopia.

Complications
As the lid heals, it sometimes becomes evident that it was under- or overcorrected and a second procedure is necessary. In undercorrection, the lid remains too low. In overcorrection, which is less common, the lid has been lifted too high. A small amount of overcorrection may resolve spontaneously, but sometimes it results in the inability to close the eye completely, requiring additional surgery. Ointment is used to prevent eye dryness, if the eye does not close during sleep.

Repair of Eyelid Malpositions

Entropion is the turning inward of the upper or lower eyelid. It develops as a result of weakened structures that support the eyelid. It occurs in people of all age groups, but is most prevalent in older people. It often occurs as a result of aging, infection, or scarring inside the eyelid. Rarely, it is congenital (present at birth).

When the eyelid turns inward, the eyelashes and skin rub against the cornea, causing severe irritation, redness, and pain. If untreated, it can cause eye infections, corneal abrasions, or an eye ulcer. These conditions can threaten vision.

Surgical correction involves rotating the lid margin to a normal position and tightening the muscles. It is usually effective and is generally performed under local anesthesia in an outpatient setting.

Ectropion is the turning outward of the margin of the lower eyelid and the eyelashes. It occurs most frequently in older people, due to relaxation of the tissues as a result of aging. Other causes include skin cancer of the eyelid, trauma, eyelid scarring, and previous eyelid surgery.

The source of tear drainage is a small opening on the lower corner of the eye. As the lower lid turns outward, this opening may pull away from its normal location, disrupting the normal tear drainage process. This can lead to excessive tearing, mucous discharge, eye irritation, and chronic conjunctivitis (infection or inflammation of the inner membrane of the eyelid).

Lubricating ointments or artificial tears can be used to relieve symptoms in mild cases, but surgery is necessary to correct the problem. The procedure is usually performed under local anesthesia in an outpatient setting. During the operation, the eyelid and underlying muscles are tightened. After surgical correction, most patients no longer have symptoms.

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