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Other Oculoplastic Procedures

Ectropion

WHAT IS ECTROPION?

An ectropion is an outwardly turned or sagging lower eyelid. The sagging lower eyelid leaves the eye exposed and dry, and as a result, excessive tearing is common with ectropion. If it is not treated, the condition can lead to crusting of the eyelid, mucous discharge, and irritation of the eye. A serious inflammation could result in damage to the eye. Ectropion can be diagnosed with a routine eye exam. Special tests are usually not necessary.

WHAT ARE THE CAUSES?

Generally the condition is the result of tissue relaxation with aging, although it may also occur as a result of facial nerve paralysis (Bell’s palsy), trauma, scarring, or other surgeries.

WHAT ARE THE SYMPTOMS?

The wet, inner, conjunctival surface is exposed and visible. Normally, the upper and lower eyelids close tightly, protecting the eye from damage and preventing tear evaporation. If the edge of one eyelid turns outward, the two eyelids cannot meet properly, and tears are not spread over the eyeball. This may lead to irritation, burning, a gritty, sandy feeling, excess tearing, visible outward turning of the eyelid, and redness of the lid and conjunctiva.

IS ECTROPION SERIOUS?

Corneal dryness and irritation may lead to eye infections, corneal abrasions, or corneal ulcers. Rapidly increasing redness, pain, light sensitivity, or decreasing vision should be considered an emergency in a person with ectropion.

WHAT ARE THE TREATMENTS?

The irritation can be temporarily relieved with artificial tears and ointments to lubricate the eye. Surgical treatment for an ectropion often depends on the underlying cause. In the type of ectropion associated with aging, most surgeons elect to shorten and tighten the lower lid. This typically is completed with an incision of the skin at the outside corner of the eyelid and reattachment of the eyelid to underlying tissues and the upper eyelid.

Sometimes, there are scars following trauma or the surgical removal of skin cancers. Your surgeon might need to use a skin graft taken from the upper eyelid or from behind the ear to repair the ectropion. Both the donor site for the graft and the surgical site will usually heal nicely within two weeks following the surgery.

The surgery to repair ectropion is usually performed as an outpatient procedure under local anesthesia, and with the patient lightly sedated with oral and/or intravenous medications. You may have a patch overnight and then you will commonly use an antibiotic ointment for about a week. After your eyelids heal, your eye will feel comfortable again.

WHAT ARE THE RISKS AND COMPLICATIONS?

In addition to the removal of the sutures, minor bruising or swelling may be expected and will likely go away in one to two weeks. Bleeding and infection, which are potential risks with any surgery, are very uncommon. As with any medical procedure, there may be other inherent risks that should be discussed with your surgeon.

IS THE SURGERY EFFECTIVE?

Most patients experience immediate resolution of the problem once surgery is completed with little if any postoperative discomfort. After your eyelids heal, your eye will feel comfortable and you will no longer have the risk of corneal scarring, infection, and loss of vision.

WHO PERFORMS THE SURGERY?

Patients are most commonly treated by ophthalmic plastic and reconstructive surgeons who specialize in diseases and problems of the eyelids, tear drain, and orbit (the area around the eye).

You should look for a doctor who has completed an American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) fellowship. This indicates your surgeon is not only a board certified ophthalmologist, but also has had extensive training in ophthalmic plastic surgery. When you are ready, you will be in experienced hands. Your surgery will be in the surgeon’s office, an outpatient facility, or at a hospital depending on your surgical needs.

Entropion

WHAT IS ENTROPION?

Entropion is a condition in which an eyelid turns inward, rubbing against the eye, making it red, irritated, and sensitive to light and wind. If it is not treated, the condition can lead to excessive tearing, crusting of the eyelid, mucous discharge, and irritation of the eye. A serious inflammation could result in damage to the eye. Entropion can be diagnosed with a routine eye exam. Special tests are usually not necessary.

WHAT ARE THE CAUSES?

The condition occurs primarily as a result of advancing age with the consequent weakening of certain eyelid muscles. Laxity of the eyelid tendons, combined with weakening of these muscles results in the eyelid turning in. Entropion may also occur as a result of trauma, scarring, or other surgeries.

WHAT ARE THE SYMPTOMS?

When the lid turns inward, the lashes and skin rub on the eye. You may have a feeling that something is in the eye, or there may be excessive tearing, crusting of the eyelid, or mucous discharge. Irritation of the cornea (the clear part of the eye that allows light to enter the eye) may develop from lashes rubbing on the eye.

IS ENTROPION SERIOUS?

A chronically turned in eyelid can result in acute sensitivity to light and wind, and may lead to eye infections, corneal abrasions, or corneal ulcers. If entropion exists, it is important to have a doctor repair the condition before permanent damage occurs to the eye.

WHAT ARE THE TREATMENTS?

Prior to surgery, the eye can be protected by taping the lower lid down and using lubricating drops and ointment.

There are a number of surgical techniques for successfully treating entropion and each surgeon will have a preferred method. The usual treatment for entropion involves tightening of the eyelid and its attachments to restore the lid to its normal position. A non-incisional entropion repair, known as a Quickert procedure, may be performed as an in-office procedure under local anesthesia with little, if any, discomfort. This procedure requires two or three strategically placed sutures that will evert the eyelid. Although there is a significant chance of recurrence of the entropion after the Quickert procedure, it is an excellent treatment for patients who are not suitable for surgery, or until more definitive surgery can be performed.

The surgery to repair entropion is usually performed as an outpatient procedure under local anesthesia, and with the patient lightly sedated with oral and/or intravenous medications. You may have a patch overnight and then you will commonly use an antibiotic ointment for about a week.

WHAT ARE THE RISKS AND COMPLICATIONS?

In addition to the removal of the sutures, minor bruising or swelling may be expected and will likely go away in one to two weeks. Bleeding and infection, which are potential risks with any surgery, are very uncommon. As with any medical procedure, there may be other inherent risks that should be discussed with your surgeon.

IS THE SURGERY EFFECTIVE?

Most patients experience immediate resolution of the problem once surgery is completed with little, if any, postoperative discomfort.After your eyelids heal, your eye will feel comfortable and you will no longer have the risk of corneal scarring, infection, and loss of vision.

WHO PERFORMS THE SURGERY?

Patients are most commonly treated by ophthalmic plastic and reconstructive surgeons who specialize in diseases and problems of the eyelids, tear drain, and orbit (the area around the eye).

You should look for a doctor who has completed an American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) fellowship. This indicates your surgeon is not only a board certified ophthalmologist, but also has had extensive training in ophthalmic plastic surgery. When you are ready, you will be in experienced hands. Your surgery will be in the surgeon’s office, an outpatient facility, or at a hospital depending on your surgical needs.

Thyroid Eye Disease

WHAT IS THYROID EYE DISEASE?

People with hyperthyroidism (overactive thyroid glands) may experience changes around their eyes. The most common abnormalities are prominent eyes, a staring expression and infrequent blinking.

WHAT ARE THE CAUSES?

Hyperthyroidism is a condition in which there is overproduction of thyroid hormones. Abnormal antibodies that attach the thyroid gland cause it to become overactive. Abnormal antibodies may also cause swelling and inflammation of the soft tissues around the eyes and the muscles that move the eyes and eyelids. As a result, the eyes may protrude, the lids may open too widely, or the eyes may not move together well causing double vision.

WHAT ARE THE SYMPTOMS?

Many patients start experiencing eye problems as soon as their thyroid gland becomes overactive. For some, the eye changes may develop before hyperthyroidism is detected, while others may not develop symptoms until months or years later. Both eyes are usually affected, however they may not be affected to the same degree. Common symptoms are pressure around the eyes, ocular irritation and tearing. Overexposure during the day and difficulty closing the eyes at night can lead to dryness or injury to the cornea (the clear front of the eye).

Inflammation of the eye muscles may result in restricted eye movement causing double vision.

If the muscles become too swollen, the enlarged muscles can compress the optic nerve resulting in progressive visual loss.

After several months, the active inflammation subsides. Many patients will be left with some degree of protrusion, lid retraction, or double vision that may require additional treatment.

IS THYROID EYE DISEASE SERIOUS?

Chronic eye exposure from protrusion or lid retraction can lead to corneal scarring. Double vision can be severe and disabling.

If the swelling is severe enough, the pressure in the orbit (eye socket) can become extremely high and compress the optic nerve. The person may experience progressive loss of vision, and possibly blindness if the condition is not treated promptly.

WHAT ARE THE TREATMENTS?

For many people, the discomfort from thyroid eye disease can be treated with topical lubricants, wrap-around tinted glasses, sleeping with eye shields and with the head elevated.

When there is active inflammation with more severe symptoms, oral cortisone or other anti-inflammatory medications may be needed to reduce the swelling. Radiation is sometimes used to treat active inflammation as well. If the swelling behind the eye is severe enough, surgery may be necessary to decompress the orbit.

The function and appearance of the eyes can usually be improved by the reconstructive eyelid or orbital surgery. Surgical treatment is generally delayed until the active inflammation subsides. The particular surgical technique used will depend on the type and severity of the eye problems.

Orbital decompression (removing part of the bony orbit and fat behind the eye to relieve pressure within the eye socket) can prevent damage to the optic nerve, and allow the eyes to move back into a more normal position in the eye socket. Misalignment of the eyes and double vision can be improved with eye muscle surgery to reposition the enlarged muscles that control eye movement.

Eyelid surgery to adjust the position of retracted lids can improve eyelid closure and restore eyelid function. Removal of excessive fat from the eyelids can also improve their appearance.

WHAT ARE THE RISKS AND COMPLICATIONS?

Minor bruising or swelling may be expected and will likely go away in one to two weeks. Bleeding and infection, which are potential risks with any surgery, are very uncommon. As with any medical procedure, there may be other inherent risks that should be discussed with your surgeon.

IS THE SURGERY EFFECTIVE?

While it may not be possible to completely eliminate all of the consequences of thyroid eye disease, surgery to correct these conditions is generally successful in satisfactorily restoring function, comfort, and cosmetic appearance.

WHO PERFORMS THE SURGERY?

Patients are most commonly treated by ophthalmic plastic and reconstructive surgeons who specialize in diseases and problems of the eyelids, tear drain, and orbit (the area around the eye).

You should look for a doctor who has completed an American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) fellowship. This indicates your surgeon is not only a board certified ophthalmologist, but also has had extensive training in ophthalmic plastic surgery. When you are ready, you will be in experienced hands. Your surgery will be in the surgeon’s office, an outpatient facility, or at a hospital depending on your surgical needs.