Eyelid

Few of us realise how complex the eyelids are and how important a role they play in our appearance and our eye health. Ensuring the preservation of this feature is a high priority for many Ophthalmologists.

Our eyelids are designed to protect our eyes from the many irritants we encounter each day whilst maintaining the moist surface required for a properly functioning eye. Made from layers of skin, muscle, ligaments, nerves, blood vessels and fat, eyelids are more intricate than they may appear and as a result can be prone to a number of disorders.

Many eye conditions requiring treatment are the result of an incorrectly positioned eyelid which may scrape the eye, expose it to injury and infection, or even obscure vision. When considering surgery to this delicate area, it is essential to consider the aesthetic appearance of your eyelids and work with an ophthalmologist who you trust to enhance rather than alter this feature.

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Conditions and Treatments:

Ptosis and Blepharoplasty

Ptosis

Drooping of one or both of the upper eyelids which can be present at birth (congenital) or occur later in life (acquired). Acquired ptosis is most often caused by a weakening of the muscle which lifts the eyelid as we age, although can also be due to an underlying neurological condition that may affect our nerves and/or muscles of the eye. Ptosis can cause strain to the upper areas of the face, headaches and tiredness, and in more severe cases obscure vision and will likely require a surgical procedure called a blepharoplasty (see below).

Blepharoplasty

Surgical sculpting of the upper and/or lower eyelid by removing redundant skin which often becomes apparent due to a reduction in elasticity as we age. Both lids can be smoothed and lifted during the one procedure. Upper eyelid Blepharoplasty involves removal of excess skin and fat through incisions made in the upper skin crease of your lid when your eyes are open. Lower lid blepharoplasty is similarly performed through an incision just below the lashes or on the back of the eyelid. Dr Vu will determine the precise amount of skin and fat that requires removal to suit your condition and objectives. The operation is usually a day surgery procedure that takes 1-2 hours under local anaesthetic and sedation.

Eyelid Malposition

Entropion and Ectropion

Conditions where the eyelid folds forward (entropion) or outwards (ectropion) most commonly occurring in the elderly as the eyelid loosens as we age. As the eye is less protected due to the eyelid fold, recurrence of these conditions can cause scarring to the surface of the eye and surgical treatment is often recommended to prevent ongoing infections or deterioration of vision.

Eyelid Retraction

Normally, the upper eyelids rest just below the upper border of the cornea/iris, while bottom eyelids rest at the lower border. Eyelid retraction is when abnormal elevation (upper lid) or lowering (lower lid) occurs. Upper eyelid retraction is most commonly caused by genetics or Thyroid Eye Disease also known as Graves Eye Disease. Lower eyelid retraction, however, is often a result of complications from previous surgery or blepharoplasty (see above) where either scar tissue has developed or too much skin was excised from the bottom eye fold. Retraction can lead to chronic eye conditions including dry eyes, excessive tearing, redness, burning and blurred vision.

Eyelid Spasms

Benign essential blepharospasm

A chronic and potentially incapacitating condition characterised by abnormal and uncontrollable blinking or twitching of the eyelids which typically affects both eyes. Botulinum toxin (Botox) injections are now the most commonly recommended treatment for blepharospasm. Injection of botox in very small quantities into the muscles around the eyes will stop the spasm temporarily and usually needs to be repeated 3 to 4 times a year. The treatment is very successful with few side effects.

Hemifacial Spasm

A condition that affects one side of the face and involves involuntary closure of the eye and is usually accompanied with spasms to the cheek, mouth, and neck muscles. Hemifacial spasm is thought to be caused by an abnormality in the nerve to the facial muscles. Generally, Botulinum toxin (Botox) injections will relieve spasms and is a relatively safe and simple procedure, but may need to be repeated as the treatment wears off. The alternative treatment involves microvascular decompression surgery which is a major neurological procedure.

Facial Nerve Misdirection

A condition similar to Hemifacial Spasm (above) caused by nerves making wrong connections when they grow back after trauma or facial palsy (sometimes called Bell’s Palsy). Usually damaged nerves grow back and re-establish their connections with the original muscles. Facial nerve misdirection is when the growing nerves are mis-wired and can cause uncontrolled interactions between muscles – for example, your mouth might move involuntarily when you close your eyes. Botulinum toxin (Botox) injections can help better coordinate facial muscle movement and many patients experience improvement in the condition. Depending on the severity of the symptoms, surgery may be an option to consider. Dr Vu will guide you to achieving the best possible long term outcome.

Our eyes are constantly exposed to environmental irritants such as dust, UV rays and foreign particles. It is vital we monitor and protect our eye health.