Eyelid surgery is a common method of treatment for entropion (inward turning of the eyelid), ectropion (outward turning of the eyelid), ptosis (drooping of the eyelid), and some eyelid tumors.
Eyelid surgery is usually an outpatient procedure performed under local anesthesia. Risks of surgery are rare but can include bleeding, infection, and eyelid asymmetry due to uneven wound healing. Differences in healing between the eyes may cause some unevenness after surgery.
After eyelid surgery, bruising or a black eye is common but resolves quickly. It may be difficult to close your eyelids completely, making the eyes feel dry. This irritation generally disappears as you heal. Serious complications are rare but can include vision loss, scarring, and infection. To most people, the improvement in vision, comfort, and appearance after eyelid surgery is very gratifying.
As we mature, the delicate skin around the eyes can appear puffy, saggy, or droopy. Eyelid skin stretches, muscles weaken, and the normal deposits of protective fat around the eye settle and become more prominent. The surgical procedure to remove excess eyelid tissues (skin, muscle, or fat) is called blepharoplasty.
Blepharoplasty can be performed on the upper eyelid, lower eyelid, or both. The surgery is performed for either cosmetic or functional reasons. Sometimes excess upper eyelid tissue obstructs the upper visual field or can weigh down the eyelid and cause the eyes to feel tired. Most often, people choose blepharoplasty to improve their appearance by making the area around their eyes firmer. When blepharoplasty is performed to improve vision rather than for cosmetic reasons only, the costs may be covered by your health insurance plan.
Blepharoplasty for the lower eyelid removes the large bags under the eyes. It is unusual for third-party payers to cover lower-lid blepharoplasty.
The surgery is usually performed on an outpatient basis and can take one to three hours. Upper-eyelid incisions are made in the natural crease of the lid, and lower-lid incisions are made just below the lash line. A procedure for lower-lid blepharoplasty, known as lower-lid blepharoplasty, removes or redistributes excess fat through an incision inside the lower lid. The incisions are closed with fine sutures.
Swelling, bruising, and blurry vision are common after blepharoplasty. Stitches are removed three to five days after surgery, except in the case of transconjunctival blepharoplasty, where the self-dissolving sutures require no removal.
Possible complications associated with blepharoplasty include bleeding and swelling, delayed healing, infection, drooping of the upper or lower eyelid, asymmetry, double vision, and dry eye, to name a few. It is important to note that the puffiness of the fat pockets may not return, but normal wrinkling and aging of the eye area will continue.
Ptosis is drooping of the upper eyelid. The eyelid may droop only slightly or it may cover the pupil entirely. In some cases, ptosis can restrict and even block normal vision.
Congenital ptosis, or ptosis that is present at birth, requires treatment in order for normal visual development to occur. Uncorrected congenital ptosis can cause amblyopia or “lazy eye,” which is an impaired visual development. If left untreated, amblyopia can lead to permanently poor vision.
Except in mild cases, the treatment for childhood ptosis is usually surgery to tighten the levator muscle, the muscle that lifts the eyelid. In severe ptosis when the levator muscle is extremely weak, the lid can be attached or suspended from under the eyebrow so the forehead muscles do the lifting. Whether they have had surgery or not, children with ptosis should be examined annually by an ophthalmologist (Eye M.D.) for amblyopia, refractive disorders, and associated conditions.
Ptosis in adults is commonly caused by separation of the levator muscle from the eyelid as a result of aging, cataract or other eye surgery, an injury, or an eye tumor. Adult ptosis may also occur as a complication of other diseases such as diabetes that involve the levator muscle or its nerve supply.
If treatment is necessary, it is usually surgical. Sometimes a small tuck in the levator muscle and eyelid can raise the lid sufficiently. More severe ptosis requires reattachment and strengthening of the levator muscle.
The risks of ptosis surgery include infection, bleeding, and reduced vision, but these complications occur very infrequently. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return.
Keeping the eyes moist and healthy requires tears. Tears are produced in the lacrimal glands, some of which are located under the upper eyelid. Tears drain from the eye into the nose through the nasolacrimal duct, or tear duct. A blockage of this drainage duct can cause wet eyes or excessive tearing. A blocked tear duct can also cause mucus buildup in the eye or ongoing infections in the lacrimal sac where tears collect. Infections are noticeable as a swelling of the inner corner of the lower eyelid.
Nasolacrimal duct obstructions can happen with no obvious cause. Sometimes previous sinus or nose surgery, or facial trauma with broken facial bones, can obstruct the tear duct.
Lacrimal drainage surgery is called dacryocystorhinostomy (DCR) and can be performed in different ways. One type of operation is an external DCR where an incision is made on the side of the nose, where eyeglasses might rest. A small amount of bone is removed to permit a new connection between the lacrimal sac and the inside of the nose. Small plastic tubes are sometimes inserted at the time of surgery to help keep the newly created opening from scarring shut during the healing process. The tubing is removed a few months after surgery.
Another type of operation uses a special instrument called an endoscope. The endoscope is a small tube with a fiberoptic light that facilitates the creation of a new opening into the nose. Various types of laser have also been used to perform the DCR operation.
In extreme cases where the tear duct cannot be reopened or repaired, an artificial tear duct can be implanted. The artificial tear duct is called a Jones tube and is implanted behind the inner corner of the eyelid to drain tears into the nose.