Problems with the eyelids are common, and can include droopy lids (ptosis), excess eyelid skin, eyelid loosening, as well as eyelid tumours and skin cancers. Some have cosmetic implications resulting in a fatigued appearance, some cause eye discomfort, and yet others have serious implications of the health of the eye and can potentially cause vision loss.

DROOPY EYELIDS (PTOSIS)

Ptosis occurs as a result of dysfunction of the levator muscle that lifts the lid, resulting in one or both eyelids drooping to a position lower than normal. This creates an unwanted aesthetic appearance of tiredness and can also impact vision.

What are the symptoms of ptosis?

The most common symptom is drooping eyelids, with the severity of the condition varying between patients. Most patients report difficulty keeping eyes open, fatigue while reading, eye strain and brow ache as a result of continually trying to keep the eyelids open. Over long periods, this can extend to neck and back pain.

What are the causes of ptosis?

If present from birth (congenital ptosis) there is a defect in development of the levator muscle which lifts the eyelid. This must to assessed to ensure the droopy lid isn’t affecting the infant’s visual development. Increasing age, eye trauma, contact lens wear or some neurological conditions can also contribute to the development of ptosis. Generally, the degree of ptosis will worse over time, and cannot be prevented.

What are the treatment options for ptosis?

Definitive treatment of ptosis is to surgically raise the affected eyelid to a more natural and aesthetically pleasing position. This involves identifying the levator muscle, removing excess skin and fat to expose it. The muscle is then detached and reattached to its normal position with absorbable sutures. Ptosis surgery is carried out under local anaesthetic as a day procedure in theatre taking 45-90 minutes.

Frequently the surgeon combines ptosis surgery with blepharoplasty, to ensure the eyelids not only function normally but patients are happy with the cosmetic appearance.

EXCESS EYELID SKIN

With age, the elastic fibres within skin tissue are lost, leading to a sagging appearance of the skin. The muscle surrounding the eye (orbicularis) can also lose tone.

Blepharoplasty is the surgical treatment for dermatochalasis (excessive eyelid skin). Upper lid blepharoplasty involves removing excessive folds of skin between the eyebrow and the eyelashes which can give a tired and exhausted appearance and obstruct vision. Lower lid blepharoplasty focuses on the area between the eyelashes and the cheek.

Blepharoplasty surgery

Upper lid blepharoplasty involves making an incision along the natural folds of the eyelid to make scars virtually invisible. Excess skin, muscle and fat are removed, and fine sutures are uses to close the incision; a similar procedure is used for the lower eyelids. However, the muscles of the lower lid are often raised at the outer corners and secured to provide tightening.

Factors that your surgeon will consider prior to operating include your age, skin type, ethnic background, degree of vision obstruction, and presence of dry or watery eyes.

Blepharoplasty is performed as a day procedure under local anaesthetic. Swelling and bruising of the eyelids post-surgery can occur but will resolve within 1-3 weeks.

EYELID LOOSENING

Entropion is the turning in of the eyelid margin, whereas ectropion is the turning out of the eyelids. Both are usually caused by age-related loosening of the eyelid and weakening of the lower lid muscles. Eyelid inflammation, trauma, scarring and eyelid skin tumours can also be contributing factors.

Patients with entropion (in-turning lids) experience significant discomfort, redness, and watering as a result of the eyelashes touching the surface of the eye. If left untreated, this can lead to corneal scarring and vision loss. Ectropion (out-turning lids) results in the overflow of tears (watery eye) which leads to discomfort, irritation, dry eye and vision reduction due to corneal scarring.

Entropion and ectropion surgery

Surgical intervention is required to treat both entropion and ectropion in order to improve comfort and cosmetic appearance, but most importantly to prevent corneal scarring and vision loss. Surgery is performed as a day procedure under local anaesthetic, and involves tightening of the eyelid (canthoplasty) at the outside corner of the eye, and tightening the internal retractor muscles of the eyelids to maintain them in good position. Occasaionally, a skin graft is required.

EYELID LUMPS, CYSTS AND TUMOURS

Lid lesions are common and occur as a result of long-term sun exposure, genetics, smoking and aging. They can be benign or malignant (cancerous).

The most common eyelid lesion is a chalazion (also known as stye) which is a blockage of the oil producing glands of the eyelid. With warm compress and massage, the chalazion may resolve on its own over time. Occasional it needs to be surgically removed under local anaesthetic by creating a small incision on the inside of the eyelid. This procedure takes place in the surgeon’s rooms. Skin tags, xanthelasma, sweat gland cysts, sebaceous cysts and warty growths can also develop on the eyelids. They too can be removed under local anaesthetic in the surgeon’s rooms.

Symptoms of skin cancer on the eyelids

Unusual lesions or nodules around the eyelids that enlarge over time, bleed or ulcerate need to be examined by an oculoplastic surgeon. Often, they are painless and present with no other symptoms. Nonetheless, they are cancerous and if left untreated, can expand to involve a large portion of the eyelid, and even invade the orbit (eye socket) or the eye itself.

Basal Cell Carcinoma (BCC)
BCCs represent the majority of eyelid cancers, which can present as a painless lump. A biopsy is required to confirm the diagnosis, followed by definitive surgery to remove the entire tumour. If the BCC is extensive, surgery can be complex, and eyelid reconstructive surgery may be required, sometimes in stages. Occasionally, a pathologist is required to attend surgery to analysis the tissue to ensure all the cancerous tissue it removed.

Less common eyelid tumours include squamous cell carcinomas (SCCs), sebaceous gland carcinomas, Merkel cell tumours and melanomas.

All surgical procedures carry some risk. The information provided here is for general educational purposes only. Please contact Forest Eye Surgery to find out if eyelid surgery is appropriate for your individual situation.

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