Oculoplastics  

Reconstructive procedures

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What is Oculoplastics?

Oculoplastics, or oculoplastic surgery, includes a wide variety of surgical procedures that deal with eyelids, tear ducts, and the adjacent areas of the face.

Entropion

Entropion means the eyelid is rolling inward toward the eyeball.  If it goes far enough, the eyelashes may start to rub on the surface of the eye, causing significant discomfort, and sometimes an ulcer on the eye.

Entropion most commonly occurs as certain tendons and connective tissues stretch within the eyelid, making it unstable when you blink or close your eyes.  Occasionally it can occur because of scarring occurring on the back surface of the eyelid.  It most commonly affects the lower eyelid, but can affect the upper lid as well.

Treatment usually involves a small operation performed under local anaesthetic, to restore the position of the eyelid.

Ectropion

Ectropion is the opposite of entropion, and means the eyelid is rolling out, away from the eyeball.  For some people, this is not a major problem, and they are happy to live with it.  However, it can be very annoying, and cause several problems:

  • A watering eye, if it slows or stops the normal drainage of tears from the eye surface
  • Irritation of the thin, moist conjunctival layer on the back of the eyelid
  • Some dislike the appearance of the misplaced eyelid

Ectropion can have several different causes:

  • Like entropion, it can be due to stretched tendons within the eyelid
  • Scarring or shortening of the skin on the lower lid is a common cause. Long term sun exposure is a common factor in Queensland in particular, as this causes the skin on the lower eyelid to tighten.  Past surgery or injuries can also be a factor
  • Lumps on the eyelid can cause the eyelid to roll out
  • Weakness of the muscles of the eyelid is an uncommon cause.

Your eye specialist can assess which of these factors is involved, and discuss treatment options.

Ptosis

Ptosis (the ‘p’ is silent) refers to tissues drooping with gravity.  The term is usually used in reference to the upper eyelid drooping, and covering more of the eye than it normally would.

The most common cause for ptosis is that the tendon of the muscle that lifts the eyelid can stretch over time. However, it is important to know that some cases are due to neuromuscular conditions which are very important to detect.  This is particularly important to consider if the ptosis has developed suddenly/rapidly, or is accompanied by other symptoms such as double vision, changes in your pupil size, pain, or signs of muscle weakness such as shortness of breath or difficulty swallowing.  Your eye specialist can perform an assessment to determine whether any further tests are required, whether the ptosis requires treatment, and what options are available.

Dermatochalasis/blepharoplasty

This refers to stretching of the skin of the upper eyelid, resulting in a fold of skin hanging over the eyelashes, and sometimes interfering with your vision (a bit like wearing a low peaked cap).  If vision is affected, it can often be corrected with a minor operation to reduce the fold of skin, known as a ‘blepharoplasty’.  Your eye specialist can assess your eyelids, discuss your concerns and suggest treatment where appropriate.

Skin Lumps and Cancers

As with the skin anywhere on the body, a number of different lumps and abnormalities can develop on the eyelid.  These can be benign lumps such as moles and simple cysts, or more serious lesions including all types of skin cancer.  Sometimes the difference is obvious on clinical examination, but sometimes a small biopsy is required, for a pathologist give the final diagnosis.  Surgery to remove lesions around the eyelid must be carefully performed to minimise the risk of causing malposition of the eyelid or damage to nearby structures including the tear drainage ducts.

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