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Eyelid Surgery

Many of the eyelid changes seen at Eye Doctors of Washington are due to chronic exposure of the eyelid skin to UV light or aging of the eyelid muscles. These eyelid changes may cause cosmetic problems or may become serious enough that they begin to cause medical problems. Either way, surgery can alleviate the symptoms of drooping eyelids.

Blepharoplasty

There are two major problems with the upper lid that may necessitate surgery. The first is drooping of the eyelid skin, which is associated with eyelid “bags.” Bags are fat pads that have stretched their membranes, creating a bulging of the skin. Usually these are cosmetic blemishes although the drooping of the skin may become so significant that it can block a patient’s vision. This drooping of the skin can also cause eye fatigue due to the increased weight of the eyelids and the effort to keep them open. At this point, it is not uncommon to use the brow to elevate the eyelid, which will eventually cause fatigue, especially late in the evening.

Blepharoptosis

The second major problem with the upper lid is drooping of the eyelid muscle, known as ptosis (toe-sis). The levator muscle is responsible for opening the eye. As one ages, the levator muscle weakens and sometimes results in a separation of the muscle from the eyelid cartilage. The lid will then slowly begin to droop down. Individuals with ptosis may have a tendency to use one or both eyebrows to lift up the lid to get a better view. In extreme cases, patients may begin to tilt their chins upward to see under the droopy lid.

The main procedure that we perform at Eye Doctors of Washington’s Facial Rejuvenation Center to address drooping of the eyelid skin and muscle is called blepharoplasty. Blepharoplasty can result in significant enhancement of your vision as well as improve the appearance of your eyes, making your look more refreshed and youthful.

Consultation for eyelid surgery

During the initial consultation for your eyelid surgery, you will be asked to look in a mirror and point out exactly what you would like to see improved. This will help Dr. Mary Catherine Fischerto understand your expectations and determine whether they can be realistically achieved.

You should come to the consultation prepared to discuss your medical history including previous surgeries, past and present medical conditions, and current medications, especially blood thinners like aspirin and coumadin. High blood pressure, thyroid problems, and diabetes should be discussed since they may increase some risks associated with eyelid surgery.

Preoperative care

Rapid healing and return to your normal activities are very important. At Eye Doctors of Washington, Dr. Mary Catherine Fischer has developed an excellent program using natural products to improve your recovery. Dr. Fischer recommends 2000 mg of Vitamin C a day. She strongly recommends starting natural healing supplements 3 days before surgery including Bromelein and Arnica Montana, both of which are effective ways to minimize post-operative swelling and bruising. They are available at all of our offices.

In addition, it is very important to stop blood thinners two weeks before surgery. If your doctor has prescribed blood thinners such as baby aspirin or Coumadin, it is extremely important to confirm the safety of stopping those medicines before surgery. You will receive a list of non-prescription medications that may cause increased bleeding. You will also need to be cleared by your primary care physician with blood work and an EKG before the day of surgery.

The procedure

On your surgery day, you will need to arrive at Palisades Eye Surgery Center approximately one hour before your surgery time. You should wear comfortable clothes and plan to spend 2-4 hours at the center. If you receive oral or intravenous anesthesia you will need a ride home.

The actual procedure takes between 1-2 hours depending on what procedure is being performed. You will receive marks that indicate where the incisions need to be placed. The incisions in the eyelid are made using a radiofrequency wire, more precise and thinner than a scalpel. The skin, fat or both are removed. Bleeding is controlled to minimize bruising and swelling. If the eyelid muscle needs to be corrected, a deeper suture (stitch) is placed that will dissolve over 3-6 months. The skin edges are brought together like a hem on a skirt or pant. A single knot is placed and the single stitch is weaved back and forth to close the incision. A final knot is placed at the outer edge of the marked incision. This suture is very thin, thinner than your hair, and is left in place for 10-14 days. At the conclusion of the surgery, you will be given an ice pack that will stay in place for 20-30 minutes while you are in the recovery area. You will be given extensive verbal and written instructions during your recovery time. If you have a family member or friend available at that time it is helpful.

Postoperative care

Following surgery, you will probably experience tearing, itching, and burning of your eyes. Some patients will experience dry eyes, light sensitivity, and blurred or double vision. There will be some swelling and bruising around your eyes.

Aesthetic eyelid surgery has the effect of making you look more rested, refreshed, and alert. Since the healing process is gradual, you should expect to wait several weeks to get an accurate picture of the ultimate result of your eyelid surgery.

You will go home with sunglasses and an ice pack but not with patches. Most patients experience little to no pain. The single stitch that we typically use to close the incision is removed about 10 days to 2 weeks after surgery. Normal activities can resume after about 3 to 5 days, though strenuous activities such as lifting, bending, and exercise should be postponed for about two weeks after surgery.

Ectropion, Entropion, and Trichiasis

There are several medical conditions associated with eyelid malpositions. In ectropion, the eyelid turns out causing tearing, itching, redness, and blurred vision. If the eyelid is not in the correct position, tears will typically run down an individual’s cheek causing significant irritation to the skin around the eye. Ectropion requires a surgical procedure as treatment. The recommended surgical approach will be selected and thoroughly discussed based on the underlying cause of the condition.

In entropion, the eyelid folds under itself, forcing the eyelashes to rub against the eye. This can be extremely uncomfortable and cause significant tearing in the eye. The causes of entropion can either be congenital, inflammatory, or from scarring. Frequently, treating the inflammation will relieve the symptoms. If not, a small surgical procedure can be done to correct entropion. It is performed under local anesthesia and takes about 20 minutes.

Not uncommonly, trichiasis (misdirected eyelashes) is associated with entropion. This condition can be easily treated using radiofrequency to permanently remove a single or multiple lash follicles to prevent recurrence. Chronic trichiasis can cause symptoms of foreign body sensation, tearing, irritation and red eyes. If left untreated, permanent damage to the ocular surface can result in vision loss.

Eyelid Retraction

The relationship of the eyelid position and the eyeball varies. Although ethnic differences are often seen, there is concern for potential visual impairment when the eyelid position exposes too much of the eyeball. This condition is most commonly seen in individuals with thyroid disease, but may also be found in patients with tumors, strokes or contralateral blepharoptosis.

Blepharospasm

Physicians and patients alike often misunderstand blepharospasm. Many patients suffer for years before they are finally diagnosed and correctly treated. The common term is benign essential blepharospasm. Ophthalmologists have been treating patients for years with Boto injections to rid or minimize symptoms of excessive blinking, which is frequently brought on by stress, fatigue or bright lights. Although sleep eliminates the spasms, they tend to return while awake. The condition can be progressive to the point where a patient becomes effectively ‘blind’ from involuntary eyelid closure. Dr Fischer at Eye Doctors of Washington has many years of experience treating patients with this disease.

If the condition is only on one side of the face or eyelid, it is called hemifacial spasm. The treatment also involves using small injections of Botox to eliminate the facial and eyelid contractions. This condition can be caused by an irritation to the facial nerve as it exits the skull. There are surgical and medical treatments that are available for this condition.

Facial or Bell’s Palsy

This common condition is seen when weakness of one side of the face occurs over a short period of time (i.e., 24 hours). It may be mild with only difficulty in blinking or closing the eyelid or severe with complete paralysis of the whole side of the face. In addition, excessive tearing, drooling and alteration in taste and hearing on the affected side can occur.

The causes are myriad, from infectious to stroke. Treatment is not always helpful and often the symptoms will resolve with only mild after-effects. Medical treatment may include oral steroids, antivirals and eye lubrication. Surgical intervention may be necessary if eyelid closure remains. The approach will be discussed with Dr Fischer.

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