A 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. This procedure can result in significant enhancement of your vision as well as improve the appearance of your eyes, making you look more refreshed and youthful.
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.
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.
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 BOTOX® 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. Our ophthalmologist Dr. Fischer 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 hemi-facial 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 infections 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.