& Turning Problems
Ectropion & Entropion Eyelid Position Problems
Ectropion is an eyelid position problem characterized by the eyelid turning outward interfering with the normal tear film functioning. Most often, ectropion results from the effects of aging and gravity so that lower eyelid stretches and become lax, no longer sitting in the proper position and rolling outward or drooping downward, so the white part of the eye may show beneath the cornea. Symptoms of ectropion can include irritation associated with drying out of the corneal surface as the tear film is no longer in the proper location and even excessive tearing. This can lead to further irritation and scarring of the tear drainage system. Fortunately, ectropion can most often be corrected with an outpatient eye surgery procedure by tightening the eyelid with a same-day surgical technique. Entropion is an eyelid position problem characterized by the eyelid turning inward causing the eyelashes and the skin of the eyelid can rub against the surface of the eye and cornea causing considerable irritation and even serious damage. The most common cause is a laxity of the lower eyelid as the aging process and effects of gravity occur. Most of the time, correction of this problem also requires a same-day surgical technique.
Eyelid Drooping & Ptosis
Ptosis is a condition characterized by a drooping of the eyelid. There are a number of causes of ptosis and with careful evaluation and diagnosis ptosis can often be minimized or eliminated with outpatient surgery to repair the eyelid.
Functional Ptosis or Droopy Eyelid
A common cause of ptosis is the gradual stretching or weakening of the main muscle that lifts the eyelid, the levator muscle. If the eyelid droops enough to block the upper vision it is considered functional ptosis. When it is the actual eyelid that is drooping, whether or not is associated with excess upper eyelid skin, ptosis becomes the diagnosis. Patients with this problem may display strong contraction of their eyebrow muscles in order to lift the eyelid, giving them furrow lines in the forehead. While most patients don’t realize that they are doing this, they may experience significant fatigue over the course of a day. Patients with this condition may appear chronically tired or angry. Not only can this affect a patient’s appearance, but it can also significantly impair the upper and peripheral visual field. The patient may not notice this, as the central vision, which is used for reading or driving, is not affected. When evaluating your ptosis, we might perform special measurements and tests including taking photographs and performing a visual field test. Visual field testing will assess whether the droopy eyelid is impairing the upper or peripheral visual field. If you are a candidate, surgical correction can be done on an outpatient basis.
Congenital Ptosis or Droopy Eyelid
Congenital ptosis is a droopy lid that is present at birth. There are several causes of congenital ptosis and is sometimes can associated with other eye problems including misdirected or misaligned eye muscles. In many instances, the eyelid muscle that elevates the eyelid does not develop well. When significant, the droopy eyelid can block the visual input to the child’s eye and impair the development of that eye and normal vision and often the child may maintain an abnormal head posture in an attempt to see underneath the droopy eyelids. If surgical correction is deemed necessary, your child will have a consultation with our specialist who will then explain the possible approaches to the surgical correction of congenital ptosis, each guided toward severity and cause of the droopy eyelid. The eyelid surgery for correction of congenital ptosis may range from a simple tightening of the upper eyelid muscle if it has adequate function. If the muscle that normally elevates the eyelid is not adequate, then there are several techniques to use the muscles that lift the brow to elevate the eyelid. Beginning with a thorough evaluation we will guide you throughout this process so we can be helpful in achieving the best possible results.
We perform eyelid reconstruction most commonly to repair defects and damage to the eyelid that has resulted from trauma or removal of eyelid tumors. More superficial eyelid defects that occur after minor trauma or removal of small growths only require a few sutures and proper wound care to properly heal. With more significant traumatic injuries or removal of larger growths or skin cancers, larger defects may course throughout the entire lid. Sometimes these wounds can be sutured together directly, but many others may require more complex reconstructions. In more complex cases, we may need to create “flaps” to transfer closely adjacent tissues or transfer skin “grafts” from other parts of the eyelid, face or body to complete the reconstruction. In instances where the eyelid reconstruction is particularly complex, we may need to perform multiple surgeries in a “staged reconstruction” in order to get the best results.