Eyelid Surgery

Eyelid Lesions or Cysts Treatment

How are lesions removed?

Punch biopsy: a small blade is used to take a circular piece of tissue from the eyelid. The tissue removed is then examined to identify the nature and cause of the lesion. These biopsies are a type of incisional biopsy, where the whole extent of lesion is not removed, but only a small amount of the lesion is sampled.

Excisional biopsy: a small blade is used to remove the entire eyelid lesion and a portion of surrounding normal skin. The whole lesion that has been excised is examined to identify the underlying cause.

Mohs micrographic surgery (MMS): MMS is a special type of surgery used to remove cancerous cells in areas of the body where it is important to remove as little skin as possible (e.g. the eyelids). The surgery involves the removal of the skin lesion and a small area of surrounding skin. The removed tissue is examined under a microscope for cancerous cells. This process is repeated until the entire lesion has been removed. MMS reduces the amount of healthy tissue that is removed and post-surgery scarring while ensuring the complete removal of cancerous lesions.

Eyelid surgery to remove lesions is usually performed under local anaesthetic. This means you will be awake during the operation. However, you will be given an injection into the affected eyelid to numb the area before the surgery, and eyedrops to make you feel more comfortable.

If you have stitches in place, these will be removed in approximately 1-2 weeks in the outpatient setting.

The cost of removing a lesion or cyst from the eye will vary depending on both the size and complexity. There may also be a charge for histology if the lesion or cyst looks cancerous.

Ectropion Treatment

What is the Treatment for Ectropion?

An operation is usually needed to fix an ectropion. The surgery lasts between 45 to 60 minutes and is Performed with “freezing injections” (local anaesthesia) as a day case procedure. This operation will involve tightening the lower lid. Which will correct the lid laxity. You may have a small incision of 10-15mm with a few stitches at the outer corner of the eye or extending down from the edge of the Eyelid. A small skin graft may be needed if there is sun damage to the lower lid skin. The graft is usually taken from behind the ear, the upper eyelid or the arm.

Sometimes a watery eye may persist after successful ectropion surgery. This is because the tear ducts may not be functioning and this may be corrected with further surgery if necessary.

Entropion Treatment

What is the Treatment for Entropion?

An operation is usually needed to fix entropion. The surgery lasts between 45 to 60 minutes and is Performed with “freezing injections” (local anaesthesia) as a day case procedure. This operation will involve tightening of the lower lid, to correct the lid laxity. You may have a small incision of 10-15mm with a few stitches at the outer corner of the eye or extending down from the edge of the eyelid. In combination with this, there may be other procedures performed depending on the cause of the entropion.

Sometimes a watery eye may persist after successful entropion surgery as the tear ducts may not be

Functioning correctly and this may be corrected with further surgery if necessary.

Ptosis Treatment

Surgical Correction for Ptosis or Droopy Upper Eyelid
The aim of surgical correction is to restore the anatomy, by addressing the various causative factors. Adult ptosis surgery is generally performed under local anaesthesia with or without sedation.

The operations for ptosis correction are generally based on the function of the levator muscle. The surgical cut is hidden within the normal eyelid crease or inside the eyelid, resulting in a scar less minimally invasive operation, which produces natural results.

Recovery times are generally quick, with most patients achieving complete recovery within 7-14 days.

Dermatochalasis Treatment

What is blepharoplasty?
Blepharoplasty is an operation, which removes excess skin (dermatochalasis) from the upper eyelids.
The surgery involves removing excess skin, bulging fat and lax muscles from the upper lids. If the sagging skin obstructs peripheral vision, blepharoplasty can eliminate this obstruction. Expanding the visual field.
Excess skin and fat are removed from the upper lid through a cut hidden in the natural eyelid crease. If the upper lid is droopy, the muscle that raises the lid can be tightened at the same time (ptosis surgery). The cut is then closed with fine stitches. Eyelids normally heal very well, and the wound should be hidden in the natural skin crease of the eyelid.

What are the Potential Risks of Blepharoplasty Surgery?

Infection
This is very rare; occasionally the stitches may have an infective or inflammatory response, which settles with oral and topical antibiotics.
Scarring
This is normally hidden in the natural skin crease of the eyelid. Stitches may be visible for the first week, then, when they are removed, a faint scar is visible. The scar may seem a bit thickened & red for 6 to 12 weeks, becoming almost invisible after that period. Not every scar heals equally well. A thickened or reddened scar can be improved with silicone scar remodelling gel, but the treatment needs to be continued for months to have a good result.
Bruising
This is minimised by following the instructions on the post-operative information sheet. A haematoma may mean you have to go back into theatre to have the blood clot evacuated and then be re-stitched with the risk of a worse scar.
Theoretical risk to vision
Any eyelid surgery carries the risk that an undiagnosed infection or bleed could damage the optic nerve. This is incredibly rare.
Asymmetry of eyelid shape, height or upper lid fold
This is rare, but can occur. Often asymmetry may be due to lid bruising and settles spontaneously as swelling resolves. Rarely, this may require revision surgery. Occasionally pre-existing asymmetry of the face, eyebrow or eyeball position, may be responsible, however this will be discussed with you prior to the operation by your surgeon.
Temporary poor blink
The muscle that shuts the eyelid has been cut to access the muscle that lifts the eyelid. Generally, blink returns to normal within 12 weeks.
Dry eye
This is treated with artificial tear drops which you will be asked to continue for a month after surgery.

Blepharitis Treatment

There is no magic cure, but measures can be taken to relieve your symptoms. Thorough cleaning of the lid margins twice a day is the most effective measure. This will reduce the frequency and severity of flare-ups of blepharitis.

Warm compresses
These are to loosen the fatty blockages of the Meibomian glands, prior to expressing these during lid   massage. Soak a cloth in hot water and apply to closed eyelids for several minutes. Commercial eyebags are also available for this purpose that can be heated in the microwave.

Lid massage
Using a finger or cotton bud, firmly stroke the skin of the eyelid towards the eyelashes, where the Meibomian glands open up – this helps to unblock the glands and express the oils. Move along the length of the eyelids.

Lid cleansing
Boil some water and let it cool. Add a pinch of Sodium Bicarbonate to an eggcup of water or add a few drops of baby shampoo to warm water in a small cup or bowl.
Then dip a cotton bud into the cleaning solution, pull the lower eyelid away from the eye with a finger and gently scrub along the eyelid margin removing any crusts from between the lashes.
For the top eyelid, this is often easiest with the eye closed.

On-Going Care
Lid cleaning may be needed long-term. It takes time to be effective but once symptoms are under control, ongoing lid cleaning will help to prevent further flare-ups of blepharitis.