Oculoplastic surgery 2017-04-25T12:32:08+00:00
If your eyelids make you look tired even when you aren’t or if your eyes have lost their youthful sparkle, then blepharoplasty could significantly improve your appearance.

Blepharoplasty involves removing the excess skin and fatty tissue from the upper and lower lids, which make your eyes look tired, thereby eradicating unsightly bags or puffiness in order to make your face appear younger and fresher. Sometimes, eyebrows may also be raised if they are sagging onto the eyelids.

This is a simple intervention and patients may return home the same day and will quickly be able to return to their normal daily routines.

What happens in the operation?

Eyelids are made of the thinnest skin found on the face and the density of collagen and elastin fibers is significantly lower than that of other areas of skin. This makes eyelids particularly sensitive to the passing of time and the effects of aging become visible very quickly.

As time passes, the epidermis that covers the eyelid becomes wrinkled and sags over the eyelashes on the upper eyelid. The lower eyelid becomes creased and fatty tissues accumulate creating unsightly bags and rings under the eyes.

The eyelids are a very delicate area, which is responsible not only for protecting the eyes, but also for controlling the flow of tears. It is essential that a qualified ophthalmologist who specializes in this type of operation (ocular plastic surgery) carries out the intervention.

Blepharoplasty treatment

The operation begins by making incisions in the skin of the eyelids in order to remove excess skin and tighten the orbicularis oculi muscle.

Next, enough fatty tissue is removed to eliminate bags under the eyes. Occasionally, the fat is repositioned on the ridge of bone under the eye socket in order to make the cheeks project more.

Finally, the incisions are closed using very fine stitches which, since the eyelids are the area of the body which heals most successfully, will have become practically invisible three months later.

The ocular plastic surgery deals with all the alterations that may appear around the eyes (eyelids, eyebrows, etc) both aesthetic and functional type. Some of the most common diseases that we can operate are drooping eyelid (ptosis palpebral), inverted eyelid (entropion), eyelid outward (ectropion), abnormal eyelashes (Distichiasis), eyelid tumors and various sequels.

Eyelid Ptosis

Treatment for ptosis

Ptosis is a medical term that describes a drooping of the upper eyelid. It can affect one or both eyelids. In some cases if the condition is severe, it may reach a stage where part of the eye’s field of vision is obstructed. In other cases, the condition may be minor or moderate, covering only the upper part of the pupil, or severe when the whole pupil is obscured by the drooping eyelid. If present at birth it is known as congenital ptosis.

What causes ptosis?

In children, the most common cause is a failure of the muscle which is responsible for raising the eyelid to develop correctly. In adults, the causes may be advanced age, injury, a muscular disease or neurological disorders. As time passes, the tendon which connects the muscle which raises the eyelid to the eyelid itself becomes weaker and stretches so that the eyelid falls and obstructs the pupil. This process often speeds up following cataract surgery.

Other conditions also exist that can trigger eyelid ptosis such as myasthenia gravis, a disease where the muscles easily become weak or tired. The eyelid may droop on only one side if the patient is suffering from Horner’s syndrome, a neurological condition which indicates damage to the sympathetic system.

What are the symptoms of ptosis?

The most common symptom of ptosis is inability or difficulty in keeping the eyes open, meaning that patients often resort to an excessive use of the forehead in order to raise their eyebrows or eyelids. Sometimes they find it necessary to lean their heads back or raise their eyelids with their fingers in order to see clearly.

Children who are born with ptosis can also develop a lazy eye, suffer from a squint or experience blurred vision.

How can eyelid ptosis be treated?

The aim of ptosis surgery is to raise the upper eyelid in order to allow the development of normal vision, save the top section of the field of vision and make both eyes symmetrical. In some cases, when there is a disorder of the muscle, neither the results nor the postoperative functioning of the eyelid can be absolutely guaranteed. Ptosis is treated with different surgical techniques depending on the degree of severity and the strength of the muscle which raises the eyelid.

Surgery involves adjusting the muscle in order to raise the eyelid to a desired level. In severe cases where the muscle is very weak, a sling operation may be performed which forms an internal connection between the upper eyelid and the inside of the muscle which raises the eyebrows.

What is ectropion?

Treatment for ectropion

Ectropion is an eversion (sagging outwards) of the edge of the lower eyelid leading to its inner surface being exposed because it has lost contact with the eyeball. It usually affects both eyelids at the same time.

What causes ectropion?

There are many causes of ectropion, but the most frequent are:

  • Senile: This is the most common cause; age and the loss of elasticity in the eyelids’ connective tissue make them turn outwards.
  • Cicatricial: Caused by a contraction of scar tissue as a result of burns, injuries etc.
  • Paralytic: Due to the loss of control in the orbital muscles. This type of ectropion may occur as a result of facial paralysis.
  • Spastic: Resulting from spasms around the eye.
  • Mechanical: As a result of some type of disease that makes the lower eyelid heavier, such as tumours, inflammation or infections.

What are the symptoms of ectropion?

A reduction of horizontal tension in the lower eyelid leads to the margin of the lid drooping outwards.

This turning outwards leads to dryness, swelling and hyperemia of the tarsal conjunctiva. It also disrupts the drainage of tears through the ducts at the inner corner of the eye which leads to watery eyes (epiphora). The mucus membrane loses contact with the eye and forms a thicker and more rigid layer which no longer conforms to the curvature of the eyeball.

Dryness of the cornea and the irritation this causes may give the patient a predisposition to eye infections, corneal abrasions or ulcers.

How can ectropion be treated?

Artificial tears can be used to alleviate dryness and keep the cornea lubricated. Surgery to adjust the muscles that keep the eyelids in position is usually effective and can be carried out as an outpatient intervention with a local anesthetic. No matter what type of ectropion the patient is suffering from, the treatment is always surgical.

Treatment trichiasis and distichiasis

This refers to the abnormal growth of eyelashes towards the eye so that they continually rub against the surface of the eyeball. As well as causing a lot of discomfort, it can also lead to lesions of the cornea and even sight loss.

Causes and differential diagnosis

There are many causes of trichiasis although often no causal process may be identified. The process of scarring around the eyelids can make eyelashes grow inwards.

It is important to distinguish between trichiasis and entropion because both conditions bring about contact between the eyelashes and the surface of the eye. In trichiasis the eyelashes grow inwards, while with entropion the eyelashes grow normally, but the eyelid is inverted towards the eyeball. Although the experience of the patient is the same (irritation of the eye by the lashes), the treatment of these two conditions is very different. While the treatment for trichiasis involves attempting to remove the hair follicles that produce the abnormal eyelashes, with entropion we correct the position of the eyelid surgically.

A third condition also exists which brings about contact between the eyelashes and the surface of the eye. This is called distichiasis. Distichiasis refers to the growth of new eyelashes from the meibomian glands. These glands are found in the eyelids very close to the surface of the eye and do not usually contain eyelashes. Distichiasis is usually caused by chronic inflammation as with trichiasis. Distichiasis may also be congenital. The treatment is the same as that outlined for trichiasis.

Frequent questions about Eyelid Surgery

Blepharoplasty can return your appearance before having that excess skin and fat, getting a natural and rejuvenated appearance.
Retrieve a normal business activity is possible after 3 or 4 days after surgery using, if you prefer, dark glasses to hide your eyes.
In the weeks after surgery you should protect your skin from the sun by using sunscreen and sunglasses. If you want to wear makeup, you should wait a week and in the case of needing optical correction, we recommend waiting at least a couple of weeks before using contact lenses.
Last updated: 25/04/2017