Oculoplastic surgery is the sub-specialty of eye surgery concerned with the medical and surgical treatment of eyelid and tear duct problems. In New Zealand’s climate much of this involves treating skin cancers, as well repairing drooping upper and lower eyelids, skin grafts and blepharoplasty.
Treatment of eyelid changes can be quite different from treatment of skin changes elsewhere because maintaining the structure and mobility of the eyelids is important to maintain the health of the eye. Liquid nitrogen treatments, for instance, should usually be avoided close to the eyes.
The commonest oculoplastic operations we perform are;
- Ptosis (droopy eyelid) surgery
- Ectropion and Entropion repair
- Skin cancer surgery
- Tear Duct operations
What is a blepharoplasty?
Blepharoplasty is the surgical removal of excess skin (and sometimes fat) from the eyelids. Upper lid blepharoplasty can be for functional or cosmetic reasons.
What is a functional blepharoplasty?
This is a blepharoplasty done to improve visual function – usually to improve the field of vision in cases where the excess skin is hanging over the edge of the eyelid.
Is it just for women?
Not at all – many men have a great functional and cosmetic improvement after blepharoplasty surgery.
Is blepharoplasty covered by medical insurance?
Functional upper lid blepharoplasty is often covered by medical insurance. Each insurance company has specific guidelines – they may require photographs or the results of other eye tests. Cosmetic blepharoplasty is not covered by medical insurance.
Is lower lid blepharoplasty covered by medical insurance?
Unfortunately, no. Lower lid blepharoplasty is always considered cosmetic.
Is an anaesthetic required?
Blepharoplasty surgery is usually performed under local anaesthesia with injections given into the eyelids. Usually an anaesthetist is also present to give sedation, so that the brief discomfort of the anaesthetic injections does not cause distress. If sedation is used we like to observe patients postoperatively for approximately two hours before discharge. We have day-surgery unit, Shore Surgery, on site at 181 Shakespeare Road.
What is Ptosis?
Ptosis is the name used to describe when the edge of the upper eyelids are lower than usual. Ptosis can be a congenital problem, or it may develop later in life due to many causes. The commonest situation is just ageing change in which the delicate attachment between the muscle which lifts the eyelid and the lid becomes thin and stretches but acquired ptosis can be a sign of several muscular or neurological conditions and sometimes further investigation is necessary to determine the reason for the problem. Ptosis may be so severe that the eyelids obscure the pupil and thus affect the vision. Some people experience discomfort in the brows and forehead from the muscular effort required to elevate the eyelids. Others desire surgery for cosmetic reasons.
What is done during ptosis surgery?
The techniques used for ptosis surgery vary depending on the cause for the problem. Typically, a fine incision is made in the crease of the upper eyelid and the attachments between the muscle and the eyelid tightened. Sometimes, if the muscle function is poor, a delicate sling is fashioned within the eyelid to support the lid.
Is ptosis surgery covered by medical insurance?
Ptosis surgery is usually covered by medical insurance but confirmation of this cover and prior approval for the costs of any operation should be obtained before surgery. We can assist with this process.
Is an anaesthetic required?
Ptosis surgery is usually performed as day surgery under local anaesthesia, with injections given into the eyelids, and an anaesthetist present to give sedation as necessary.
Ectropion and Entropion Surgery
What is ectropion and entropion?
Ectropion is the name used to describe lower eyelids which have turned outwards so that the back surface of the eyelid is no longer in contact with the surface of the eye. Entropion is the opposite situation in which the eyelid rolls back against the eye such that the eyelashes rub on the cornea causing discomfort. There can be multiple factors contributing to the development of ectropion and entropion. These include;
- A general laxity of the tissue which comes with age.
- Thinning and stretching of the delicate attachments between muscles and the structure of the eyelids.
- Tightening of the skin of the lower eyelid and cheek due to sun damage or scarring from injury or previous surgery.
- Sagging of the mid-facial structures with age.
What is done during ectropion and entropion surgery?
Surgery is tailored to suit the individual situation taking into account the causes of each person’s problem. The things which are commonly done include tightening the eyelid, redirecting the muscle action on the eyelid, and sometimes using a skin graft to overcome the effects of scarring or sun damage.
Is entropion and ectropion surgery covered by medical insurance?
Ectropion and entropion repair is functional, and the surgery is usually covered by medical insurance. We can assist with obtaining confirmation of this cover and prior approval for the costs with your insurance company.
Is an anaesthetic required?
Ectropion and entropion surgery is usually performed as day surgery under local anaesthesia, with injections given into the eyelids, and an anaesthetist is often present to give sedation as necessary.
Skin Cancer Surgery
Skin cancers affecting the eyelids are relatively common – especially on the lower eyelid, probably because it is exposed to more sun. Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are most common.
What should I look out for?
Any new lump or bump on the eyelid that persists for more than a couple of weeks could be a skin cancer, especially if it seems to be getting bigger. A lump which ulcerates and crusts, or one which bleeds when you touch it, is highly suspicious and should be assessed by a specialist.
What can you do for eyelid skin cancers?
In general, skin cancers of the eyelids need to be surgically removed. The reconstruction is very important because it must preserve the structure and function of the eyelid which protects the eye. Other treatments such as ointments and cryotherapy (liquid nitrogen or freezing) are usually not recommended around the eye because of the risk of damage to the normal part of the eyelid, or to the eye itself. Careful planning of surgery usually allows a single operation to cure the skin cancer and leave a functionally and cosmetically great result.
Is this treatment covered by medical insurance?
Almost certainly. Surgery is generally performed under local anaesthetic with some sedation to help you feel relaxed and comfortable.
What can I do to prevent skin cancers around the eye?
Reducing sun exposure is probably the most important thing you can do. While sunscreens are important for the rest of the face, it is often difficult to apply it to the eyelids without it irritating the eyes. Sunglasses and a peaked cap or broad brimmed hat are effective ways of reducing sun exposure to the eyelids.
Watery eyes are very common. Often the problem is simply associated with a cough or cold because the tear ducts drain into the nose, but there are many possible causes. Generally speaking watery eyes are either due to problems which cause the eye to produce too many tears – like an eyelash rubbing the eye – or because of problems with tear drainage such as a blocked tear duct.
Problems with overproduction of tears are often treated with drops or ointment. Sometimes something as simple as carefully cleaning the eye every morning can reduce or fix the problem. Paradoxically, for many people, lubricating drops will be the answer.
Problems with tear drainage are more likely to require surgery to fix. Sometimes a very minor procedure like enlarging the entrance to the tear duct in the eyelid can improve things dramatically. If surgery to reposition the eyelids is required, this usually only requires local anaesthetic – usually with some sedation. Obstruction of the tear ducts often requires more major surgery to bypass the blockage – an operation called a Dacryocystorhinostomy or ‘DCR’. Silicone tubes are usually inserted at the time of surgery to stent the passages open. These days even more complex surgery of this nature is done on a day stay basis under local anaesthetic with sedation and generally does not leave significant scarring.
Each individual case is different and requires careful assessment of multiple possible contributing factors.