Eyelid Surgery

This is the commonest of eyelid lumps. They are due to chronic inflammation of a blocked meibomian or oil gland. Meibomian glands produce oil, which makes up part of the tear film and lubricates the surface of the eye. Similar lumps include a stye, an acute infection within a lash follicle, or a hordeolum, an acute infection or abscess within a meibomian (oil) gland.

The exact cause in an individual can be difficult to identify but is likely to be related to thickened oil within the oil glands. There is an increased risk of chalazion in patients with rosacea, blepharitis, dermatitis, stress, smoking and diabetes. Infection is usually caused by bacteria that live on our skin and eyelashes.

Chalazion are likely to spontaneously resolve within the first two weeks.
Repeated warm massage of the lump, towards the eyelashes, can encourage drainage and resolution.
The heat softens the oil and widens the oil gland opening. Massage of the lump promotes drainage of the oil.
Oral antibiotics are not indicated unless there is evidence of cellulitis (the whole eyelid is red and swollen).

During blepharoplasty or eyelid reduction, a variable amount of skin and fat is sculpted to alter the appearance of the eyelids.
Upper eyelid or lower eyelid surgery can be performed separately or together. Combined surgery may take up to 3 hours to complete.
The aim of upper eyelid reduction is to achieve a smoother, less tired and heavy appearance. It may improve the quality of the vision.
Lower eyelid surgery aims to smooth the appearance of the eyelid and reduce bags and wrinkles.
Surgery can be used to alter the location of the skin crease or fold in the upper eyelid and create a double eyelid.

It is important to have an expert assessment and individualised advice before surgery.
A preoperative evaluation is necessary to develop a plan for surgery, outline realistic expectations and detail the risks and benefits of surgery.
The priority for surgery is to maintain healthy vision and eyes.
There are limits that determine how much skin can be safely removed so the closure or the shape of the eyelids is not affected.
A natural and refreshed appearance should be maintained after surgery.

Upper eyelid reduction involves careful measurement and excision of excess skin.
The incision is hidden in the fold of the upper eyelid.
Surgery is performed as a day case procedure under twilight sedation and local anaesthetic.
The dressing is removed at the hospital before discharge.
Most procedures take 45 minutes.

Lower eyelid reduction repositions fat to reduce eyelid bags. The incision I made on the inside of the lower eyelid.
A skin incision will be made, just below the eyelashes, if redundant skin needs to be removed.
Lower eyelid reduction is more complex surgery and can take up to 2 hours.
Recovery is similar to upper eyelid blepharoplasty however, swelling may take longer to resolve.

Upper and lower eyelid blepharoplasty can be combined but does take up to 3 hours.
A general anaesthetic may be required.

Driving can be resumed after 24 hours.
A period of 5 to 7 days off work is recommended after surgery.
Light exercise is encouraged but vigorous exercise is delayed for approximately 1-2 weeks
Routine postoperative visits are at 1 and 4 weeks after surgery
Sutures may need to be removed after 1 week but some sutures are dissolving.
Postoperative discomfort is usually mild and can be treated with paracetamol.
Bruising of the eyelids is obvious in the first week but can be variable between patients. It will resolve over the first few weeks.

Most people will only require a single blepharoplasty surgery in their lifetime.
Ageing is a continual process and surgery does not prevent ongoing changes.
It would be unusual to recommend repeat surgery within 10 to 15 years after a successful procedure.

If the focus of surgery is to maintain the health of the eyes and there are realistic expectations, eyelid reduction has a high rate of satisfaction and low complications.
Common issues in the early postoperative period include uneven or prolonged swelling, itching sensation, redness of the wounds and tightness of the eyelids.
These issues are part of the normal healing processes and likely will improve with time.
Less common risks include infection, bleeding, dry eye, nerve damage or pain.
It is uncommon to have noticeable scarring, significant asymmetry or an unsatisfactory outcome after surgery.
Sometimes revision surgery is recommended. Additional costs may be incurred depending on the circumstances.
It is rare to have visual loss or disturbance or serious side effects from the anaesthetic.

There are certain criteria that need to be met for the procedure to be Medicare and private health fund eligible.
The eligibility criteria need to be individually assessed after consultation and examination.
Patients may elect to proceed on a cosmetic basis.
If surgery is recommended, an estimated cost will be provided as part of the consent.
The complexity of the surgery will vary between patients and the quote is determined after the assessment of the eyelids.
The cost of surgery includes surgeon fees, anaesthetist fees and surgical facility costs.

The most common cause is ageing changes of the eyelid muscle or tendon.
Children can be born with ptosis (congenital).
Other causes include nerve or muscle problems and trauma.
A thorough history and examination is necessary to determine the cause.

The majority is treated with eyelid surgery.
The type of surgery recommended is based on the assessment.
Rare forms of ptosis can be treated with medication.

Surgery for ptosis involves tightening the eyelid muscle or tendon that opens the eye.
Surgery is performed as a day case procedure under twilight sedation and local anaesthetic.
Most procedures take between 30-60 minutes.
A skin incision is made in the skin crease or fold of the upper eyelid. In some cases, surgery is performed underneath the eyelid and is scarless.
Eyelid skin reduction (blepharoplasty) can be combined with ptosis surgery.
Dissolving sutures are often used.
The dressing or eye pad is removed an hour after surgery but may be left overnight in certain cases.
Driving can be resumed 24 hours after surgery (if the eye pd is removed).
A period of 5 to 7 days off work is recommend after surgery.
Routine postoperative visits occur at 1 and 4 weeks after surgery.
Light exercise is encouraged from the first day but vigorous exercise may be delayed for 1 to 2 weeks.
Discomfort is usually mild and may require only simple analgesia such as paracetamol.

Most people achieve good results after surgery and risks are uncommon.
Bruising of the eyelid can be obvious for the first week and usually resolves over the first few weeks.
Infection, significant pain, ocular irritation or bleeding are uncommon.
If a skin incision is used, there will be a scar but it is unlikely to be noticeable. The scar will continue to improve over 12 months with the majority of the healing within the first few months.
If the upper eyelid is too high, too low, uneven compared to the other side or changed in shape, a further procedure may be required.
Visual loss or disturbance is rare.

A loss of the tightness of the skin and other tissues around the eyes, associated with ageing is the cause in most people. Chronic sun-damaged skin can contract, become tight and pull the eyelid down. Previous facial surgery and resultant scarring can also be a factor.

Conservative management including eyedrops can provide temporary relief. Surgery can provide longer term improvement of symptoms.

Eyelid surgery is performed to correct the position and laxity of the eyelid. More severe cases may require a skin graft.
Surgery is performed as a day case under twilight sedation. The length of the procedures is usually between 30 to 60 minutes.
A dressing or eye pad is worn overnight and removed the next day. If a skin graft is required, a dressing will be worn for 5 to 7 days.
Dissolving sutures are used for most cases.
Driving can be resumed after 24 hours unless a dressing is required for longer.
Light exercise is encouraged from the first day, but more vigorous exercise may need to be delayed for one to two weeks.

Most people do well after surgery with excellent results.
Bruising of the eyelids is more noticeable within the first week and is variable between patients. Bruising is temporary and will improve within a few weeks.
Some patients will have tearing or discomfort of their eyes in the first two weeks.
Infection, bleeding, obvious scarring is uncommon.
The wounds will improve over the first few weeks and continue to improve over months after surgery. The wounds are designed to be hidden as much as possible.
In some cases, the eyelid is not fully restored to its original position.
Recurrence is uncommon and may require further surgery.
Ageing changes of the eyelid will continue after surgery.

There are many different causes of facial palsy.
Determining the diagnosis of the facial palsy is important.
The treatment and prognosis vary greatly depending on the cause.
The most commonly known cause is Bell’s palsy.
Other causes include viral infections, trauma, stroke or after surgery.

The treatment varies depending on the cause of the facial palsy and how long the facial palsy has been present
There are non-surgical or medical treatments including eyedrops and ocular surface protection
Surgical treatments include upper or lower eyelid reconstruction, use of an upper eyelid weight, brow lift or tear duct surgery.

Blepharitis is inflammation of the eyelid margin.
There are different types of bleharitis including meibomian gland (oil gland) dysfunction.
It is a common cause of ocular discomfort and irritation across all ages and ethnic groups.
It can be associated with dry eye disease and skin conditions such as acne rosacea and dermatitis.
It is not usually vision threatening but can result in alteration of the eyelid margin, misdirected eyelashes and scarring of the surface of the eyes.

Blepharitis is a chronic condition with exacerbations.
Treatment is directed at control of the symptoms and reduction of inflammation.
A treatment regime can include eyelid hygiene, topical and oral medications, laser.
A stepwise approach to treatment is utilised and tailored to each individual.
Treatment can take 1-2 months to be effective and is required in the long term.

It is injected in small amounts using fine needles.
The placement and number of injections is dependent on the condition being treated and the response to treatment.
The ideal amount of botulinum toxin to use can take a few treatments to determine.
The effect usually lasts approximately 3 months.

A condition where patients experience involuntary and excessive eyelid blinking.
It is due to spasms of the orbicularis oculi muscle that controls blinking.
The exact cause is unknown.
Common secondary causes of blepharospasm include blepharitis, dry eye disease, conjunctivitis medication or trauma.

Botulinum toxin injections are the treatment of choice.
Avoidance of triggers can be helpful.
If injections stops working or is not effective, oculoplastic surgery is often recommended.
The surgery involves removal of some of the muscle surrounding the eyelids.