Is the ophthalmology subspecialty devoted to the study and management of eye socket (cavity where the eye is located), eyelid, tear duct and ocular loss problems. Surgery is performed for functional and aesthetic purposes, yielding surprising results in cases where, for various reasons, the eye loses its shape and natural appearance, restoring its beauty and harmony.

 

1.Blepharoplasty:

cirugia_parpadosIt is an eyelid surgery that aims to remove the upper and/or lower eyelid tissue which is characteristic of dermatochalasis. It may be aesthetic to rejuvenate the appearance of the face through the intervention of the eyelids or functional to enhance the visual field.

 

In both, the upper or lower eyelid is reshaped by removing and/or repositioning the excess tissue as well as strengthening the surrounding muscles and tendons. When a significant amount of skin is on the eyelid, it may hang over the eyelashes and cause loss of peripheral vision. Very often when they reach their 40s, people have drooping eyelids due to the excess skin on them. It may occur in both, the upper and the lower lids.

Blepharoplasty is performed through external incisions calculated according to the patient’s appearance, made along the natural lines of the eyelids or eyelid folds, such as the lines on the upper eyelids and below the lashes in the lower eyelids, or the inner surface of the lower lid. It is an outpatient surgery.

Recovery depends on the healing capacity of the patient and postoperative care observed. Initial swelling and bruising takes one or two weeks to disappear but it takes at least several months until the final result becomes stable and definitive. Depending on the scope of the procedure, the operation takes one to three hours. It is performed under local anesthesia and pseudo analgesia, that is, intravenous anesthetic drugs are administered by the anesthesiologist so that the patient is drowsy but always collaborative.

Non-absorbable sutures are made on the skin, which are removed after 10 days. For post-surgery care, relative rest, the application of antibiotic ointment, lubricating eye drops, oral anti-inflammatory drugs and ice on a regular basis are prescribed to the patient. The patch must only be removed by the doctor until the following day. It is important that the patient be aware that the first few weeks need “extra” lubrication, since the blinking frequency and neurological connection are altered because the eye is now more open and tears evaporate more easily.

 

2.Ectropion:

ectropion1It is characterized by eversion, usually of the lower eyelid, which causes patient discomfort such as frequent eye watering, due to poor drainage of tears caused by poor positioning of the tissues; keratitis due to exposure, poor eyelid closure; and inadequate spreading of the tears. Ectropion may be caused by age, may occur in patients with facial paralysis and/or if a tumor is present, which forces the eyelid down.

It can be corrected with one or more procedures, such as the tarsal strip procedure, where a portion of the tarsus is removed and the strip is placed on the bony portion of the orbital rim and/or retractors relocated on the tarsus with sutures on the skin. Sometimes we need to resort to additional procedures such as eyelid wedge reaction to reduce its length.

 

3.Entropion:

entropionIt is characterized by a reversal of the upper and/or lower eyelid that causes a permanent and continuous rubbing of the eyelashes which in turn causes a secondary keratitis characterized by frequent tearing as a result of foreign body sensation and secretions.

 

Surgical correction is required to place the lower eyelid retractors in place at the level of the tarsus or with spacers in the case upper lid entropions, as in the case of donor sclera, for example. Non-absorbable sutures are placed on the skin, which are removed after 10 days approximately.

Entropion is more common in the lower eyelid. Its most common etiology is involutional origin caused by aging; however, if it appears in the upper eyelid, we should rule out trachoma, an infection caused by iethracomatis chlamydia which generates excessive scarring of the tissue causing the described pathology.

 

4.Eyelid Ptosis:

ptosis-2It is a very frequent malposition which goes unnoticed because patients do not try to regularly lift their eyelids to check if they can see better. It is characterized by a drooping upper eyelid. If it is degenerative or caused by aging (aponeurotic ptosis), it may be accompanied by dermatochalasis, that is, it will be necessary to put the upper lid back in place making a blepharoplasty as a combined procedure, along with the replacement of the levator aponeurosis to correct ptosis.

Ptosis origins may be aponeurotic, paralytic or neurological; traumatic and mechanical.

Ptosis origins may be aponeurotic, paralytic or neurological; traumatic and mechanical. A patient with aponeurotic ptosis requires surgical correction, where the part or a large part of the aponeurosis which is normally attached to the tarsus at 2-3 mm from its upper margin, has degenerated, detaches from its origin, and is put back in place.

Paralytic or neurological ptosis is the result of paralysis of the third cranial nerve innervating the levator aponeurosis. It occurs in patients with uncontrolled diseases such as hypertension, diabetes mellitus, collagen disease, associated vascular diseases, Myasthenia Gravis, compressive tumors at the level of the central nervous system and/or viral.

In such cases, it is important to have a thorough neurological examination as well as blood tests and radio imaging such as MRI and/or CT scan of the orbits and/or brain.

In cases of traumatic ptosis due to tissue detachment, it is important to replace the detached tissue surgically.

In mechanical ptosis, we would solve the root cause, such as can be: eyelid and conjunctiva tumors, which make the eyelid droop by gravity causing secondary ptosis.

In the case of ptosis surgical correction, the aponeurosis of the upper eyelid is put back in place and the postoperative care and medication are the same as for blepharoplasty.