Eye lid surgery

Blepharitis is a very common condition. It usually refers to crusting at the margin of the eye lids (see photo).

Symptoms of blepharitis include:

• sore eyelids
• itchy eyes
• a gritty feeling in the eyes
• flakes or crusts around the roots of the eyelashes
• red eyes or eyelids
• eyelids sticking together in the morning when you wake up

Although Blepharitis is not a serious condition, if untreated, it can cause other eye problems such dry eyes and recurrent conjunctivitis.

In majority of cases, simple regular and daily washing of eye lids is curative.

How to clean your eyes:

1. Soak a clean flannel or cotton wool in warm water and place on your eye for 10 minutes.
2. Gently massage your eyelids for around 30 seconds.
3. Clean your eyelids using cotton wool or a cotton bud. It might help to use a small amount of baby shampoo in water.

You could also use special blepharitis lid clean wipes. These wipes are not necessarily and better but some patients find the wipes more convenient. You could purchase these wipes from your local pharmacy or from internet. 

Some patients with Blepharitis have no symptoms. If you are having cataract surgery, it is important that Blepharitis is treated before the surgery to reduce the chance of infection inside the eye after cataract surgery.

Ectropion is a condition whereby the lower eyelid droops. It causes the eyelid inner lining to look red and angry.

Ectropion can cause redness of the eye, discharge, stickiness, irritation and watery eyes.

Ectropion also disturbs the drainage of the tear film by pulling down the opening of the tear duct.

Patients with Ectropion are more prone to have recurrent infections of the eyelid and conjunctivitis.

Causes of Ectropion

Most cases of ectropion are associated with ageing. It can occur as the tissues and muscles of the eyelids become weaker as you get older.

Less common causes of ectropion include:

• a problem with the nerves that control the eyelid – this is often seen in a type of facial paralysis called Bell’s palsy
• a lump, cyst or tumour on the eyelid 
• damage to the skin around the eyelid as a result of an injury, a burn, a skin condition such as contact dermatitis, or previous surgery

Treatment for Ectropion

The treatment depends on severity. In mild cases it might not require any surgical intervention and can be treated conservatively with lubrication eye drops or ointments.

More troublesome cases can be corrected by surgery. Surgery for Ectropion is relatively small and is usually done with local anaesthesia and a minor day case procedure. The would be some initial bruising and tenderness at corner of the eye lid but this usually settles after a few weeks.

Various different techniques can be used, depending on the severity of ectropion and its underlying cause.

Following surgery, a pad will be placed over your eye to protect it. This will need to remain in place for about a day.

A course of antibiotic and steroid drops or ointment will usually be prescribed to help prevent infection and reduce inflammation. 

You’ll have a follow-up appointment a week or two after your operation. This is to check on the position of your eyelid and sometimes to remove any stitches.

Entropion is in-turning of the eyelid. The eyelids protect the surface of the eye and keep the surface moist by blinking. The eye lashes are usually pointing out and away from the surface of the eye.

In Entropion, the eyelid points the wrong way and causes the eye lashes to rub against the surface of the eye (cornea). This causes irritation and if untreated can cause ulcers of the surface of the eye.

There are a few reasons why one can develop entropion but the most common reason is laxity of the eye lid caused by aging of the face.

There are 2 main procedures for treating Entropion.

1. Everting Sutures:

This is a small outpatient procedure. It involves a local anesthetic injection into the eyelid and 3 stiches to evert the eyelid. The skin does not need to be cut. It is a quick procedure and usually takes about 10 minutes. There would be some bruising. The stitches are self-absorbing and will fall off in a few weeks (see photo) The disadvantage of the procedure is that in some people it does not work so well and in some people it only works for a few weeks or months. It can be repeated if needed.

A blepharoplasty is an operation to tighten the skin and soft tissues of your eyelids.

Is Blepharoplasty suitable for me?

As you get older, gravity pulls down on the skins and soft tissues of your eyelids, causing them to sag. The fat that was supported by these tissues also drops down, making one looks older. Usually a fold of skin appears above the eyelids which in your case are fairly prominent. Over time it hangs down enough to interfere with peripheral vision.

Blepharoplasty can be an effective treatment to improve both of these elements however, in NHS setting, you can only be offered surgery if it interferes with your peripheral vision.

How is Blepharoplasty carried out?

I usually perform the surgery under local anaesthesia. However, you could choose to have general anaesthesia.

I will make a cut in the natural skin crease of the upper eyelid and remove extra skin and fat if necessary. I will then close the cut with stitches. The scar tends to be hidden in the natural skin fold and not noticeable.

If you have local anaesthesia, you will have an initial discomfort but you should not feel anything sharp after it. Sometimes I top up the local anaesthesia during the surgery if needed. If general anaesthesia is chosen, the anaesthetists will discuss the risks with you.

Post-operative pain tends to be mild and is usually treated with simple painkillers such as Paracetamol. Bleeding should also be mild. Your eyes are likely to look bruised and swollen but this usually settles after a few days. If you get any bleeding afterwards, you should press firmly on the wound for a few minutes with a clean tissue. Usually the bleeding stops after 10 minutes, however,

If the bleeding continues or you develop a visual disturbance, keep on pressing firmly on the wound and contact us or go to your nearest A/E department. Infection in the site of surgery is rare but if your eyelid becomes painful and swollen a few days after the surgery, you should let us know. Usually an infection can be treated with antibiotic.

Lower eye lid Blepharoplasty is an operation to tighten up the lower eye lid and reduce the puffiness which can come with age.

As one gets older the skin and muscles of the face become lax and droopy. The fat around the eye (orbital fat) can protrude and prolapse causing swelling of eye lids.

The surgery is usually performed under local anesthesia but can also be done under general anesthesia. I will make a cut in the natural skin crease of the lower eyelid, just underneath the eye lashes and remove extra skin and fat if necessary. I will then close the cut with stitches. Sometimes I need to tighten up the muscles of the upper face and the eyelid as well. The scar tends to be hidden in the natural skin fold and not noticeable. Sometimes if the problem is mainly the protruding orbital fat (swelling), then I can do the surgery from inside the eye lid and there would be external skin cut.

If you have local anaesthesia, you will have an initial discomfort but you should not feel anything sharp after it. Sometimes I top up the local anaesthesia during the surgery if needed. If general anaesthesia is chosen, the anaesthetists will discuss the risks with you.

Post-operative pain tends to be mild and is usually treated with simple painkillers such as Paracetamol. Bleeding should also be mild. Your eyes are likely to look bruised and swollen but this usually settles after a few days. If you get any bleeding afterwards, you should press firmly on the wound for a few minutes with a clean tissue. Usually the bleeding stops after 10 minutes, however,

If the bleeding continues or you develop a visual disturbance, keep on pressing firmly on the wound and contact us or go to your nearest A/E department. Infection in the site of surgery is rare but if your eyelid becomes painful and swollen a few days after the surgery, you should let us know. Usually an infection can be treated with antibiotic.

Watery eyes are a common problem. Sometimes symptoms can be transient but in some cases the symptoms can be persistent and troublesome. Broadly speaking, watery eye can be caused by 2 things:

1. Too much tear being produced. This is usually the case if there are reasons to irritate the surface of the eye. There is a long list of possible causes for irritation but the commonest one is a condition called Blepharitis (please see the section on Blepharitis).
2. Blockage of the tear duct. The tear duct runs from the corner of the eye to the back of the nose. If there is any blockage of any part of it, then the eye can be watery or sometime discharge yellow mucus. Sometimes the tear sac can become infected (Dacrocystitis).

If you are suffering from watery eyes, the first thing that we need to do is to examine the front of the eye and exclude obvious signs of irritation. The second stage is to test the tear duct. This is done by injecting salty water through a blunt canaliculus (like a syringe) into opening of the tear duct. If the fluid is felt in the back of the throat, then the tear duct is open and flushed. If it is blocked, then the test will give us an indication where the blockage is.

The treatment of blocked tear duct depends on the site of obstruction and patient symptoms. It ranges from simple local anesthetic procedure to bigger procedures which requires general anesthesia.

Styes are acute swellings of eyelids. Styes are very common. Styes are formed as a result of blockage and inflammation of eyelid margin glands which secrete part of the tear film. Styes can be painful and unsightly. They are usually associated with chronic inflammation or infection of eye lid margin (Blepharitis).

In majority of cases, simple lid massages with the aid of a warm cloth can help and speed up resolution. In some cases, styes can persist and require active intervention.

There are two possible interventions:

1. Incision and drainage. This is a very minor procedure performed under local anesthesia and in the clinic. The procedure takes approximately 5 minutes. There is no cut in the skin. A very small cut is made inside the lining of the stye and the content is drained. A topical antibiotic is applied. The recovery is usually fairly rapid and initial bruising improves after one week. The procedure sometimes need to be repeated.

2. Injection of small amount of steroids inside the stye. I do the injection instead of incision and drainage if the stye is small and looks more inflamed. It is a very small injection into the skin. It usually takes a few weeks for it to work.

There are other lumps and bumps of the skin around the eyes. These lumps and be uncomfortable and unsightly. I offer a service whereby these lumps can be excised at the same time as your clinic appointment. Far majority of these lesions are benign but on some occasions, these lesions can be cancerous and need to be biopsied. This is very unusual in younger patients but need to be excluded in older people. I am the clinical lead for eyelid cancer services for NHS Lanarkshire.

Droopy eyelids (Ptosis) usually happens as a part of aging process but can also happens as result of long-term contact lens. Droopy eyelids can interfere with peripheral vision, cause headache due to constant effort of forehead muscles to lift up the eyelids and are obviously unsightly.

The operation for droopy eyelids is specialized surgery usually only performed by oculoplastic surgeons such as myself. I have performed over 2500 cases of droopy eyelid surgery including complex re-do cases.

The surgery is performed with local anesthesia and as a day case surgery. There is minimal and usually invisible scarring and can be very effective. The surgery in my hand usually takes 45-60 minutes. Satisfaction rates after the surgery is well above 95%.