Drooping Eyelids l Eyelids that turn in or out l Tearing l Tumors

Functional problems: True drooping eyelids

Blepharoptosis: Drooping or inferior displacement of the upper eye lids, caused by weakness of the muscle responsible for raising the eyelid, damage to the nerves which control those muscles, or laxity of the skin of the upper eyelids.  Some people have true ptosis, or droopy eyelids.  This is a condition where the eyelid muscle does not function correctly, causing the eyelid to droop over the eye and obscure vision.  If people ask if you are sleepy, or if you have difficulty opening your eyes you may be a candidate for a Levator advancement (tightening of the muscle).

Why does this occur?
Sometimes one is born with a week muscle, and often times these children will be noticed at or shortly after birth.  However, more often, as we age, the muscle that opens the eye becomes weak, and unable to lift the eyelid appropriately, thus causing droopy eyelids.

What can be done?
A procedure called a levator aponeurosis advancement can be performed to tighten the muscle returning the normal lid height and contour and restoring the face to its more youthful, awake, and relaxed appearance.

How is this procedure performed?
An incision is made with a carbon dioxide (CO2) laser in the upper eye lid crease, to hide the scar. The CO2 laser greatly decreases bruising, bleeding, and accelerates recovery.  The extra skin, muscle,and fat are removed.  Dissection is carried down to the levator muscle (the muscle that opens the eyelid), and the muscle is tightened.  The incision is then closed with dissolvable sutures.

What can I expect?
Usually there is some very mild bruising that usually lasts from 2 – 7 days.  One can often return to work in to work in 3 days and normal activity shortly there after.  There is usually very little other discomfort, other than occasional itching, or crusting of the wound.  One may experience dry eyes after   the operation because there is increased tear evaporation.  This is usually transitory as the eye adjusts to being more open.

Functional problems: Eyelids that turn in or out

Patients with eyelids that turn into the eyeball so that lashes scratch the eyeball have a condition called entropion.  Patients with eyelids that turn away from the eyeball so that there is greater exposure have a condition call ectropion

Why does this occur?
As we age, the structures that support the eyelids become loose.  This laxity allows gravity to wreck havoc with the eyelid.  The area where the greatest gravity is decide whether one develops entropion or ectropion.

What can be done?
A procedure to tighten and rotate the eyelid can be performed to correct the condition

How is this procedure performed?
There are several different procedures that can be performed depending on the severity and laxity of the eyelid.  Most require a small incision at the corner of the eye, and then correcting the inappropriate position of the eyelid by strengthening the tendon.

What can I expect?
Usually there is some very mild bruising that usually lasts from 2 – 7 days.  One can often return to work in to work in 3 days and normal activity shortly there after.  There is usually very little other discomfort, other than occasional itching, or crusting of the wound.

Functional problems: Tearing

Excessive tearing is a common problem that can occur at any age.  Many times it indicates allergies, or colds.  However it can be a symptom of a more serious problem.  The majority of the time, excessive tearing is actually a symptom of dry eyes.  There are basically two types of tearing mechanisms the underlying system and the reflex system.  The underlying tearing system is present to keep the eyes lubricated.  The reflex system functions when we cry, get something in our eyes, or have dry eyes.  Dry eyes can have many different causes, so one needs to be evaluated to discover the exact cause.

What is the more serious problem?
Occasionally tearing is a symptom of a clogged drainage system.  This clogging can lead to infections called dacryocystitis, or cysts called dacryocoeles. 

What can be done?
If one has a clogged drainage system, one most often needs an operation called aDCR (dacryocystorhinostomy) which can correct the problem.

How is this procedure performed?
A small laser pipette is threaded through the tear drainage system, to a point just above the normal opening into the nose.  The laser is then used to form a new drainage hole, rerouting the system.  A tube is placed in the new drainage system, to help keep the system open until it heals properly.  The tube remains in place for about three months, until it is removed

What can I expect?
There is usually very little discomfort.  Very infrequently is there any bleeding.  One can usually return to normal activities with in 24 hours.

Functional problems: Tumors

There are numerous tumors that can occur in and around the eyeball and face.  Thankfully most are not cancerous.  However, some mild appearing lesions can in fact, be quite serious.  There is no way to tell if a lesion is cancerous unless it is examined.  There are some signs that point to malignancy.  Some concerning signs include:

• Discoloration
• Unusual color
• Irregular borders
• Quick growth
• Crusting or bleeding
• Maceration
• Bulging of the eyes
• Double vision

If any of these signs appear, or if you are just worried about a particular lesion, it is always wise to have any suspicious areas examined.