Common Eyelid Problems

Dermatochalasis (Heavy Eyelid Skin)

Dermatochalasis is an excess of eyelid skin causing heaviness and a droopy appearance of the upper eyelid. This is differentiated from ptosis (see below) in that the skin alone is drooping down, rather than the entire eyelid. It is usually age related. Surgery is required when the droop is so severe that it interferes with part of the vision. In this situation, the patient will be raising their eyebrows most of the time to compensate.

 

Heaviness of the eyelid skin can be caused by other factors, such as eyebrow droop or the protrusion of fat from the eye socket. This will be checked during your eye examination.

Surgical reduction of heavy eyelids is called a blepharoplasty. This is performed at a day surgery under local anaesthetic with sedation. Excess skin is removed via an incision along the natural eyelid crease. Sometimes fat is also removed. The eyelid crease is recreated by scar formation along the incision line, which disguises the scar.

 

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Dermatochalasis

 

Ptosis (Drooping eyelids)

Many things can cause ptosis; however, the most common cause is weakness of the muscle attachment due to ageing. The muscle responsible for lifting the eyelid is attached to the eyelid by a thin tendon called the aponeurosis. The aponeurosis can stretch and weaken or detach, causing drooping of the upper eyelid.

 

Examination is required to rule out other more serious causes of ptosis, such as neurological conditions that might require treatment. Surgical repair of the ptosis is done under local anaesthetic with sedation and only requires day surgery. The most common technique is to re-attach and/or shorten the aponeurosis to the eyelid via a skin incision. The incision is placed along the natural lid crease.

 

Skin Cancer (Basal cell carcinoma (BCC), Squamous cell carcinoma (SCC), Melanoma)

The eyelids, and more commonly the lower eyelid, are sites of potential skin cancer due to sun exposure. The skin cancer may be difficult to recognise at first due to its initially small size. It may appear as only a small skin-coloured bump. During your consultation, a slit lamp examination will provide a magnified view. If suspicious features are seen, such as ulceration or the loss of eyelashes, the lesion will be biopsied.

 

A biopsy is performed in the office under local anaesthetic. A small portion of the skin lesion is removed and sent to the pathologist for testing. If cancer is identified within the specimen, surgical excision of the entire lesion is required.

 

Skin cancer excision is performed at a day surgery under local anaesthetic with sedation. A pathologist will attend the operation to check the excised lesion to ensure its complete removal. The eyelid is then reconstructed to repair the defect left by the excised skin cancer. Different techniques are required, depending on the size and location of the defect and may include a skin flap or graft. The smaller defects require less reconstruction, thus early detection is the key.

 

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Skin cancer on lower eyelid (BCC)

 

Ectropion

An ectropion is a loose lower eyelid that turns outward. Sometimes the portion turning outward involves the punctum (the entrance to the tear duct) which then leads to a watery eye. At other times, the whole eyelid turns out exposing the delicate conjunctiva that lines the inside of the eyelid, allowing the conjunctiva to become red and inflamed.

 

Ectropions are mostly related to ageing causing the weakening of the tendons holding the eyelid in position against the eyeball. Sometimes there is an element of sun-damaged skin tightening and pulling the eyelid down. Uncommonly, they can be caused by other medical conditions such as skin cancers.

 

Surgical repair of the ectropion is performed at a day surgery under local anaesthetic with sedation. Recreating and re-attaching the tendons repositions the eyelid. Sometimes a skin graft is required to relieve the tight and sun-damaged skin.

 

Ectropion

Ectropion

 

Entropion

An entropion is a loose lower eyelid that turns inwards. This usually causes the eyelashes to rub against the eyeball leading to discomfort, redness and watering.

 

Entropions are mostly related to ageing causing the weakening of the tendons holding the eyelid in position against the eyeball. The muscles of the eyelid tighten in such a way that the edge of the floppy eyelid rolls inward, causing the eyelashes to rub against the eye. Uncommonly, entropion can be caused by other medical conditions such as inflammatory disorders that cause scarring of the conjunctiva (the delicate membrane lining the inside of the eyelid).

 

Surgical repair of the entropion is performed at a day surgery under local anaesthetic with sedation. The eyelid is strengthened and repositioned by recreating and re-attaching the tendons. This holds the eyelid in the correct position and prevents the eyelid from rolling inward.

 

Entropion

Entropion