Oculoplastic surgery is a highly specialized surgical field that involves surgery of the eyelids, eyebrows, forehead and cheeks. These conditions are medical conditions and are covered by insurance.
Common indications for surgery include excess eyelid skin, skin cancers of the eyelids, styes, droopy eyelids that obstruct vision, tear drain blockage, trauma and lacerations around the eye, spasms around the eye, thyroid eye disease and eyelids that turn in (entropion) or turn out (ectropion).
Blepharoplasty, also commonly known as eyelid surgery, is an office procedure that removes excess eyelid skin from the upper lid. This procedure has natural results and can rejuvenate the eyes.
Usually this excess skin hangs into the field of vision and can cause difficulty with reading or driving. After appropriate testing, the tests are submitted to insurance for coverage. The same procedure can also be performed as cosmetic surgery, but most Blepharoplasty surgeries are covered by insurance.
Recovery includes heavy lifting restrictions and some bruising and swelling can be expected. Pain is minimal and most patients resume normal activity within 1-2 weeks.
Ptosis, aka droopy eyelids, refers to an eyelid that is droopy and interfering with superior vision. This can be a unilateral or bilateral condition and can affect adults and children.
This is a medical condition that usually results from gradual weakening of the eyelid muscle. In children it can result from a congenital defect causing a weak eyelid muscle. Ptosis can also result from certain neurologic conditions and trauma.
The surgical repair is done as an outpatient and takes about 30 minutes. Recovery includes heavy lifting restrictions and some bruising and swelling. Pain is minimal and most patients resume normal activity within 1-2 weeks.
Eyelid Ectropion and Entropion
Ectropion is an eyelid that turns out from the eye and can cause exposure or dryness of the eye. This is a medical condition that occurs because of aging changes to the eyelid muscle, or scarring from chronic sun damage that pulls the eyelid down. The repair depends on the etiology of the ectropion and in some instances can be performed as an office procedure.
Entropion is an eyelid that turns in and causes the eyelashes to rub on the cornea which can feel very irritating to the eye. This condition also usually occurs from aging changes to the lower eyelid but can occur from scarring on the inside of the eyelid. Repair is usually done as outpatient surgery and takes less than one hour.
Both ectropion and entropion repair have some heavy lifting restrictions for 1-2 weeks and have minimal post op pain. Bruising and swelling can be expected for 1-2 weeks after surgery.
Blepharospasm, aka eyelid spasms, is abnormal contraction of the eyelid muscles leading to involuntary closure of both eyelids.
Symptoms usually begin as mild and infrequent spasms that progress over time to forceful and frequent contractures of the eyelids.
The treatment of choice for blepharospasm is periodic injection of botulinum toxin into the orbicularis oculi muscle.
Benign Essential blepharospasm is a clinical diagnosis and must be distinguished from secondary blepharospasm, which can occur in association with a syndrome, movement disorder, or a specific ocular disease such as in reflex blepharospasm secondary to ocular irritation.
“Eyelid lesion” refers to both benign and malignant eyelid tumors. The most common benign eyelid lesions are styes, cysts, moles, and papillae. These are all considered medical conditions and insurance covers the removal such lesions. The procedures are done in the office and Dr. Patel-Sitole will usually send the specimen to a pathology lab to confirm the diagnosis.
The most common malignant tumors are basal cell and squamous cell tumors. These tumors are skin cancers that can occur at any age and any skin type. In Colorado we are particularly susceptible because of chronic exposure to UV light.
Removal of malignant tumors from the eyelid possess a unique challenge because the entire tumor should be removed, but the integrity of the eyelid for function and cosmesis is extremely important. Without a functioning eyelid, the eye is at risk for dryness and infection. The eyes also function to many patients as part of their personality and who they are. Achieving the best cosmetic outcome after tumor removal is invaluable. For this reason, Dr. Patel-Sitole employs various techniques and tailors each surgical plan based on tumor size, location and tumor depth.
Thyroid Eye Disease
Thyroid eye disease also known as Thyroid associated ophthalmopathy (TAO) or Grave’s orbitopathy is an autoimmune disorder characterized by enlargement of the extraocular muscles and increase in fatty or connective tissue volume.
Thyroid eye disease affects each patient differently. Some patients have severe disease and surgery to orbital bones and eye muscles is necessary. In other situations, the eyelids are retracted and patients can have difficulty closing the eyes with resulting eye irritation.
First and foremost the thyroid hormone levels should be addressed to achieve normal levels. And any vision threatening conditions should also be dealt with.
Treatment options include observation, treatment with corticosteroids, treatment with radiation, orbital decompression surgery, extra ocular muscle surgery or eyelid malposition surgery. Treatment depends on severity of disease. It has also been shown by many research articles that smoking cessation can dramatically improve symptoms.