Eyelid Reconstruction Surgery
Available at Conlon Eye Institute located in Saskatoon, SK
Eyelid reconstruction surgery can be an effective treatment for a number of eyelid related issues including ptosis repair (drooping upper eyelid), thyroid eye disease, eyelid skin cancer, eyelid malposition (out-turning/in-turning of the eyelid) and eyelid blepharospasm (twitches or spasms).
Ptosis is the medical term for drooping of the upper eyelid. This condition can affect one or both upper eyelids, and can occur as a result of aging, trauma, muscular or neurological conditions or may be congenital. Correction of ptosis in adults may be done at the same time as blepharoplasty and is accomplished by repositioning the levator muscle tendon (anterior approach) or resection of the Muller's muscle and conjunctiva (posterior approach).
Ptosis surgery is usually performed under local anesthesia with light sedation. The procedure takes approximately 30 minutes and can be combined with other functional or cosmetic eyelid procedures.
Thyroid Eye Disease
Patients that have over or underactive thyroid disease or even euthyroid (normal) Graves' disease can develop associated eye and eyelid problems. One of the most common features of thyroid eye disease is a staring appearance to the eyes. Even when the systemic disease process is clinically stable, there can be edema (swelling), exophthalmos (protrusion of the eyes), upper or lower eyelid retraction, hypertrophied contracted eye muscles with secondary double vision, and in some instances excessive orbital fat which can bulge into the eyelids. Common symptoms of thyroid eye disease include burning and excessive tearing of their eyes secondary to corneal irritation from the protrusion of the eyes and retraction of the upper and lower eyelids, which makes the lids not cover the eyes as well.
Eye drops, steroids, and time may provide relief for many, but symptomatic treatment is ineffective for approximately one-third of patients with thyroid eye disease. In some cases, a series of surgical procedures around the eyelids and orbit is required to correct the stigmata of Graves' eye disease.
The treatment of thyroid eye disease is complex, and patients should understand that often more than one procedure, and time between procedures, is required to achieve the desired result. Fortunately, with patience and appropriate therapy excellent outcomes can be achieved.
Ectropion refers to out-turning of the lower eyelid and is a commonly seen eyelid malposition in the elderly. The most common cause of ectropion is a loss of eyelid tone with aging, leading to laxity of the tissue, which allows the eyelid to hang away from the eye. Less common causes of ectropion include Bell's Palsy, skin conditions (eczema or psoriasis), or congenital malformations. Once the eyelid begins to lose contact with the eye, it is very common for people to experience irritation of the eye and tearing. The eyelid itself will often undergo secondary changes such as thickening of the lid margin, keratinization of the conjunctiva (roughness of inner aspect of the eyelid), and redness with discharge (secondary inflammation and mucus production).
The correction of ectropion is surgical and involves tightening the lower eyelid. In more complex cases, tightening of the eyelid may be combined with a skin graft to the lower eyelid. Dr. Conlon, as an oculoplastic surgeon, is very familiar with the different surgical techniques available to correct ectropion.
Entropion refers to in-turning of the lower eyelid. This condition is most commonly related to the aging of the eyelid structures, but often there is a co-existent spastic component, which increases the intensity of the eyelid malposition. Entropion often develops insidiously with the patient first experiencing intermittent irritation of the involved eyelid and eye, but eventually, it becomes constant and quite uncomfortable.
The correction of entropion is surgical and requires correction of the underlying anatomic defects which lead to the condition. In most cases, the surgical correction involves correcting a component of eyelid laxity, combined with reattachment of a muscle complex, located deep within the eyelid, called the lower eyelid retractors. In complex cases, scarring of the inner lining of the eyelid (palpebral conjunctiva) needs to be addressed with some form of a mucous membrane graft.
Dr. Conlon has found many patients experience fairly immediate relief (within 3 days) of the spastic component of entropion by the use of Botulinum toxin A injection to the pre-tarsal muscle. Patients appreciate the pain relief, and the temporary paralysis induced by the BOTOX® facilitates the surgical repair.
Benign essential blepharospasm is the name given to uncontrolled contraction of the muscles that surround the eyelids. The condition is always bilateral (affecting both sides of the face) and in some cases may involve the lower muscles of the face and neck (Meige's Syndrome).
Over the years a number of therapies have been used to treat blepharospasm, including anti-depressive and anticonvulsive medications, howeverBOTOX® injections have been the first line to treatment for at least the last 10 years. Dr. Conlon has been treating patients with blepharospasm for over 15 years and is familiar with both the diagnosis and treatment of this disease.
Unfortunately, at the present time, there is no cure for blepharospasm, however many patients experience excellent relief from their spasms with periodic BOTOX® injections.
Hemifacial spasms characterized by the uncontrolled contracture of muscles on one side of the face. Usually, the left side of the face is more commonly involved, however it may also occur on the right side of the face. The cause of hemifacial spasm is usually related to irritation of the facial nerve as it exits the brain stem. In many cases, a blood vessel can be seen on magnetic resonance imaging (MRI) touching the facial nerve, which gives rise to uncontrolled contracture of the facial muscles. In a small percentage of patients (<1%), a tumor may be responsible for the irritation of the facial nerve, so imaging is mandatory in all patients with hemifacial spasm.
The main form of treatment for hemifacial spasm is BOTOX® injections to the periocular and upper cheek muscles. In some case, there is a surgical option to treat the disease, by neurosurgical microvascular decompression of the nerve; however, this is a complex surgical procedure, and should only be considered in carefully selected cases, at a center specializing in this surgical technique.
Eyelid Skin Cancer
Skin cancers around the eyelid are common. In many cases, skin cancer begins as an innocuous lesion that does not resolve over time and ultimately draws attention to its self. The most common type of skin cancer that occurs around the eyelid is basal cell carcinoma. Fortunately, this type of skin cancer is treatable, and the outcome excellent if intervention occurs reasonably early in the disease process.
The recommended treatment of skin cancers around the eyelids is surgical excision, however, many different modalities have been used in the past. The surgical management of eyelid skin cancer requires an in-depth knowledge of the eyelid anatomy and the periocular structures, including the nasolacrimal duct system.
Dr. Conlon uses both his experience as a fellowship trained ocular pathologist and oculoplastic surgeon to develop the most appropriate treatment plan.
A variety of reconstructive techniques are used to repair the surgical defect once the eyelid skin cancer has been removed. And in the later stages, CO2 laser has been helpful correcting minor eyelid and eyelid margin irregularities.
Dr. Conlon will examine your eyes prior to treatment and review a number of physical parameters unique to your eyes, to determine whether or not you are a candidate for refractive laser surgery. The treatment recommendations are highly individualized and are based on the characteristics of your eyes. Dr. Conlon will recommend a specific treatment plan that best meets your needs, depending on the unique physical characteristics of your eyes, and your specific visual needs.