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Oculoplastic Treatment - 1

Oculoplastic surgery is a field within ophthalmology focused on the surgical and medical management of conditions affecting the eyelids, orbits, and surrounding facial structures.

Oculoplastic procedures may address congenital abnormalities, trauma, disease or age-related changes.

At OKKO Eye Specialist Centre, our goal is to provide comprehensive care tailored to your individual needs.

From upper eyelid skin reduction like blepharoplasty to the management of complex conditions such as thyroid eye disease, our range of treatments aims to restore both form and function. On this page, we will explore various oculoplastic treatments, highlighting their purpose and what you can expect during the process.

Upper eyelid skin reductionBlepharoplasty

Over time, the skin around our eyes loses its elasticity and, in some cases, your eyelid may begin to obscure your eye, making it hard to see properly.

Contributing factors include ageing, sun exposure and genetics.

Blepharoplasty, also known as eyelid lift surgery, removes excess eyelid skin (dermatochalasis) and sometimes fat from the upper eyelids.

It involves discreet incisions for minimal scarring. Excess skin and fat are usually removed through the natural crease of the upper eyelid.

Surgical intervention carries risks such as bleeding and infection, although these are rare. Please inform your surgeon if you are on blood thinners, as this may increase the risk of bleeding.

Other potential issues include anesthesia-related risks, swelling, scarring, and the possibility of needing further surgery. Minor bruising and swelling are common but typically resolve within one to two weeks.

While most patients experience significant improvement and minimal postoperative discomfort, there is always a possibility that additional treatments may be required to achieve the desired outcome.

It is important to discuss all potential risks and alternatives with your surgeon before proceeding.

Post-surgery care for eyelid procedures generally involves using cold compresses to reduce swelling and bruising, applying antibiotic ointment or drops, and avoiding strenuous activities for several days. Warm compresses may be suggested later to aid in healing.

Patients should keep their head elevated to reduce swelling. Pain is typically mild and can be managed with non-aspirin pain relievers. Most patients can resume normal activities within a few days.

General blepharoplasty timelines

Surgery time

1-2 hours

Hospital admission

Day case

Time off work

3 days to 1 week

Driving

1 day

Full recovery

2-6 weeks

Eyelid Ptosis (Droopy or Low-Riding Eyelid)

Ptosis of the upper eyelid occurs when the eyelid falls, potentially obstructing the upper field of vision. It can affect one or both eyes.

Ptosis can be mild, where the lid partially covers the pupil, or severe, where the lid completely covers the pupil.

When ptosis is present from birth, it is referred to as congenital ptosis.

In children, ptosis commonly results from improper development of the levator muscle, which is responsible for lifting the eyelid. In adults, ptosis may develop due to ageing, trauma, or diseases affecting the muscles or nerves.

As we age, the tendon attaching the levator muscle to the eyelid can stretch, causing changes in the eyelid skin. Additionally, ptosis can occur after cataract surgery or be caused by injury to the oculomotor nerve or the tendon connecting the levator muscle to the eyelid.

Symptoms of ptosis include difficulty keeping the eyes open, eye strain, forehead aches from the effort to raise the eyelids, and fatigue, especially when reading. Some individuals may need to tilt their head back or use a finger to lift the eyelid to see better.

In children, ptosis might also lead to reduced vision in one eye (amblyopia or “lazy eye”), strabismus (misalignment of the eyes), or refractive errors such as astigmatism.

Ptosis can sometimes be a sign of more serious conditions such as myasthenia gravis, a disorder where muscles become weak and tire easily, or Horner’s syndrome, a neurological condition affecting one side of the face due to sympathetic nervous system injury.

Surgical intervention for ptosis is often necessary when the condition affects vision. It may also be undertaken to address cosmetic concerns.

The primary objectives of ptosis surgery are to lift the upper eyelid to improve vision, enable proper visual development (in children), and create symmetry with the opposite eyelid. The procedure typically involves tightening the levator muscle to elevate the eyelid. Surgeons may make incisions along the natural skin crease of the upper eyelid to minimise scarring.

If the levator muscle is extremely weak, a “sling” operation may be used to allow forehead muscles to help lift the eyelid.

Congenital ptosis is treated based on its severity and the strength of the levator muscle. It is important to note that achieving a completely normal eyelid position may not always be possible.

Ptosis surgery is usually performed on a day surgery basis with older children and adults often undergoing “twilight” anesthesia. Young children will require general anaesthesia.

As with any surgery, potential risks include bleeding and infection, though these are rare. Please inform your surgeon if you are on blood thinners. Minor bruising and swelling are common and usually resolve within one to two weeks. Some patients may experience dry eyes after surgery, which could make contact lens use uncomfortable or require over-the-counter eye drops.

The final position of the eyelid may not be exactly as desired, and touch-up surgery might be needed. While perfect symmetry between the eyelids cannot always be guaranteed, most patients see significant improvement and are satisfied with the results. Discussing all potential risks and expected outcomes with your oculoplastic surgeon is crucial before proceeding with the surgery.

General Eye Ptosis Surgery Timeframes

Surgery time

1–2 hours

Hospital admission

Day Case

Time off work

3 days to 1 week

Driving

1 day

Full recovery

2-6 weeks

Ectropion

Ectropion is a condition where the lower eyelid turns outward, exposing the eye to the environment. This can occur naturally as a result of the ageing process, or it may be caused by previous facial trauma, scarring, paralysis or surgery.

Ectropion is a treatable condition, and early diagnosis and intervention can help prevent complications. It’s important to discuss all available treatment options with your oculoplastic surgeon to determine the best approach for you.

  • Visible outward turning of the eyelid: The most noticeable sign of ectropion is the obvious outward turning of the lower eyelid, often leaving the eye exposed and vulnerable.
  • Dryness and irritation: When the inner surface of the eyelid is exposed to the air, it can become dry, irritated, and uncomfortable. This often leads to a burning sensation, a gritty feeling, and excessive tearing.
  • Redness and discharge: The dryness can cause redness of the eyelid and conjunctiva (the white part of the eye). In some cases, crusting or mucous discharge may also occur.
  • Vision problems: If left untreated, corneal dryness can lead to eye infections, corneal abrasions, or corneal ulcers, which can potentially impact vision.
  • Artificial tears and ointments: Temporary relief can often be achieved by using artificial tears and ointments to lubricate the eye.
  • Surgery: If the condition is chronic or causing significant discomfort, surgery may be necessary to address the underlying cause.
  • Procedure: The specific type of surgery depends on the cause of the ectropion. However, it typically involves tightening the lower eyelid tissue to restore its normal position. In some cases, a skin graft from the upper eyelid or behind the ear may be used to rebuild the eyelid structure.
  • Benefits: Surgery aims to alleviate irritation, dryness, and the risk of vision problems associated with ectropion. It can also improve the appearance of the eyelid.
  • Recovery: Ectropion repair is usually a day case procedure with minimal discomfort. Healing takes a few weeks.
  • Bleeding and infection: While uncommon, bleeding and infection are potential risks with any surgical procedure. It’s important to inform your surgeon about any blood thinners you’re taking, as they may increase the risk of bleeding complications.
  • Bruising and swelling: Minor bruising or swelling is expected and should go away within a week or two.

General Ectropion Timeframes

Surgery time

1–2 hours

Hospital admission

Day case

Time off work

3-7 days

Driving

1 day

Full recovery

2-6 weeks

Entropion

Entropion is a condition characterised by the inward turning of the upper or lower eyelid, causing the eyelashes to rub against the eye.

This inward turning can lead to irritation, redness, sensitivity to light and wind, and potentially more serious issues like corneal damage, infections, and vision loss if left untreated.

Entropion is often caused by age-related weakening of the eyelid muscles or stretching of the tendons. Other causes include scarring from previous surgeries, trauma, or neurological conditions that affect eyelid movement.

Surgical correction

Procedure: The standard treatment for entropion involves surgical tightening of the eyelid and its supporting structures to restore the lid’s proper position. The surgery is typically performed under local anesthesia with sedation and is often done on a day surgery basis. Postoperative care usually includes the use of antibiotic ointment.

Techniques: Various surgical techniques are available, and the choice depends on the surgeon’s preference and the specific characteristics of the entropion.

Non-surgical options

Eyelid taping: Temporarily taping the eyelid outward can provide relief in mild cases.

Injections: For those who cannot have surgery or have entropion due to forceful eyelid movements or spasms, injections can be used. These injections help relax the overactive muscles, allowing the eyelid to return to its normal position for several months.

The inward-turned eyelid can cause a foreign body sensation, excessive tearing, crusting, and discharge. Over time, these symptoms can lead to acute light sensitivity, eye infections, corneal abrasions, or ulcers. Addressing entropion promptly is crucial to prevent permanent damage to the eye.

Entropion is usually diagnosed through a thorough examination with your specialist/ophthalmologist.

Surgical intervention carries risks such as bleeding and infection, although these are rare. Patients should inform their surgeon if they are on blood thinners, as this may increase the risk of bleeding. Other potential issues include anesthesia-related risks, swelling, scarring, and the possibility of needing further surgery. Minor bruising and swelling are common but typically

resolve within one to two weeks. While most patients experience significant improvement and minimal postoperative discomfort, there is always a possibility that additional treatments may be required to achieve the desired outcome. It is important to discuss all potential risks and alternatives with your surgeon before proceeding.

General Entropion Surgery Timeframes

Surgery time

1 hour

Hospital admission

Day case

Time off work

3-7 days

Driving

1 day

Full recovery

2-6 weeks

Watery eye / blocked tear ducts

Tears begin their journey through two small openings known as puncta, located in the inner corners of the upper and lower eyelids. These puncta lead to tiny tubes called canaliculi, which channel tears into the lacrimal sac, situated between the inner corner of the eye and the nose. From there, tears travel through the nasolacrimal duct, passing through the bony structures of the nose and draining into the nasal cavity.

Blinking helps spread tears across the eyes, keeping them moist, and facilitates the drainage of old tears through the puncta, lacrimal sac, and nasolacrimal duct into the nose.

A blockage in this tear drainage system can result in symptoms such as mucus buildup at the inner corner of the eye, excessive tearing, and blurred vision. Depending on the location of the blockage, you might also experience redness,

tenderness, and swelling between the inner corner of the eye and the side of the nose. A thorough eye exam by your specialist can often pinpoint the exact location of the blockage.

Post-surgery, patients might experience minor nosebleeds for a few days, and most recover within a week. Common risks of these procedures include bleeding and infection, though these are rare. Minor bruising and swelling between the eye and nose are expected and typically resolve within one to two weeks.

Scarring or narrowing of the passageways may occur, potentially necessitating further surgery. The success of the procedure cannot be guaranteed, and there is always a possibility that additional treatment may be needed. Discuss all potential risks, benefits, and alternatives with your surgeon to make an informed decision.

Treatment for blocked tear ducts varies based on the severity and location of the blockage:

Conservative measures

Warm compresses and antibiotics: In some cases, applying warm compresses and using antibiotics may alleviate symptoms and manage mild blockages.

In-clinic procedures

Punctoplasty or stenting: These minor procedure can be used to help reopen blockages at the punctum or canaliculus.

Surgical intervention

Dacryocystorhinostomy (DCR): If the nasolacrimal duct is obstructed, a DCR is often required. This procedure involves creating a new drainage pathway from the lacrimal sac directly into the nasal cavity to bypass the blocked duct. This surgery is typically performed under local anesthesia with or without sedation, and a temporary silicone stent may be placed to keep the new drainage pathway open during the healing process.

Conjunctiva dacryocystorhinostomy (CDCR): In cases where there is a complete blockage at the canaliculus, a CDCR may be performed. This involves placing a glass prosthesis (Jones or Gladstone-Putterman tube) to connect the eye’s surface directly to the nasal cavity. Talk to your surgeon about how to manage the glass tube before you decide to proceed as this can be challenging for some patients.

General Timeframes

Surgery time

1–2 hours

Hospital admission

Day Case

Time off work

3-7 days

Driving

1 day

Full recovery

2-4 weeks

Eyelid skin cancer lesion surgery

Your eyelids play a crucial role in keeping your eyes healthy. They help spread tears to keep your eyes moist, clean the front surface of your eye (the cornea), keep out dust and dirt, and protect your eyes while you sleep.

If a cancerous tumour grows on your eyelid, it can alter the shape of the lid or affect the surrounding tissue. This can irritate your eye and, if left untreated, could potentially invade deeper structures like your eyeball or eye socket.

Skin cancer on the eyelids can often be treated with a day case surgery under a twilight anaesthesia. During the procedure, the surgeon will remove the tumour along with a small amount of healthy skin around it (called the margin of clearance). The goal is to ensure that no cancer cells remain.

The removed skin is then sent to a lab where a pathologist examines it under a microscope to check for any remaining cancer cells.

In some cases, this testing is done immediately at the hospital (called a frozen section).

If the results show that no cancer cells are left, the surgeon can proceed with reconstructing your eyelid right away. If cancer cells are found, more skin will be removed until the margins are clear.

  • Small tumours: If the tumour was small, the reconstruction might just involve a few stitches.
  • Large tumours: For larger tumours, the reconstruction might be more complex. It might require special flaps to move tissue around to reconstruct the defect or a skin graft.

After the surgery, you might experience some bruising and swelling around the eyelid. Sometimes, additional procedures may be needed as a secondary procedure (for example two staged complex reconstruction), or for fine tuning the eyelid’s position.

Even after successful surgery, there is a chance that the cancer might return months or even years later. If this happens, you might need further surgery or radiation therapy.

It’s important to discuss all your options and what to expect with your doctor to ensure the best outcome for your eye health and appearance.

General Timeframes

Surgery time

1–3 hours

Hospital admission

Day case

Time off work

3-7 days

Driving

1 day

Full recovery

2-6 weeks

Chalazion

A chalazion is a swollen lump on the eyelid caused by a blocked oil gland located near the eyelashes. If an eyelid becomes inflamed for any reason, these oil glands can get congested with very thick oil. This thick oil not only flows and functions poorly but can also lead to more inflammation.

Your immune system then walls-off or isolates the inflamed oil gland tissue into a nodule, which is called a chalazion.

  • Non-tender or mildly tender lump on the eyelid
  • May develop over days to weeks, sometimes at the site of a recent stye (eyelid infection)
  • Visible, red, and noticeable lump to the touch
  • May go away if its contents drain, either through the skin surface or onto the eyeball surface

The oil glands at the eyelid margin normally help keep the eye surface moist and comfortable by stabilising the tear film. When these glands malfunction, the eye can feel uncomfortable, dry, irritated, or itchy.

Some patients complain of a foreign body sensation in the eye, and some have watery eyes. The eyelashes can also develop flakes that look like dandruff. All these problems can lead to blurry vision.

  • Applying warm, moist compresses with gentle pressure to the affected eyelid several times daily (sometimes referred to as performing “lid hygiene”). The heat of the compress can help the thick oil in a chalazion become thinner, allowing it to flow out of its gland or drain better. Baby shampoo is sometimes added to the compress for the same reason and to help wash away eyelid dandruff. The heat also improves blood flow in the area, which can help clear away the inflamed chalazion tissue. Important: The heat should not be so hot that it scalds the skin.
  • In addition to warm compresses, your family doctor may prescribe antibiotic drops or ointment.
  • Your family doctor may recommend you see an oculoplastic surgeon for an injection of steroid medicine or surgical drainage of the chalazion. There are small risks associated with any medical procedure. It’s important to ask your oculoplastic surgeon about the risks and possible complications.

Bleeding and infection, which are potential risks with any surgical procedure, are uncommon.

Be sure to tell your surgeon if you are on blood thinners/fish oil supplements, as they may put you at increased risk for bleeding complications.

General Timeframes

Surgery time

10-20 mins

Hospital admission

Outpatient or day case

Time off work

1 day

Driving

Next day if padded post-op

Full recovery

3-7 days

Thyroid eye disease

Thyroid eye disease is an autoimmune disorder that affects the tissues surrounding the eye. It occurs when the body’s immune system mistakenly attacks its own tissues. In this case, the tissues around the eye are targeted, leading to inflammation, swelling, and bulging of the eye.

Relationship to Thyroid Disease

While thyroid eye disease and thyroid disease both originate from the immune system attacking healthy tissue, one does not directly cause the other. The immune system can attack both the thyroid gland and the tissues around the eye, and the timing and severity of these two conditions can vary significantly from person to person.

Phases of thyroid eye disease

1. Inflammatory phase: This phase typically lasts six months to two years, characterised by active inflammation.

2. Stable phase: After the inflammatory phase, the active inflammation subsides. However, many patients may still experience some degree of eye protrusion, eyelid retraction, or double vision.

  • Swelling around the eyes
  • Bulging of the eyes
  • Irritation and redness
  • Pressure sensation associated with headache
  • Pain with eye movement
  • Restriction of eye movement causing double vision
  • In severe cases, compression of the optic nerve, leading to progressive vision loss and potentially blindness.
  • Chronic eye exposure from protrusion or lid retraction can lead to severe dryness of the eye and corneal scarring.
  • Double vision can be severe and disabling.
  • Severe muscle enlargement and orbital tissue crowding can lead to optic nerve compression and permanent loss of vision in the most severe form of thyroid eye disease

Non-surgical treatments

For many, the discomfort from thyroid eye disease can be treated with topical lubricants, wrap-around tinted glasses, sleeping with eye shields, or elevating the head of the bed at night.

Medical treatments

When there is active inflammation, certain medications, including steroids and anti-inflammatory medicines, may be used. Radiation therapy is also sometimes considered.

Surgical treatments

In some cases, surgical intervention may be necessary to improve the function and appearance of the eyes. This can include:

  • Orbital decompression: Removing part of the bony orbit and fat behind the eye to relieve pressure on the optic nerve and allow the eye to move back into a more normal position.
  • Eye muscle surgery: Repositioning the enlarged muscles that control eye movement to correct misalignment and double vision. This involves repositioning the enlarged muscles that control eye movement.
  • Eyelid surgery: Adjusting the position of retracted lids to improve eyelid closure and restore eyelid function.

If you are concerned about any aspect of your vision

Please visit one of our OKKO Eye Specialist Centres

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