Ptosis refers to an upper eyelid position that is too low (droopy eyelid). There are many causes of this condition, but it is most commonly due to weakness or stretching of the muscles that raise the upper eyelid. Ptosis repair may be performed externally (through a skin incision) or internally (from the inside of the eyelid), and the goal is usually to tighten the muscles that raise the eyelid. Infrequently, if the ptosis is severe and muscle function is weak, a sling may need to be placed between the brow and the eyelid (frontalis sling procedure).
Dermatochalasis refers to excess eyelid skin. When there is significant upper eyelid dermatochalasis, the skin may overhang the lashes and potentially interfere with vision. Corrective surgery involves removing the excess skin and sometimes fatty tissue (blepharoplasty).
Inward rotation of the eyelid (entropion) often results in eyelashes rubbing against the surface of the eye. This condition may cause significant eye irritation. There are a number of potential causes of entropion, and it is important to understand the basis of the entropion before proceeding with corrective surgery.
In certain cases, even though the eyelid is in normal position, there are misdirected eyelashes that are turned inward toward the eye (trichiasis), which may be quite painful. Simple epilation involves individually pulling out the inturned eyelashes, but those lashes usually grow back. Electrolysis or cryotherapy (where electrical current or freezing treatment is used to destroy the misdirected eyelashes) may provide a more permanent solution.
Outward rotation of the eyelid (ectropion) may result from eyelid laxity and/or tight eyelid skin. Symptoms include a watery eye (due to malposition of the opening of the tear duct) or redness and irritation of the eye (due to exposure of the inside of the eyelid and the surface of the eye). Surgical repair typically involves tightening the lax eyelid, and occasionally it is necessary to place a skin graft, use a skin flap, or raise the cheek to address the tight eyelid skin.
Eyelid retraction refers to an upper eyelid that is too high or a lower eyelid that is too low. Potential causes of this condition are thyroid eye disease (Graves’ disease), eyelid scarring, or simply an eye that is prominent (proptosis). Eyelid retraction may cause the eye to feel dry and irritated. It is correctable with surgery, which may occasionally require placing a tissue graft on the inside of the eyelid.
Lumps and bumps around the eye
There are many benign and cancerous growths that occur on the eyelid and face, including the same skin cancers that appear elsewhere on the body, such as basal cell and squamous cell carcinomas and melanomas. Most growths are benign and display slow growth over months to years. These include cysts, papillomas (such as seborrheic keratoses), warts, hemangiomas (reddish vascular lesions), moles, etc. These lesions can usually be easily removed in the office.
Certain features are suggestive that a lesion may be malignant: rapid growth, irregular shape (rather than round with a smooth surface), ulceration (breakdown of skin overlying the lesion), or spontaneous bleeding. With pigmented (darkly colored or brownish) lesions, one should monitor the lesion for the following features (the “ABCDE’s”) that may suggest a lesion could be a melanoma:
A = asymmetry (irregular shape rather than round or oval)
B = border (the edges of the lesion are irregular or jagged rather than smooth)
C = color (the lesion displays different colors rather than being one single color)
D = diameter (larger than 6mm in size)
E = evolving (changing in size, shape, color, elevation, or other features over time)
If there is suspicion that a growth may be cancerous, then a biopsy or removal of the lesion should be performed. If the lesion is found to be malignant and it was not completely excised, further surgery will usually be necessary to remove the remainder of the tumor, which may involve the assistance of a Mohs surgeon (a dermatologist specializing in removal of skin cancers).
Blepharitis and Chalazia
Blepharitis (crusting of the eyelashes and/or dysfunction of the oil glands of the eyelid) is a very common condition. It may cause soreness, itching, and redness of the eyelids. Blepharitis is typically treated with daily warm compresses, eyelid scrubs (to clean off the eyelashes), and oral flax seed oil and omega 3 fish oil. In certain cases, oral doxycycline and antibiotic eye drops or ointment are prescribed. Blepharitis may increase the risk of developing a chalazion or stye (also known as a hordeolum). This is a blocked and inflamed oil gland in the eyelid, which often manifests as a tender, inflamed bump on the eyelid. Chalazia and styes are initially managed with frequent warm compresses, and they will often resolve spontaneously. If they don’t go away, they can usually be removed in the office.