Eyelid tumour - Tumours of the eyelid can be either benign or malignant, and can or cannot involve the border of the eyelid. Especially when a malignancy is suspected and the border of the eyelid is involved it is best opting for treatment by an experienced eyelid surgeon. Since each type of tumour requires a different approach, ample experience in the surgical treatment and reconstructive options is paramount to achieve a good functional and an aesthetically pleasing result. In the vast majority of cases, a single stage procedure (excision and reconstruction in the same intervention) is possible. In cases were a irregular growth pattern is suspected, or is proven to be so by a prior biopsy, one is often best off first excising the lesion, and reconstructing it in a second intervention after having received the pathology rapport informing us that the margins of the excision are completely clean (i.e. void of any tumor). This treatment is usually very well accepted as the bulk of eyelid malignancies occur in the lower eyelid and one can perfectly be symptom free by using frequent lubrication ointment until the eyelid is reconstructed.
When the eyelid tumor is located in the upper eyelid and is relatively large, it requires an even more tailored approach as the upper eyelid is more important in protecting and lubricating the eye than is the lower eyelid. We will discuss with you what your best option is so that you can have it treated without much delay, pain free and as aesthetically pleasing as possible.
For reconstruction of large eyelid defects dr. van der Veen uses a gamma of reconstructive techniques such as: Hughes tarso-conjunctival grafting, Cutler Beard flap, Tenzel flap, Mustarde flap, free and pedunculate skin(-mucsle) flaps, free tarso-conjunctival grafts, mucosal graft either autologous (a patients own conjunctiva or oral mucosa) or allografts (a donor or artificial material, such as donorsclera, amnionic membrane, Tutopatch©) and autologous cartilage grafts from, for instance, the ear.
Eyelid lumps - With lumps of the eyelid we mean benign swellings of the eyelid, often these are chalazion (see Photo) or styes, which can be quite bothersome and painful when inflamed. Cleaning these inflamed glands in adults is normally done with local anaesthesia alone and is a short intervention that only lasts a few minutes, can be done in office and leaves no visible scar afterwards, since the incision is almost always made in the inside of the eyelid. The eye will be patched after surgery for a few hours and an antibiotic ointment will be prescribed. Although these inflammations do normally not interfere with vision, one should count on blurred vision after the intervention because of the antibiotic ointment and some swelling. This subsides rapidly however in maximally in a few days. The eyelids can also contain simple cysts filled with fluid or sebaceous content and are easy to clean as well and leave no visible scar afterwards.
Entropion - An entropion is an inward rotated eyelid and it is a very uncomfortable condition to suffer from, as the eyelashes can rub against the cornea every time you blink. This can be painful, create abundant tearing and can, in severe cases and when infected, even lead to corneal ulceration with (partial) loss of vision. We always aim to treat these eyelid problems as soon as possible and in a way that recurrence is minimal. This requires in most cases a combination of two different procedures, with which the eyelid is shortened horizontally and the eyelid border is everted. Besides having the normal postoperative discomfort, the pain caused by the offensive eyelashes improves directly after the intervention. Dr. van der Veen offers his patients also the option of performing the intervention via a hidden incision in the inside of the lower eyelid, as to avoid the normally present incision and scar below the eyelashes.
Ectropion - An ectropion is an outward rotated and downward displaced eyelid border. This can cause a foreign body sensation and tearing eyes. In the vast majority of cases this condition is caused by ageing of the face and can be fairly easy repaired with a horizontal eyelid shortening procedure of which people usually recover within one week. In other, more rare cases, the ectropion can be caused earlier in life by shortening of the skin-muscle layer, as for instance in patients that suffered an eyelid trauma or patients with skin disorders such as ichthyosis. Dr. van der Veen has extensive experience in reconstructive procedures for these causes of ectropion in which the surgery will be a more elaborative procedure with a longer recovery time of between 2-4 weeks depending on the technique used and skin health.
Lastly there is group of patients that suffer from a general midface decent, which means that the area from the lower eyelid until the upper lip (also known as the middle third of the face) has descended altogether and will need to be corrected by a midface lift. Not addressing the descended tissues by means of a lifting, can result in unsatisfactory results as one cannot correct vertical descend by horizontal shortening as is done in the typical treatment for ectropion. This procedure can be performed partially or totally through hidden incisions in the inner aspect of the lower eyelid (see also the section on Lower eyelid bags) and temporally behind the hairline (see section on Endoscopic brow lifting for more details).
Facial palsy surgery - Long standing facial palsy can severely affect the position of the eyelids, the reason for this is twofold. First and foremost the nerve palsy, regardless of the cause, causes general lack of muscle tone and atrophy of the muscles surrounding the eye, which leads to a lax and low positioned lower eyelid and eyebrow. Furthermore, the upper eyelid can become retracted (too high positioned). This occurs because the levator muscle is not affected by a facial palsy. This muscle determines for a great part the position of the upper eyelid. As its action is not counteracted by the orbicularis muscle (the muscle that surrounds the eye and closes it) in a facial palsy, the upper eyelid retracts, further impeding sufficient closure of the eye. The procedures to correct these problems are the following:
- Lateral tarsal strip procedure. See also the section above on ‘Ectropion’. This technique is performed when there is more severe eyelid laxity and a general lack of muscle tone, such as is the case in long standing facial palsy.
- Midfacelift. As long standing facial palsy can cause a decent of the complete middle third of the face (the part of the face from the upper lip to the lower eyelid), this should in some cases be addressed by a lifting of the midface tissues as to correct the ectropion, reposition the lower eyelid and restore the aesthetics of the face. The exact surgical procedure differs in each patient and will be discussed thoroughly beforehand.
- Gold weight implant. These implants (see photo below) are placed in the upper eyelid in order to increase its weight and therefore making it easier for the patient to close the eye upon a slight attempt to do so. The eyelid can also become slightly lower positioned, which can further help in the ease to close the eye and is generally not considered to be a problem.
Ptosis or ‘droopy’ eyelid – One of the most frequent additional findings when somebody consults us for an upper eyelid correction is a droopy, or ptotic, eyelid. When this is not addressed properly, either as solitary procedure or as an adjunct to a blepharoplasty, the end result can be unsatisfactory and aesthetically underwhelming. When correcting a ptosis you operate on the muscle that determines the position of the upper eyelid and moves it upwards. When done as an add-on procedure in upper eyelid blepharoplasty the muscle can be reached through the same skin incision. When only the ptosis has to be corrected and the ptosis is not too severe, the approach can be performed via the conjunctiva (without a visible scar). The procedure of choice for you will be discussed during your visit, as it differs from case to case depending on severity of the ptosis, amount of excess skin and aesthetic wishes of each person.
Tarsoraphy - A partial closure of the eyelid aperture is called a tarsoraphy, and is usually performed laterally either to better protect the eye against drying out or to improve the appearance of the eye and eyelids in patients with bulgy eyes, either because of very high myopia or because the eyes have protruded more forward due to for instance Graves orbitopathy. The procedure is very safe, fast and has a tremendous effect on eyelid closure and aesthetics. Important to know is that it can always be undone by simply opening the eyelid where it has been closed before. These interventions are normally performed under local anaesthesia only, unless when combined with more ample procedures such as orbital decompression or other reconstructive surgery.
Trichiasis – This condition of inward growing eyelashes can literally be an ‘eyesore’ for patients. The constant ocular irritation and foreign body sensation this causes, can leave people desperate. Fortunately there are many ways of solving this in a more definite fashion than epilating them manually, such as electric epilation, small block excision of a cluster of eyelashes and different eyelash everting procedures. Which procedure suites you best will be discussed with you in advance. In any case, these interventions require hardly any down time postoperatively for the patient.
Revision eyelid surgery – The reasons to undergo revision eyelid surgery are ample. The most frequent reason is that eyelid surgery has not been satisfactory either in functional result or that it is aesthetically displeasing. Dr. van der Veen has extensive experience in these revision procedures and takes pride in helping those that have suffered a non-desirable surgical outcome, whatever the reason therefore may be. Unfortunately, it does not always mean that one can undo, what has been done. But it is worthwhile exploring your options with an oculoplastic reconstructive surgeon and decide together what the best solution would be in your specific case.