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The eyelids can be affected by many abnormalities. The most commonly seen problems are ptosis (droopiness of the eyelid), entropion (the lid rolls inward), and ectropion (the lid rolls outward).
PTOSIS (TOH-sis) is a condition in which the upper eyelid(s) droops. This can be an acquired (develop over time), or congenital (present at birth). Acquired ptosis can worsen after other types of eye surgery, or after episodes of ocular swelling. Sometimes, excess skin (dermatochalasis) on the upper lids will cause them to droop. In either case, this droopiness can progress to a point where it interferes with vision, limiting peripheral (side) vision and even interfere with your ability to read or drive. When these symptoms are present, surgery to correct the problem is considered medically necessary. Surgery may be performed in the absence of these symptoms, but is generally considered cosmetic and not eligible for insurance benefits.
Congenital ptosis can affect visual development. A child with this condition may be seen tilting his or her head back in an effort to see. While it doesn’t always lead to poor vision, it is important to have the child seen to evaluate for related problems with visual development.
Treatment for ptosis is surgical. Additional testing will also be done to document the medical necessity of the procedure for insurance purposes.
ENTROPION occurs when the eyelid turns inward, and is most often associated with the aging process, but can also be secondary to infection or scarring. When the lid turns inward, the lashes rub on the clear surface of the eye (cornea), causing redness, irritation, and increased tearing. Left untreated, entropion can lead to significant discomfort, corneal abrasions, eye infections, and/or corneal ulcers.
Treatment for ectropion is surgical, although artificial tears or ointments may temporarily provide relief.
ECTROPION occurs when the eyelid turns outward, exposing the normally protected inner surface. This condition is also commonly seen as part of the aging process, but can be caused by facial palsies (i.e. Bell’s palsy), birth defects (commonly seen with Down’s syndrome), or facial scarring. Left untreated, ectropion may lead to severe dry painful eyes, excessive tearing, chronic conjunctivitis, or keratitis (inflammation of the cornea).
Treatment for ectropion may include the use of artificial tears and ointments to relieve symptoms, but surgical correction is needed to correct the lid position.
Dr. Ballitch specializes in the evaluation and treatment of eyelid abnormalities. Surgery is performed in our onsite AAAHC certified surgery center.
A STYE (internal or external hordeolum) results from an infection along the edge of the eyelid near the eyelashes. Symptoms are generally sudden, and present with redness, swelling, and tenderness. These generally go away without treatment, but can sometimes leave a fluid-filled cyst behind.
A CHALAZION (Shuh-lay-zee-uhn) is caused by the blockage of one of the ducts draining the glands that produce the oily part of the tears (Meibomian gland). These glands are located along the eyelids, a little further back than the eyelashes. They can be asymptomatic (no symptoms), or can be red, tender, and swollen. If very large, they can cause blurry vision.
Treatment for chalazion and stye may include warm, moist compresses, antibiotic drops or ointment if an infection is present, steroid injections to reduce inflammation, and surgery if conservative treatment is not effective. Surgery is minor, and can be done in the doctor’s office with a local anesthetic.
An INCLUSION CYST is a benign, white, painless skin growth. At times, it may be difficult to distinguish from a basal cell carcinoma (cancer), and biopsy may be recommended.
NEVUS or freckle is a pigmented lesion present on the skin. These can often be present for many years without change. However, changes in size, color, or bleeding require evaluation and possible biopsy.
SKIN CANCER may appear on the eyelids, or the skin around the eyes. Growth associated with loss of eyelashes, or lesions that change in color or size, bleed, or flaking should be evaluated. Excision and/or biopsy may be indicated.
A common procedure, blepharoplasty is the name given to the surgical correction of ptosis. Although this may be considered cosmetic, there are also medical indications for the procedure.
Blepharoplasty is considered cosmetic when performed in the absence of visual symptoms such as loss of peripheral vision due to the droopiness of the upper lid(s), or difficulty with reading or driving secondary to the abnormal lid position. In this case, the procedure is done to enhance one’s appearance, and not to correct visual symptoms.
Medically necessary blepharoplasty is done to relieve or improve the symptoms present due to the lid’s abnormal position. Generally, these patients have difficulty seeing because the lid is droopy and interferes with their ability to see. Frequently patients will note significant improvement if they manually lift the lids to a higher position. Insurance companies generally require specific testing and documentation, and prior authorization is generally needed to receive benefits for the procedure. Testing will include a computerized visual field test with eyelids in the relaxed position, and a repeat of the same test with the eyelids manually fixed (with tape) in a higher position.
Whether the surgery is cosmetic or medically indicated, it is typically done on both eyes in one session, and is done under local anesthesia with mild sedation in our ambulatory surgery center. Dr. Ballitch has been performing these procedures for more than fifteen years, and has done in excess of a thousand.