Eyelid Malpositions and Growths

The eyelids can be affected by many abnormalities. Our state of the art eye care clinic offers the latest in treatments for eyelid deformity.

Types of Eyelid Deformities

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.

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.

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).

Types of Growths

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.

Treatment

A common procedure, blepharoplasty is the name given to the surgical correction of ptosis. Although this may be considered cosmetic when performed in the absence of visual symptoms, there are also medical indications for the procedure.

Medically necessary blepharoplasty is done to relieve or improve symptoms present due to the lid’s abnormal position. Generally patients have difficulty seeing because the lid interferes with the ability to see. Frequently patients see significant improvement when manually lifting 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 includes 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 cosmetic or medically indicated, surgery is typically done on both eyes in one session, 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.

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