What is blepharoplasty?

Blepharoplasty, or dark circles surgery, is a plastic surgery operation aimed at correcting eyelid defects and deformities, or to aesthetically modify the region around the eyes. It often involves the removal of excess skin, muscle, and fat that accumulates around the eyes with age, causing sagging and the appearance of bags under the eyes.

Why is blepharoplasty done?

As we get older, our skin loses its elasticity and the eyelids are no exception. As they stretch, creating excess skin, and the muscles that support them weaken, excess fat can start to collect above and below the eyelids, causing drooping eyebrows and upper eyelids and bags under the eyes.

If this excess fat and skin prevents your eyes from opening fully, it can interfere with your peripheral vision, meaning that blepharoplasty may be done to improve vision. However, most cases (particularly operations on the lower eyelids) are performed purely for cosmetic reasons, as the removal of bags and dark circles has the effect of rejuvenating the face.

What does blepharoplasty consist of?

There are two ways to perform this surgery:

External route: A small cut is made under the eyelashes allowing the surgeon to remove excess skin, muscle, and fat. It is then sealed by a very fine suture that facilitates skin tightening.

Internal route: A small incision is made in the inner part of the lower eyelid, through which fat is extracted. Some surgeons do not even use a suture to close the incision, since this tissue heals easily by itself. The eyes are protected by an orbital metallic strip, which is inserted after the patient is under anaesthesia (local or general, depending on whether the blepharoplasty is part of a longer procedure).

The duration of the surgery is usually between 30 minutes and one hour, depending on the number of eyelids that will be operated on.

Preparation for blepharoplasty

Before the blepharoplasty procedure, you will meet with an ophthalmologist and/or plastic surgeon, who will take your medical history and discuss your expectations with you. You will also have to undergo a physical examination, an eye test, and photos will be taken of your eye(s). Smokers will have to stop smoking several weeks before the operation.

Care after blepharoplasty

Once the surgery is completed, an ointment will be applied to the eyes to lubricate them and in some cases, a soft bandage.

Patients may experience blurred or double vision, excessive production of tears, hypersensitivity to light, discomfort or pain, and some swelling and bruising for a short while after a blepharoplasty.

Your doctor may suggest that you take steps such as sleeping with your head elevated higher than your chest for a few days and using cold compresses on your eyes in order to reduce inflammation and bruising.

You will be informed if you are required to apply eye drops to keep your eyes hydrated. Oedema and bruising will gradually diminish until it disappears completely and you will begin to look and feel much better.

What is a chalazion?

A chalazion is a small, painless lump which grows on the eyelid. Unlike a stye, a chalazion is not caused by infection but by a gland in the eyelid becoming clogged.

Chalazions often go away on their own after a few months, but there are some treatment options if it is causing symptoms such as:

• mild pain or irritation
• blurred vision or part of your vision becoming blocked

Conservative treatments

You can often help treat a chalazion yourself with heat compression treatment. This involves soaking a cotton wool pad in hot water and gently pressing it against your eyelid, taking care not to get hot water in your eye. The pressure and heat can sometimes cause the chalazion to release its content.

If this hasn’t worked, your doctor can prescribe you antibiotics to reduce any inflammation.

Surgical treatment

If the treatments above haven’t worked, surgery may be required.

Surgery to remove chalazion is quick and can be carried out at an eye clinic. You’ll be asked to lie down on a couch and you will be given eye drops to numb the area around your eye. The surgeon will then make a very small incision to remove the chalazion from the eyelid.

After the procedure your eye will be bruised for a few days, and you’ll need to take antibiotic ointments a few times throughout the day to make sure that the eye doesn’t become infected. The risks of complications from surgery are very low and any complications that do occur will be minor.

Eyelid malpositions can occur for various reasons and are relatively frequent. Along with being considered unsightly, they can lead to vision and eye problems that could become serious.

What is oculoplastics?

Oculoplastics, also known as oculoplastic surgery, is an umbrella term for a number of surgical procedures on the eye and the surrounding structures, including the eye socket, eyelids, tear ducts, and parts of the face.

Oculoplastic surgeons are specialised ophthalmologists, who have undergone additional fellowship training. Some surgeons from certain other specialties, such as plastic surgeons, ENT surgeons and oral and maxillofacial surgeons may be trained in some procedures that fall under oculoplastics.

Why is it done?

Oculoplastic procedures may be done for a number of reasons. Many, such as upper and lower eyelid blepharoplasty, eye bag removal and eyebrow lifts, are done for cosmetic reasons, while others, such as eyelid repair for entropion, ectropion and ptosis are done for functional reasons – to make life easier for the patient. Other procedures, such as eye removal and reconstruction may be essential for the patient’s wellbeing.

What does oculoplastic surgery involve?

Oculoplastics can involve a number of techniques, depending on the specific operation. Oculoplastic procedures can range from the cosmetic, such as Botox injections, liposuction, and blepharoplasty to essential surgery, such as eye removal and orbital reconstruction.

Types of oculoplastic procedures

Eyelid surgery

Cosmetic/Aesthetic

• Upper eyelid blepharoplasty – removal of excessive upper eyelid skin and hooding
• Lower eyelid blepharoplasty – A procedure to reduce bags by removing excessive skin and subcutaneous fat.
• Brow lifting – raising or reshaping of the brow

Eyelid Malposition

• Ptosis (droopy eyelid) repair
• Lower eyelid entropion (inturning) or ectropion (out turning) repair

Eyelid lesions benign and cancerous

• Excision or biopsy of cysts/moles/lesions of the eyelids
• Eyelid tumour removal – the eyelids can be affected by skin cancers, like basal cell carcinoma or squamous cell carcinoma

Tear duct surgery

• Procedures to reduce watering and unblock tear ducts
• Biopsy or removal of a lacrimal gland
• Removal of part of a lacrimal sac

Eye removal

• Complete removal of the eye and possibly also the connecting tissue and muscles – usually done due to the presence of a malignant orbital tumour.
• Removal of the inside of the eye, leaving the scleral shell – usually done to reduce pain in a blind eye.

Orbital reconstruction

• Artificial eyes
• Orbital decompression for Graves’ disease

Cosmetic procedures

• Botox injections
• Facelift – part of the facelift procedure can involve the eyelids and surrounding area.
• Eyebrow/forehead lifts
• Liposuction of the face and neck

What is optic neuritis?

Optic neuritis (ON) is the swelling or inflammation of the optic nerve. The optic nerve is responsible for transmitting the image from the retina to the brain. It is one of the most common disorders of the optic nerve, others include glaucoma, eye atrophy, or drusen.  

Disease prognosis   

Patients who get optic neuritis and do not have a linked disease, such as multiple sclerosis, have a higher chance of full recovery. However, although people with an autoimmune disease have a more negative prognosis, they may still regain vision in the affected eye.

What are the symptoms?   

If the neuritis affects the eye nerve fibers then it could cause short or long term vision loss.  There can also be changes in the way the eye reacts to bright lights, a chromatic vision loss, and the patient may also have pain with eye movement.

Tests for optic neuritis

To rule out other diseases, the patient will be given an eye colour test, a visual acuity test, visual field test, a brain MRI, and an indirect ophthalmoscopy to examine the optic disc.

What causes it?

The exact cause for optic neuritis remains unknown, but it is quite often linked to the following diseases:     

• Multiple sclerosis which is a chronic neurological disease that causes inflammation and demyeliation of the nerve fibres. Optic neuritis is often the first symptom of the disease, while it is estimated that half of all people with MS will develop optic neuritis at some point.   
• Cryptococcosis
• Respiratory infections
• Autoimmune diseases such as lupus
• Bacterial infections such as meningitis
• Viral infections such as chicken pox
• Vitamin B12 deficiency
• Leber’s optic neuropathy

When it develops with no known cause, it is known as idiopathic neuritis.

How can it be prevented?  

Consult an ophthalmologist and a neurologist so that they can study each case and detect risk factors. Quite often a brain MRI will be done if it is suspected that the patient may have one of the related diseases.  

What is the treatment?

Treatment for optic neuritis will vary depending on the related disease; sometimes intravenous or oral tablet form corticosteroids are used to shorten the duration of symptoms and accelerate visual recovery.

In some cases, vision may return within 2-3 weeks without any treatment.   

What specialist should I see?

The specialist that diagnoses optic neuritis is an ophthalmologist.      

What is orbital cellulitis?

Orbital cellulitis is an acute infection of the tissues surrounding the eyes, specifically the eyelids and eyebrows that can spread to the cheeks.

What are the symptoms of orbital cellulitis?

Symptoms can include:

• Painful inflammation of the upper and lower eyelid and possibly of the cheek and eyebrow
• Decreased vision
• Bulging eyes
• Fever, usually 38.9°C or higher
• Eye pain, especially when moving the eye
• A general feeling of discomfort
• Bright red or purple eyelid
• Difficult or painful eye movements

How is orbital cellulitis diagnosed?

Your doctor will diagnose the condition with a simple physical exam and take a look at your medical history. If eye pain and vision problems are present, your doctor may perform a blood test. Sometimes a CT scan or MRI scan will be used to get a clearer picture of the eye and the inflammation. 

What are the causes of orbital cellulitis?

This condition is usually the result of a sinus infection which spreads to the eyes, eyelids and areas surrounding the eyes, like the brows and cheeks. Bacterial infection, that might occur after an injury or an insect bite can also lead to orbital cellulitis. Children are more likely to be infected in comparison to adults. The bacteria that most commonly causes orbital cellulitis are:

• Haemophilus influenza
• Staphylococcus
• Streptococcus

Can orbital cellulitis be prevented?

Hib (Haemophilus influenza type B) vaccines can prevent Haemophilus influenza type B infection in children and prevent this from causing orbital cellulitis. It is also possible that children who share a family group with someone who has this infection have to take antibiotics to avoid becoming infected.

On the other hand, adequate treatment of a sinus infection or a dental infection can prevent bacteria from spreading to the eyes and causing cellulitis of the eyelids and tissues around the eyes.

What is the treatment for orbital cellulitis?

It is essential to treat orbital cellulitis adequately so that it does not cause damage that can persist into adulthood. Most cases will require hospitalization. Antibiotics will be given intravenously through a vein in the arm.

Surgery may also be needed to drain the abscess or relieve pressure around the eyes. Orbital cellulitis should be treated rapidly to avoid complications or loss of vision. 

What is Ptosis?

Ptosis is a drooping of the upper eyelid. It is usually due to a problem in the muscle responsible for raising the eyelid (the levator muscle). The problem may be degenerative or congenital in nature.

There are different types of ptosis:

Aponeurotic ptosis – this is the most common variant and occurs because the tissue of the eyelid ages naturally and over time the levator muscle stretches, becoming looser, causing the eyelid to droop.

Neurogenic ptosis – characterized by the lack of nervous stimulation in the muscle. It usually occurs in children and is also called Marcus Gunn Syndrome.

Mechanical ptosis – occurs when there is a cyst or tumour in the upper eyelid.

Myogenic ptosis – the levator muscle does not perform well and prevents the eyelid from being in the optimal position.

What are the symptoms of ptosis?

Symptoms of ptosis include:

• Drooping of one or both upper eyelids, partially or totally covering the eye
• Reduction of visual field and interference in vision, in severe cases
• Need to tilt the head back or even lift the eyelid with your finger to see

Causes of ptosis

The drooping of the eyelid is due to a weakness of the levator palpebrae muscle, to damage to the nerves that control the eyelid or to the fact that the skin loosens in the upper eyelids. Ptosis can be congenital (the patient is born with it) or acquired. Acquired ptosis may be due to normal ageing, illness or injury.

Conditions that can cause ptosis include:

• A tumour around the eye
• Diabetes
• Horner's syndrome
• Myasthenia gravis
• Eyelid inflammation (stye)

Can ptosis be prevented?

Ptosis cannot be prevented but it can be diagnosed in the initial phases, being able to act before it affects the visual field and the unsightly effect is pronounced.

What is the treatment for ptosis?

Ptosis is usually treated surgically by a process called blepharoplasty. The aim of the surgery is to repair or tighten the muscle that lifts the eyelid. However, in some cases ptosis may not be severe enough to need treatment, while in cases caused by an underlying condition, successfully treating that condition may also resolve the ptosis.

What is it?

A stye is the result of an inflammation on or inside the eyelid or around the eye. It is a red, hard and painful lump originating from the eyelid’s sebaceous glands or from the eyelashes’ follicles.

What are the symptoms?

The symptoms of a stye include a painful lump which grows more and more red, lacrimation and, sometimes, a scratchy sensation on the inside of your eyelid. The signs of a stye on the outer eyelid are caused by bacteria attacking the follicles, thus accumulating pus.

If you do not have treatment early on, the infection may evolve into a chalazion (a type of cyst).

How is it diagnosed?

In order to diagnose it, your doctor will simply take a look at the infection to determine what stage it has reached.

What causes a stye?

A stye originates from a bacterial infection, mainly from the Staphylococcus bacterium, which penetrates into the eyelashes’ follicles and causes an infection of the sebaceous glands. The bacterium is transmitted by direct contact: the simple act of touching your eyes can be enough.

How can it be prevented?

Avoiding infection involves proper eye and facial hygiene and refraining from touching your eyes excessively. It is also very important to pay attention to proper hand hygiene and to changehand towels as frequently as possible.

If you wear make-up, remove it completely before going to bed. You shouldn’t share any eye cosmetics. Make sure you replace your eye make-up regularly.

How is it treated?

Most cases of styes usually resolve on their own after seven to ten days. From the moment the stye bursts open and starts releasing the pus, it will heal on its own. However, you should remember not to touch or try to burst the stye open yourself, because this could further aggravate and spread the infection.

In order to help the stye heal, you could apply warm compresses on your eyelid. If the infection has been going on for a long time, you could also use a macrolide antibiotic-based ophthalmic ointment - that should stop the bacteria from spreading.

For more severe cases, the doctor may decide to remove the eyelashes closest to stye, so that the pus is released more easily.

Thyroid eye disease is an autoimmune disease in which the cells that protect us from infections or other aggressive agents act defectively, attacking different organs or tissues of the body such as the thyroid and eyes. For example, with hyperthyroidism (excessive or out of control hormone production), inflammation of the eye may occur or there is an increase in pressure behind the eyes. This can lead to protruding eyes (proptosis), misalignment of the eyes (strabismus) and dysfunctions in the eyelids where, in severe cases, visual disturbances occur. Tobacco and stress are risk factors for developing hyperthyroidism. Treatment includes endocrine control, steroids or, in more severe cases, surgery.

Watery eyes, also known as epiphora, is a condition where there is an overflow of tears onto the face. It is very common and can develop at any age, although it is more common in babies and people over the age of 60. It may affect one or both eyes and usually manages to get better without any treatment or, if need be, it can easily and effectively be treated.
 

What causes watery eyes?

The causes of watery eyes are:

• Blocked tear ducts
  Some people are born with underdeveloped tear ducts and it is normal for newborn babies to have watering eyes, which clear up as the ducts develop. In adults and older children, the most common cause is blocked ducts or ducts that are too narrow. Narrowed ducts are a result of swelling or inflammation. If the tear ducts are blocked, the tears will build-up and not be able to drain. The build-up of tears in the tear sac increases the risk of an infection, meaning the eye will produce a sticky liquid.
• Overproduction of tears
  Eyes that become irritated may produce more tears than normal. The eyes can become irritated by a number of factors, including; some chemicals, such as fumes, infective or allergic conjunctivitis, an injury to the eyes, such as a scratch or from grit, from the eyelashes growing inward or to the lower eyelid turning outward.
• Other causes
  Watering eyes can result from an infection of the cornea (keratitis), an open sore on the front surface of the eye (corneal ulcer), styes, Bell’s palsy, dry eyes, allergies such as hay fever and the use of certain medications due to the preservatives as an ingredient. .

Treatment of watery eyes

In mild cases of watery eyes, the doctor may recommend ocular lubricants in the form of dry eye drops and monitor progress. Depending on the cause of watering eyes, there are different treatment options. For watery eyes caused by an irritation, if it does not clear up by itself then a course of antibiotics may be necessary. For blocked tear ducts, surgery may be required to create a new channel between the tear sacs to the inside of the nose. The surgical procedure is called dacryocystorhinostomy (DCR).

Home remedies for watering eyes

It is recommended to take a break from reading, computer or phone screens. Most dry eye drops are available to purchase over the counter at a pharmacy to keep the eyes lubricated. Holding a warm, damp cloth over the eyes may help to release any blockages also. Cleansing the eyelids with lid wipes or a saline solution can also help alleviate symptoms of dry eyes if linked with blepharitis.