Eyelid Surgery

Eyelid surgery

Surgery of the eyelids and structures around the eye is called oculoplastic surgery.

It should be performed by a surgeon who is specifically trained in ophthalmology and plastics. The speciality includes repositioning eyelids that have become droopy or which are turning in or out.

It also includes the removal of lid abnormalities and subsequent reconstruction of the eyelid.

Cosmetic surgery of the eyelids also comes under this heading and is best performed by a surgeon trained in oculoplastic surgery and ophthalmology. Botulinum toxin therapy can be given either to prevent spasm of the eyelid or facial muscles or to rejuvenate the face for cosmetic reasons.

Eyelid malpositions

Entropion = eyelid turning inwards

Ectropion = eyelid turning outwards

Ptosis = drooping upper eyelid

The position of the eyelids may be affected by various factors. Simple ageing of the lid tissues may cause them to droop or to turn inwards or outwards. The lid position may also be affected by laxity of the tissue caused by repeated lid rubbing over the years or by other causes such as scarring or inflammation of the surrounding tissues. Long term contact lens use can cause drooping of the upper eyelid and the lower eyelid may droop due to a weakness of the surrounding facial muscles. The cause of your lid position will be discussed with you in the clinic before your surgery as will the best treatment for you.

What can I expect on the day of surgery?

Most surgery is carried out under local anaesthetic and performed as a day case. You may be asked to return a day or two after surgery for a post-operative check.

You will have some drops put into the eye which may sting for a few seconds and which will numb the surface of the eye. The local anaesthetic is given using an injection into the lid. This will also sting for a few seconds but once the stinging has gone, you should not feel anything else.

The surgeon will then clean the area using a sterilising iodine solution. Your head will then be draped to help keep the area sterile.

The surgeon will then start the surgery and will usually use an operating light to make things clearer which will be bright to start with but which you will get used to.

You may feel sensations of pressure but you should not feel any pain. If you do feel anything please let the surgeon know because more local anaesthetic can be given.

During the surgery you may hear various beeps and buzzing noises from the machines which are used. At the end of the surgery, some ointment may be put into the eye and a pad put on the eye. The surgeon will tell you when you should remove it and may give you a prescription for some drops to put into the eye once you have taken off the pad.

What should I do if I am taking blood thinners?

Blood thinners will increase the tendency to bleed during surgery. Please let Mr Sandy know before surgery if you are taking any of these. Blood thinners include Aspirin, Warfarin, Clopidogrel, Apixaban, Edoxaban and Rivaroxiban. The length of time to stop them prior to surgery varies according to the drug. This will be discussed with you before surgery.

How long will it take for the lid to heal completely?

Usually the wound will have healed in a week or two. The lid may be bruised for this length of time. If you have had an operation to correct the position of the lids it may take a few months before the final result is achieved.

What are the complications?

The lids may be bruised and swollen. This will settle over the first days and weeks. Very rarely in the first 24 hours after lid surgery bleeding into the eye socket may occur. This is painful and may be associated with severe visual loss. If you develop a severe pain in the eye after lid surgery please contact the on-call eye doctor immediately. Wound infection is a possible complication which can lead to wound breakdown but it is uncommon.

Am I likely to require further lid surgery?

It is possible that you will require more than one operation to achieve a satisfactory result. Occasionally the lid heals in such a way that the lid position or appearance is unsatisfactory after your operation and this is when further surgery is required.

Care of the lid after surgery

When you take the eye pad off, you may find some dried blood and mucus in and around the eye. The lids may be bruised and swollen. If you have had an upper lid operation, the lower lid may also look bruised. The vision may be slightly blurred due to the ointment and mucus in the eye. The swelling may actually get worse on day 2 after surgery before it starts to subside.

Very gently clean away any excess blood from around the eye and the wound. Do not clean the wound itself because it will almost certainly break down. (The stitches that are most commonly used dissolve in water over a period of a few weeks and cleaning them in water will make them dissolve quicker). Be very careful not to put any pressure on the wound because that too may increase the chance of wound break down.

You will probably be asked to return to clinic a week after surgery when you may have your stitches removed.

You may be given a prescription for antibiotic drops and ointment. Please use these as instructed.

Cosmetic blepharoplasty

Blepharoplasty is one of the most common oculoplastic procedures. It involves reshaping of the eyelids to a more acceptable contour. It may involve removal of tissue but tissue may occasionally be added to fill unacceptable hollows in the skin.

Excess eyelid tissue may cause visual problems and may cause ocular discomfort. Blepharoplasty can alleviate these symptoms but it is often performed for cosmetic reasons. The eyes and eyelids have a major influence on the cosmetic appearance of the face and rejuvenation of this area alone can be of great benefit to the facial appearance.

Various types of blepharoplasty may be performed depending on patient requirements. In some cases a simple excision of skin or muscle may be all that is needed but in some cases some fat may need to be removed in order to improve the bulgy appearance. Occasionally the height of the lids needs adjustment at the same time as the blepharoplasty and this will be discussed with you before your operation.

Upper lid blepharoplasty

An incision is made in the upper eyelid skin in the natural crease. The required amount of skin is removed along with some underlying muscle. If fat prolapse is part of the problem some fat may also be removed. Fine sutures are then placed in the skin. The eye may be padded for a few hours after surgery.

Lower eyelid blepharoplasty

Most eyelid sugery is performed under local anaesthetic. If you prefer, some sedation may be given or a general anaesthetic can be arranged.

With skin removal An incision is made below the eyelashes in the lower eyelid to the outer corner on the eye. The required amount of skin is removed along with a small amount of muscle. If fat prolapse is a problem, some fat may be removed and the remaining fat may be placed in a way that smoothes the surface contour of the lower eyelid and prevents a hollow appearance or the appearance of a trough at the lower part of the eyelid. The outer corner of the eyelid may be supported with a suture to prevent sagging. Fine sutures are placed in the skin.

Without skin excision If there is no excess skin, any excess fat may be removed without a skin scar. This is done by making the incision on the inside of the eyelid and removing fat through it. Small dissolvable sutures are placed on the inside of the eyelid.

After the operation

The eyes may be padded for an hour or so after surgery and you will asked to sit up to minimise swelling. You will be helped to have something to eat or drink by a nurse. The pads will be removed and the vision and wounds will be checked. You will then be allowed to go home. At this stage the vision may be slightly blurred and the eye may be watery. This is quite normal and will improve over the first few days. For the first few nights I advise patients to sleep with an extra pillow. This helps to reduce swelling. For the first few days the eye may appear slightly red and may water. It may also feel slightly gritty. These symptoms are very common and settle over the first week or two. You may be asked to use some eye drops for the first week to make the eyes more comfortable. If you have stitches in the skin, these will be removed between 5 and 10 days after surgery, depending on the type of stitch used.

You will be able to discuss your progress at this visit. Do not worry if the lid is not how you would like immediately. It is likely to settle with time.

After your eyelid surgery, bruising and swelling of the lids can be expected. The amount and severity is variable. If you have had upper eyelid surgery, some bruising of the lower lid may take place. The bruising and swelling may be at its worst on day 2 after surgery. After this, it usually settles over a week or so. There may be some minor residual swelling which can take a few weeks to settle and in some cases, the lid is not at its best for a few months.

Some people like to take Arnica preparations in the hope of minimizing bruising. Please feel free to do this, although the medical evidence that it actually helps is lacking.

Do take life gently over the first few days
Don't swim for three weeks
Don't strain or take heavy exercise over the first week

If you have any undue pain or worsening swelling or any other concerns, please do not hesitate to contact me through my secretary.

Complications of surgery

In the hands of an experienced oculoplastics specialist, complications are few but even in the hands of the most experienced surgeon, they may occur.

Infection

Infection of the wounds is rare and steps are taken at the time of surgery to minimize this risk. If the eyelid swelling increases two to three days after the surgery and is associated with increasing pain, please seek advice without delay.

Bleeding

Bleeding into the eye socket is a very rare complication of blepharoplasty (about 1 in 2500 cases). It may have a marked effect on the vision if it is not detected or treated appropriately. This complication does not tend to occur with skin-only blephahroplasty but is a rare complication of a fat blepharoplasty. It occurs a few hours after surgery and causes marked bruising and swelling of the eye and eyelids, severe pain and reduced vision. Emergency treatment of the problem is needed and it is important to seek the advice of the surgeon without delay.

Double vision

This is also a rare complication and is caused by damage to the muscles around the eye. It usually settles spontaneously over the first few weeks.

Scarring

The wounds tend to heal very well but occasionally the tissues beneath the skin scar more than usual. This may lead to an unacceptable eyelid position which may settle spontaneously or may require further surgery. An oculoplastic surgeon is trained to prevent and manage such a problem.

If you have any questions regarding this information, please ask your eye doctor.

Chalazion (meibomian cyst)

A meibomian cyst is a benign lump which can appear on the eyelid. The cyst is caused by the blockage of one of the oily glands in the lid. The mouth of the gland becomes plugged and the gland becomes swollen and red and may become infected. (This kind of cyst may be mistaken for a stye which is the blockage of one of the more superficial glands near the lashes).

What is the treatment?

The cysts sometimes spontaneously improve and require no treatment. In the early stages of the cyst, applying a hot compress to the lid may help to encourage the cyst to discharge. If the cyst does not resolve spontaneously, a small operation may be needed.

The operation is a very small procedure carried out in the outpatients department. A local anaesthetic injection is given to freeze the lid. A small incision is made on the underside of the lid to allow the contents of the cyst to discharge. Some antibiotic ointment is applied to the eye and a pad is put on the eye.

A few hours later the pad may be removed. There may be some blood and ointment on the pad when it is removed which you can wipe away with cotton wool and cool boiled water.

You will be asked to insert some antibiotic ointment into the eye for about a week.

Side effects

The lid may be bruised and you may have some blood in the eye when you remove the pad. There may still be a small lump in the lid due to the persistence of scar tissue but this should settle over a period of a few weeks. Occasionally, other cysts may develop in the same area as the original cyst but cleaning your lids regularly may prevent this.

Please note If your eye is padded, do not attempt to drive or operate machinery because your distance judgement may be reduced.

If you have any questions regarding this information, please ask your eye doctor.

Removal of abnormal lesions from the eyelids

If you have developed a lump on your eyelid, it may be recommended that it is removed. Many eyelid lumps are benign and can be left alone but some others may be suspicious of a more serious problem. Eyelid lumps very rarely will be serious enough to affect your general health. Removal of an abnormal eyelid lump allows us to send a specimen to the pathology department to help with the diagnosis so we can plan further management. It is sometimes also important to remove them due to their unsightly appearance. Removal of lumps and bumps takes place with a local anaesthetic (to freeze the skin), as a day case. The amount of surgery needed to repair the defect depends on the size, location and nature of the lesion. This will be discussed with you in the clinic before your operation.

Eyelid Surgery

Eyelid surgery

Eyelid malpositions

What can I expect on the day of surgery?

What should I do if I am taking blood thinners?

How long will it take for the lid to heal completely?

What are the complications?

Am I likely to require further lid surgery?

Care of the lid after surgery

Cosmetic blepharoplasty

Upper lid blepharoplasty

Lower eyelid blepharoplasty

After the operation

Complications of surgery

Infection

Bleeding

Double vision

Scarring

Chalazion (meibomian cyst)

What is the treatment?

Side effects

Removal of abnormal lesions from the eyelids

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NHS Practice