1	Eyelid Problems
2	The eyelid Our eyelids play both a protective and an aesthetic role for our eyes. Lubricate and wash away irritants. Shield eyes from bright lights and allow sleep. Frame the eyes; give us expression. If eyelids are misshapen, irritated or infected, vision may be impaired.
3	Common eyelid problems Dermatochalasis Blepharoptosis Entropion Skin cancer Eyelid lesions Blepharitis
4	Dermatochalasis Dermatochalasis is defined as droopy or baggy eyelids. Can affect both upper and lower eyelids. May affect peripheral vision as well as make eyes look and feel tired. May make wearing eyeglasses difficult if lower lids are significantly affected.
5	Dermatochalasis Blepharoplasty is the most common treatment for dermatochalasis. Outpatient surgery, performed under local anesthesia. Designed to correct baggy or sagging eyelid skin, muscle and fat pockets. Provides functional and cosmetic improvement with minimal risk of serious complications.
6	Blepharoptosis (Ptosis) Upper eyelid droops, as though there is a shade in your vision. With severe ptosis, eyelid can fall into your field of vision, impairing peripheral vision; affects activities such as reading and driving.
7	Ptosis Can be congenital, inherited or acquired. May involve interference with the nerve supply to the muscle which lifts the eyelid. Some causes are nerve palsy, myasthenia, or Horner’s syndrome.
8	Ptosis Treatment usually involves outpatient surgery. Several different types of surgery, depending upon the strength and function of levator muscle (muscle which lifts the eyelid). Adults-local anesthesia; children-general anesthesia.
9	Goals of ptosis surgery Elevate the upper eyelid to restore as normal a field of vision as possible. Attempt to achieve the best possible symmetry with the opposite eyelid.
10	Entropion A condition where the lower eyelid and lashes turn inward. Commonly due to the relaxation of eyelid tissues with gravity and time. Lid and lashes constantly rub against the cornea, causing a foreign body sensation/constant tearing. Usually seen in adults, but may occur in children (usually resolves itself as children mature).
11	Entropion Symptoms of entropion: Red and irritated eyes. Excessive tearing and discharge of the eyes, crusting of the eyelid and impaired vision. If left untreated, entropion can cause infection and scarring of the cornea.
12	Entropion Treatment usually involves outpatient surgery under local anesthesia. Several surgical techniques used to tighten and reposition the eyelid. Surgery relieves redness, tearing and foreign body sensation.
13	Ectropion Abnormal lower eyelid that turns outward and no longer touches the eye. Usually due to relaxation of eyelid tissues with gravity and time. Most often seen in older patients who develop stretching and weakness of the structures supporting the lower eyelid.
14	Ectropion Causes other than age include trauma, burns, skin cancers, or wound constriction following eyelid or facial surgery. Ectropion may develop following facial nerve palsy (Bells Palsy), and may be aggravated by constant wiping of the eyelid by a tearing patient, further pulling the eyelid from the eye.
15	Ectropion Symptoms of ectropion include excessive tearing, crusting of the eyelid, discharge, infection and impaired vision. The exposed inner lining of the eyelid becomes dry, red and inflamed, and ultimately the eye can be damaged.
16	Ectropion Treatment occasionally involves using artificial tears or lubricant ointment to protect the cornea. If eyelid tissue problems are not addressed, surgery for ectropion may be required. If ectropion is a result of scarring, skin cancer, facial nerve palsy or other problem, treatment of underlying condition may be done before or at the same time.
17	Eyelid skin cancer Most common eyelid skin cancers are: Basal cell carcinoma Squamous cell carcinoma Malignant melanoma Sebaceous cell carcinoma
18	Eyelid skin cancer Lesions occur most often on lower eyelid but may be found anywhere around the eye. Symptoms of lesions include a painless elevation or bump in the eyelid, loss of lashes, bleeding or crusting of the eyelid margin.
19	Eyelid skin cancer Excessive exposure to sunlight is single most important factor associated with skin cancers on the face, eyelids and arms. Fair-skinned individuals more often affected. May be hereditary.
20	Eyelid skin cancer Treatment involves complete removal of the cancer followed by reconstruction of the affected area. Removal of the cancer uses frozen section diagnosis, or Mohs excisional surgery. Usually an outpatient procedure under local anesthesia. After surgery, healing may take up to six months. Any form of eyelid surgery for skin cancer will leave a scar. Efforts are always made to minimize scarring and maximize cosmetic results.
21	Eyelid lesions Chalazion A painless, slowly enlarging bump on the eyelid, formed by inflammation of the meibomian glands.
22	Eyelid lesions Hordeolum (Stye) A localized infection or inflammation of the eyelid margin involving hair follicles of the eyelashes or meibomian glands.
23	Other eyelid lesions Inclusion cysts: Proliferation of epidermal cells within a specific skin area. Seborrheic keratoses: Non-cancerous growths of the outer layer of the eyelid skin. Papilloma: Non-cancerous warts or tumors on eyelid skin. Dermoid: Non-cancerous cyst on eyelid skin. Foreign body: Uncharacteristic growth on eyelid skin.
24	Blepharitis Chronic redness, irritation and flaking of the eyelids. Skin problem that leads to lid infection and irritation of the eye.
25	Blepharitis Long term effects of blepharitis can include: Thickened lid margins Eyelash loss Entropion (inward turning of eyelid) Ectropion (outward turning of eyelid) Chronic irritation of the eyes
26	Blepharitis Treatment for blepharitis includes applying warm compresses, cleaning, and applying antibiotic ointment to the eyelids.
27	Botox (Botulinum Toxin) Physician-administered facial treatment that can temporarily reduce moderate-severe frown lines between the eyebrows/around eyes (“crows feet”). Two muscles largely responsible for frown lines between your brows; when those muscles contract, they draw brows together. As your skin becomes less elastic over time, repeated frowning can result in the moderate to severe lines between your brows.
28	Botox Botox is most commonly used for: Blepharospasm (eyelid twitching) Hemifacial spasm (involuntary muscular contractions on one side of the face) Seventh nerve dysfunction (facial nerve dysfunction) Treatment of facial lines and wrinkles
29	Botox Botox blocks nerve impulses, which reduces the movement of muscles. With less movement, the skin in the treated area starts to smooth. Your ophthalmologist will determine where on your face to administer the few tiny injections of Botox. No anesthesia is required, though your ophthalmologist may numb the area with a cold pack or anesthetic cream prior to the injections. Discomfort is minimal and brief.
30	Botox
31	Botox You can expect to see results within days after treatment; one Botox treatment can provide visible results lasting up to four months. If you discontinue Botox treatment, your brows/eyes will eventually return to their pre-treated appearance. You may consider follow-up treatments.
32	Preserve the health of your eyes You should regularly visit your ophthalmologist at the following intervals: Age 20-29 years: At least once during this period. Those with risk factors for glaucoma (people of African descent or those who have a family history of glaucoma) should be seen every 3-5 years. Age 30-39 years: At least twice during this period. Those with risk factors for glaucoma (people of African descent or those who have a family history of glaucoma) should be seen every 2-4 years. Age 40-64 years: Every 2-4 years. Age 65 years or older: Every 1-2 years.