Operations on the eyelids
The characteristics of the eyelids, i.e. their position, contour and also the condition of the skin, play a large part in a person’s facial expression.
As the eyelids may require treatment – either due to age or for medical reasons – there are specialists in eyelid surgery. These are usually specialists in ophthalmology with advanced training in ophthalmoplastic surgery.
The eyelid
Human eyelids consist of an upper and lower eyelid, which are supplied by nerves and vessels. Associated muscles ensure the mobility of the eyelids. There are also sweat glands and sebaceous glands around the lashes, which can become blocked.
The purpose of the eyelids is to moisturise the eye by distributing tear fluid and offer it protection against environmental influences, foreign bodies or trauma. This protection is ensured by the closure reflex in the event of danger.
Symptoms
However, your eyelids can also cause you increasing problems and the associated symptoms may manifest themselves as follows:
- You have a “tired look”.
- You have hooded eyelids.
- You suffer from increased tear flow (epiphora) or an increased feeling of dryness.
- You notice a limitation of your field of vision.
- You notice that your eyelid is no longer in the correct position (eyelid malposition; lower eyelid turned outwards or inwards).
- The edges of your eyelids are inflamed.
- Your lashes rotate inwards, causing you to feel a foreign body sensation or even pain.
- New tissue is forming at your lids.
- You have a stye (medical term: hordeolum) or a cyst (medical term: chalazion).
If you have any of these or similar symptoms, it is absolutely necessary to carry out a thorough examination to determine the exact cause of the symptoms.
Causes
Medically necessary interventions on the eyelid are mainly performed after serious injuries, for tumours, for inflammation of the eyelid, for diseases of the tear duct, for lid malpositions or for lid malformations. However, aesthetic reasons can also lead to surgery on the lid.
Serious injury to the eyelid
A serious injury to the eyelid requires immediate examination by an ophthalmologist. Therefore, please never wait for a wound or pain involving the lid to improve “by itself.” In the event of injury, contact a specialist or a hospital as soon as possible.
Tumour disease of the eyelid
The eyelids may also be affected by skin tumours (nodules). Medicine distinguishes between benign and malignant lesions (the destruction of tissue or cell clusters by injury or disease processes). Malignant lesions are cancers; benign lesions may include cysts, styes or deposits of fat on the eyelids. Eyelashes falling out near such a nodule may indicate its malignancy. Benign changes may also include moles, connective tissue nodules (known as fibromas), warts or cysts. Tumours pose a risk to the eyelid, eye and eye socket and may even be life-threatening.
Inflammation of the eyelid
A common cause of inflammation of the eyelids are styes (hordeolum). People suffering from acne or diabetes are more likely to be affected. The cause of inflammation is an infection of the glands around the rim of the lid, which is caused by bacterial pathogens.
There is also a cyst known as a chalazion which forms as a slow-growing, painless nodule on the eyelid. The cause is usually a blockage of the glandular ducts, which leads to impaired glandular secretion with accumulation of sebum and thus to an inflammatory reaction, which in turn manifests itself in the form of swelling.
Blepharitis – i.e. inflammation of the rim of the lid – is a common disease with a chronic, often persistent course. This inflammation of the rim of the lid is often caused by impaired glandular secretion. Favourable factors are dust, dry rooms and smoke. This may also lead to a secondary bacterial infection.
Diseases of the tear duct
A disease of the tear duct may also make a medical intervention necessary. Here, tears run over the rim of the lid or the cheek. The affected person’s vision is blurred, while their eyes are itchy and very red. The dried-up tear fluid leads to the formation of a yellowish crust on the skin of the eyelid and at the angle of the eyelid (“sticky eyes”).
Eyelid malpositions
Essentially, medicine distinguishes between three types of eyelid malposition:
- entropium, i.e. eyelid turned in,
- ectropium, i.e. eyelid turned out and
- ptosis, i.e. drooping upper eyelid.
Eyelid malpositions result in complications such as reddened eyes, burning eyes, inflammation of the eye or corneal ulcers.
With the help of eyelid surgery, the affected eyelid is tightened and thus restored to its natural shape and position. As a result, the after-effects usually disappear.
Eyelid malformations
In rare cases, congenital malformations of the eyelids, such as insufficient tissue in the area of the eyelids (known as coloboma), adhesions between the upper and lower eyelid (called ankyloblepharon) or the opening between the eyelids being too short (blepharophimosis), may require surgery of the eyelid.
Aesthetic reasons for surgery on the eyelid
The older a person gets, the more the skin loses elasticity. This can cause the upper eyelid to hang down (“hooded eyelid”) or the skin around the lower eyelid may slacken and form unattractive “bags”. Both can be an issue for aesthetic reasons, but hooded eyelids can also significantly impair vision by hanging over the eyes.
Diagnosis
In addition to the optical examination, further eye examinations may be useful, depending on the symptoms, and depending on the outcome of the examination carried out, surgery may be necessary at a later date.
The following may be diagnosed:
- Upper eyelid slackening: The skin of the upper eyelid hangs down and thus narrows the eye’s field of vision. Due to the reduced light into the eye, chronic states of tiredness and exhaustion may appear.
- Ptosis (drooping eyelid): Ptosis refers to a congenital or acquired drooping of the upper eyelid due to muscle weakness or a nerve disorder. Vision may be severely impaired if the eyelid covers the pupil.
- Brow ptosis (drooping of the eyebrow): If the eyebrow is drooping, this usually also affects the eyelid. This is often caused by slackening of the skin and the muscle structures that connect the eyebrow to the forehead. Those affected find it more difficult to open their eyes. The increased tension in the forehead muscles can increasingly cause headaches over time.
- Chalazion (cyst) and hordeolum (stye): Both are types of nodule-like inflammation that can occur on the eyelid at any age. Cysts are a chronic but non-infectious condition that is not accompanied by pain. Styes, on the other hand, are a purulent swelling that can cause severe pain.
- Dermatochalasis (hooded eyelid): Hooded upper eyelids are equivalent to bags under the eyes involving the lower eyelid. They occur with age and can significantly reduce the visual field. When the eye is open, the eyelid is only partially visible and is covered by sections of the skin above.
- Blepharochalasis (swelling of the eyelid): Blepharochalasis refers to recurrent swelling of the upper lids. As a result of increased swelling, the connective tissue of the upper eyelid slackens and eventually droops over the eyelid. The eyes can then no longer open fully and vision will be limited.
- Ectropium (outward rotation of the rim of the eyelid): An eyelid rim turned outwards is usually the result of slackening of eyelid tension. As a result, the conjunctiva is no longer adequately protected, which may make it more susceptible to conjunctivitis. Caution is also advised here, as ectropium can become chronic if left untreated. Symptoms: tears in the eyes, inflammation of the rims of the eyelids (blepharitis), pain caused by disorders affecting wetting.
- Entropium: Entropium is a temporary or permanent malposition of one or both eyelids. The eyelid is turned inwards, so the eyelashes rub against the surface of the eye. Symptoms: painful corneal abrasions and inward rotating eyelashes.
- Xanthelasma (deposits above the eyelid): Xanthelasma are yellow or red sharply defined fat deposits (cholesterol) that often occur above the eyelids. They are harmless and not harmful to health, but in rare cases they may cause ptosis. Treatment is only necessary from a cosmetic point of view.
- Basal cell carcinoma: Basal cell carcinoma is a malignant, ulcer-like lesion that can occur anywhere on the skin, but usually places that are frequently exposed to the sun. Basal cell carcinoma is not uncommon around the eyes, but requires special attention, as late treatment increases the risk of permanent damage to the eye.
- Wrinkle correction: As a rule, eyelid surgery is not necessary to correct small wrinkles on the eyelids. In this case, botox or hyaluronic acid injections work very well as it is. However, the disadvantage is that the effect of injections tends to fade with time, so new therapy sessions are required at regular intervals.
Treatments
The term lid surgery encompasses both medical (curative) and aesthetic (plastic) procedures. The medical correction of eyelid malpositions or the removal of tumours is necessary for health reasons and is therefore not merely cosmetic in nature.
So while curative interventions serve the purpose of correcting anatomical and functional malpositions of the eyelids or eliminating eyelid tumours, plastic interventions are more concerned with improving the aesthetic appearance. However, there is often no clear divide between functional and aesthetic aspects.
Medical eyelid surgery
In order to remedy underlying causes such as malposition of the eyelids, surgery must deal with the muscles responsible for excess inward or outward rotation. If there is too much skin, the eyelids sag and hooded eyelids or bags under the eyes appear, which can be treated by simply removing the excess skin via surgery.
Even benign nodules can be removed without any problems or just a minimal incision. In the case of malignant nodules, however, a larger area has to be removed to ensure the entire “diseased area” has been removed and there is also a sufficiently large distance from the healthy tissue.
Dry eyes are a common complaint and symptoms include a foreign body sensation, burning, tears and red eyes. If supportive measures such as eye drops no longer provide sufficient relief, the lachrymal punctum (which tears flow through) can be closed with a “stopper” in a minor surgical procedure. As a result, less tear fluid drains away and remains in the eye for moisturisation purposes. In another scenario, displacement of the lachrymal caniculus (which drains tears away) can lead to permanently watery eyes. In this case, the channel must be probed by inserting a thin plastic wire from the inner corner of the eye through the passage to the nasal cavity. The wire stays there for a few days to stop it closing up again.
Aesthetic eyelid surgery
Most upper lid surgery is for so-called hooded eyelid. The natural slackening of the skin on the eyelid leads to a tired and bored look. This can be perceived as unattractive and restrict the field of vision. Surgical correction of hooded eyelids is called blepharoplasty and is performed on an outpatient basis. Only local anaesthesia is required for the 30-90-minute treatment.
During the operation, a fine incision is made in the eyelid crease and excess fatty tissue and skin tissue are removed from there. Thanks to this incision, the scar left will be barely visible if at all with the eye open. If eyelids or creases are asymmetrical, these can also be adjusted.
Due to small pads of fat, bags can develop under the eyes and lead to a tired and exhausted look. A lower eyelid lift can help. This procedure is performed on an outpatient basis under local anaesthesia and lasts between one and two hours. Excess connective tissue and fatty tissue are removed there and then and the skin is tightened.
Aftercare
As with any other surgical procedure, it goes without saying that the doctor’s instructions must be followed after an eyelid operation and any subsequent examinations must be attended with diligence. Immediately after the operation, exercise and physical exertion should be avoided for a few days, as should contact between the eye and any cleansing products or water.
FAQs
Is general anaesthesia always required as part of an eyelid operation?
Thanks to modern and gentle treatment procedures, general anaesthesia is no longer necessary in most cases. In the majority of cases, the patient is sedated but still conscious – like during a gastroscopy – or local anaesthesia is performed.
What are the signs of hooded eyelids?
An eyelid is described as “hooded” when the eyelid is only partially or almost invisible when the eye is open because it is covered by the hooded area above the eye. That’s why hooded eyelids often make your gaze look tired or worn out. However, they can also severely impair your vision.
Does a doctor need to see a stye?
In the case of a stye, the inflammation can spread to the conjunctiva, eyes or eye socket. So the rule is this: if general symptoms such as headaches, fever or swollen lymph nodes occur, consult a doctor immediately. The same applies if styes come back again and again.
