Blepharitis is an inflammation of the eyelid edge, specifically affecting the eyelash follicles and the glands between them. It is generally associated with a proliferation of excess bacteria that is normally found in the skin.
It is caused when the glands on the edge of the eyelid become blocked and the fat that normally drains away remains, creating an optimum environment for the proliferation of bacteria that releases toxins which irritate the ocular surface.
It is a repetitive and involuntary spasmodic contraction of the orbicularis muscle (the muscle around the eye), which causes abnormal positions and movements (dystonia). Essential or primary blepharospasm is bilateral and may be accompanied by involuntary movements of the neck, face or mouth, which only disappear when the patient is asleep. It is usually a process which advances gradually, increasing in intensity and frequency little by little. The forced closing of the eyelids may lead to visual disturbances. Blepharospasm is one of the most common facial dystonias.
It can be caused by:
- A Neurological Functional Disturbance in the Central Nervous System;
- Side Effects of Certain Drugs;
- Lack of Lubrication on the Ocular Surface. can cause increased eyelid activity in an attempt to evenly distribute insufficient or poor-quality lacrimal fluid;
- Hemifacial Spasm: although not a dystonia, affects the muscles on one side of the face, causing irregular and continual involuntary movements, which can also affect the eye. In many cases, hemifacial spasm occurs due to compression of the facial nerve by an artery or as the result of a trauma.
The eyelid margin turns outwards and away from the eyeball. Ectropion of the lower eyelid is a very common problem. There are three kinds of ectropion of the lower eyelid: cicatricial, paralytic and involutional. It is usually caused by tissue relaxation due to aging, but can also occur as a result of paralysis of the facial nerve (Bell’s palsy), trauma, scarring and surgery.
It is the movement of the eyeball towards the back part of the orbit. Can be originated: Fractures of the Orbit; Orbital Fat Atrophy; Patients with Breast Cancer Metastasis.
The eyelid margin turns inwards or twists towards the eyeball. The skin of the eyelid margin and the eyelashes rub against the cornea and the conjunctiva, causing irritation and redness. There are four main types of entropion: involutional, spastic, cicatricial and marginal.
It is the projection or bulging of the eyeball outwards (proptosis), which may give the impression of "bulging eyes". This may affect one eye or both, depending on the causes. In a high percentage of cases, exophthalmos is associated with thyroid orbitopathy, an inflammatory disease related to hyperthyroidism.
The disease may be very serious, since the orbit is a non-extensible osseous cavity, in which an inflammatory process such as this can compress the optic nerve and cause blindness.
Other processes, which may cause exophthalmos, are Orbital Tumours, a Large Eyeball, High Myopia or Congenital Glaucoma, as well as other Thyroid or Inflammatory Orbital Diseases.
Orbital Infections and Inflammations:
Orbital infections and inflammations are those that can be caused by a previous injury or a systemic disease. Can be diagnosed by a full ophthalmological examination and eyelid and periocular examination. Photos are taken to assess the patient's condition before and after treatment.
Lagophthalmos refers to the inability to completely close the eyelids. The space left between the upper and lower eyelids causes the ocular surface to become exposed, resulting in problems of dryness that can become serious and threaten the integrity of the eye and the quality of vision. Lagophthalmos can occur for several reasons:
- Paralytic: the facial nerve is responsible for transmitting information to the muscle that closes the eyelids (orbicularis). When this nerve is damaged (facial paralysis, tumours, trauma, cerebrovascular disease, etc.), the muscle loses strength and cannot close the eyelids.
- Mechanical: this occurs when the nerves in the muscle function correctly, but an external factor prevents closing, such as scars on the eyelids or conjunctiva, eyelid retraction, exophthalmos or eyelid laxity.
Eyelid malposition is the abnormal positioning of the eyelids due to various causes. The disorder is relatively common. As well as looking unsightly, it can lead to visual and ocular problems, which can become serious.
The most common forms are:
- Eyelid Retraction: the upper eyelid is abnormally high or the lower eyelid is abnormally low.
- Ptosis: drooping of the upper eyelid.
- Entropion: the eyelid turns inwards causing the eyelashes to brush against the cornea.
- Ectropion: the lower eyelid turns outwards.
Usually they're caused by tissue relaxation due to ageing, but can also occur as a result of paralysis of the facial nerve (Bell’s palsy), trauma, scarring and surgery. Ageing is the main cause of eyelid malformation.
Tear Duct Obstruction:
Sometimes, tears cannot drain from the eyes and this can lead to a blockage of the duct that transports tears from the surface of the eye to the nose. There are two types of tear duct obstruction:
- Acquired: This is the most common type and usually affects adults. It may result from a variety of causes (infections, conjunctivitis, etc.). This type of tear duct obstruction becomes more common with age.
- Congenital: This affects children and is caused by a membrane that prevents tears from emptying into the nasal cavity.
The main causes are: Ageing; The Use of Certain Drugs uch as Chronic Eye Drops and Chemotherapy; A Congenital Defect from Birth; Radiotherapy in the Eyelid Area.
In order for the eye to stay healthy, it is important that it is well lubricated. To do so, it has a gland that is responsible for producing lacrimal fluid. When we blink, the eyelid spreads the lacrimal fluid across the surface of the eye. Excess fluid is drawn into a small duct, eventually flowing into the nasal cavity.
Lacrimal fluid is essential to keep the eye healthy. However, excess of lacrimal fluid, represents a relatively frequent problem, one of the symptoms affecting patients visiting the ophthalmologist. When the duct that drains the fluid into the nasal cavity is not functioning properly, it blocks, causing a accumulation of tears on the surface of the eye ans they overflow onto the cheek.
Thyroid orbitopathy is an immunological disorder that affects the functioning of the thyroid gland and orbital components, together or separately. It produces an enlargement of the volume of extraocular muscles and orbital fat, causing proptosis or exophthalmos (bulging eyes).
In most cases, the condition is associated with hyperthyroidism, but can also occur in patients with hypothyroidism or even patients without thyroid disease. It occurs when certain molecules that are present in the thyroid gland and orbit react to the gland and orbital tissue (orbital fatty tissue and extraocular muscles) and inflame them.
It's the inability to move the facial muscles. At ocular level, it paralyses the orbicularis muscle, which is responsible for closing the eyelids.
This condition can cause: Lagophthalmos; Ectropion; Watery eyes.
Approximately half of facial paralysis cases have unknown causes. Some of the most common causes are: Trauma or Accidents; Tumours; Infections; Neurological Diseases; Surgery: Eye Surgery, Parotid Gland Surgery, etc.
Eyelid ptosis is the drooping of the upper eyelid. It usually occurs because of dysfunction of the levator muscle, due to degenerative or congenital causes. Aging is the main cause of ptosis.
There are different types of ptosis:
- Aponeurotic Ptosis: this is the most common. It is caused by aging of the eyelid muscles and loosening of the levator muscle, causing the eyelid to droop.
- Neurogenic Ptosis: an abnormality characterised by a lack of nerve stimulation in the muscle. It usually appears in children (Marcus Gunn Syndrome).
- Mechanical Ptosis: this occurs when there is a cyst or tumour in the upper eyelid causing "mechanical" drooping.
- Myogenic Ptosis: the upper eyelid’s levator muscle does not work as it should, which means that the eyelid cannot remain in its normal position.
They are tumours that occur around the eyelid or in the orbit (the cavity where the eyeball is located).
Eyelid tumours are very common; they are mostly benign and can easily be treated without leaving a visible scar. A variety of malignant tumours also exist, which can affect the periocular region (around the eye).
Orbital tumours are rare. The majority are benign and develop slowly. Some malignant tumours can, however, appear suddenly and grow rapidly. In these cases, patients should visit an ophthalmologist as a matter of urgency, as immediate treatment may be required.
Some eyelid tumours are related to exposure to the sun and usually occur in people over the age of 40. Fair skin is a major risk factor. In the case of orbital tumours, many of them are congenital in origin.
Sometimes, orbital infection or inflammation is caused by a tumour. In these cases, a biopsy of the tumour is taken and sent for analysis in order to prescribe a specific treatment.
Entropion and Ectropion Surgery:
It involves the correct positioning of the eyelids. There are various techniques, which are selected according to each case. In moderate and severe entropion/ectropion cases, in which lubricant treatment is not sufficient.
Thyroid Orbitopathy Surgery:
Thyroid orbitopathy causes the volume of the muscles and fat behind the eye to thicken and increase. Exophthalmos occurs, because the orbit is a rigid space and the muscles and fat move the eye forward in search of space. During this process, the eyelids and strabismus also retract. Orbital decompression surgery for exophthalmos involves opening up space in the orbit by means of creating windows in the bone. This provides the muscles and fat with more space and enables the eye to return to its correct position.
Once the exophthalmos problem has been solved, any strabismus and eyelid retraction can be corrected. Surgery is indicated for all exophthalmos cases, but, in cases where vision is seriously threatened by pressure in the orbit, it must be performed as soon as possible.
The correction of eyelid ptosis involves raising the upper eyelid to its normal position. Ptosis correction is recommended in all cases, as this is not just an aesthetic problem. In children, if the eyelid covers the pupil, surgery should be performed as soon as possible to prevent visual development problems. Surgery can be postponed to just before the child starts school.
In adults, since ptosis can affect the visual field and eventually can cause torticollis and neck pain, it should be corrected as soon as the condition is detected.
Orbital Volume Restoration Surgery:
This consists of restoring volume to the areas surrounding the eye, in particular, the eyelids. To do so, autografts (grafts taken from the same patient) are used. It's indicated for cases of Upper Eyelid Retraction.
Eyelid Retraction Surgery:
Eyelid retraction surgery consists of placing the eyelid in the right position to protect the eyeball and achieve eyelid symmetry. It is carried out in the following cases: Eyelid Malposition; Tyroid Orbitopathy.
Consists of restoring volume to the areas surrounding the eye, in particular, the eyelids. To do so, autografts (grafts taken from the same patient) are used. It is carried out in cases of Upper Eyelid Retraction.
Benign Tumour Surgery:
This involves small incision surgery. It consists of the surgical removal of the tumour with minimal scarring. It is indicated for all cases, but, as these tumours are benign, some of them can just be observed and clinically monitored.
Malignant Tumour Surgery:
This consists of the complete surgical removal of the tumour with minimal scarring to subsequently produce an optimum aesthetic and functional result by means of reconstruction techniques. It is indicated for all cases and requires pathological examination (biopsy) of the tumour to confirm the diagnosis and the total resection of the lesion.
Gold and Platinum Weight Implantation:
Gold and platinum weight implantation is a surgical procedure that consists of inserting a gold or platinum weight into the patient's eyelid. It is inserted into the upper eyelid so that it closes correctly. It is indicated in patients with Facial Paralysis.
It is a surgical procedure recommended for patients with tear duct obstruction and consists of forming a new lacrimal duct using the patient's own tissue. It is indicated when the tear duct is Obstructed Below the Lacrimal Sac.
Orbital decompression is a surgical procedure carried out to treat exophthalmia (prominent eyes). Patients with exophthalmia usually suffer from increased pressure in the retroocular area. By means of this surgical treatment a larger cavity is created for the orbit so that the surgeon can replace the eyeball afterwards carrying out bone or fat decompressions. In this way the pressure on the orbit is reduced by enlarging the eyeball’s volume. It is carried out in the following cases: Patients with Exophthalmia; Patients with Thyroid Orbitopathy.
An abscess is an infection and inflammation characterised by the presence of pus. In this case, the oculoplastic surgery specialist assesses the patient to determine the cause of the abscess. The abscess is then opened up in the operating theatre and the pus is drained.
The enucleation is the total removal of the eyeball. It is carried out in Ocular Tumours Cases.
Evisceration is a surgical procedure consisting of removing the internal contents of the eye maintaining the sclera and its muscles. It is carried out in the following cases: Painful Blind Eyes; Eyes that Lose Their Volume (phithisis); Very Large Eyes (buphthalmos).
Exenteration is a surgical procedure consisting of removing the orbital contents (either partially or fully) depending on the location of the intraocular and eyelid tumour. It is carried out in the following cases: Orbital Tumours; Eyelid Tumours.
Orbiculectomy is a type of surgery that weakens the muscles that cause the forced and involuntary closure of the eyelids. It is carried out in severe cases and in cases that do not respond well to Botulinum Toxin.
This surgical procedure consists of recovering the anatomy of the orbit. It is carried out in the following cases: Anophthalmic Cavity; Enophthalmos.
Eyelid reconstruction is a kind of surgery consisting of recovering the function and anatomy of the eyelids. In is it carried out in the following cases: Eyelid Tumours; Anophthalmic Cavity.
Tear Duct Explorations:
Tear Duct Explorations is a surgical procedure, usually indicated in children (between 9 months and one year) to treat congenital obstruction of the tear canal. It is carried out in cases of Congenital Obstruction of the Lacrimal Sanal.
This is a surgical procedure that involves replacing the tear duct with an artificial drainage tube. This creates a channel between the surface of the eye and the nasal cavity through which tears can drain.
The Aesthetic Surgery of the Eyelids seeks to enhance and rejuvenate the eye, correcting the effects of aging, or other problems in the region of the eyelids such as excess of skin, muscle or fat.
The relaxation of the eyelid tissue and its narrowing, results in excess of skin, on the upper eyelid and dark circles. Relaxation of the septum or the supporting tissue, results in bags. Blepharoplasty aims to reduce or eliminate eyelid imperfections, via conjunctival or cutaneous.
The surgery is performed in ambulatory setting under local/general anesthesia and the post-operative is simple, and may cause, in the first few days, some difficulty in closing the eyes, tearing and/or dry eye sensation. The scarring becomes practically imperceptible after 3 months. Technological advances today allow excellent aesthetic and functional results.