No two people are exactly alike. Every one of us has a unique facial structure and aging process. These sound like vague statements but, to the plastic surgeon, they are guiding principles. When a patient visits our Denver practice to correct droopy eyelids, we keep these principles at the forefront of our minds. Here, we discuss what causes the eyelids to droop and what a skilled plastic surgeon does to correct this problem.
The undereye area is one that can become puffy with age. The upper eyelids; they droop. They can look heavy and redundant, obscuring the natural crease of the eyelid. When the upper eyelids are droopy, the face can look sleepy, tired, or angry. It isn’t the drooping itself that causes the face to look a certain way, it is the angle and severity of the heaviness that occurs. In some instances, hooded upper eyelids are the natural, hereditary appearance. Often, the problem develops as the skin thins and sags due to a loss of collagen. However, we must also recognize that the eyelids do not live in a bubble. They are not solitary and are affected by surrounding structures. This is an important piece of information for a plastic surgeon to acknowledge because it may drive treatment planning.
Lifting the eyelids can do wonders for the appearance of the face. Hence, the popularity of the blepharoplasty procedure. However, we cannot look at blepharoplasty as a definitive solution for every person. In addition to existing alongside the ligaments and bones of the eye socket, the eyelids are also part of a continuum of tissue that includes the eyebrows and forehead. As such, a loss of volume, elasticity, firmness, and integrity of these areas is bound to contribute to the drooping of the upper eyelid.
Addressing Eyelid Drooping the Right Way
The eyelids are not immune to age-related changes. Nor is eyelid droop a problem in itself. Therefore, a plastic surgeon will observe more than the eyelids when consulting with a patient about eyelid rejuvenation. They will look at the position of the lash line of the upper eyelid in relation to the pupil, the quantity and quality of skin and fat on the upper eyelid, and brow position. The thoroughness of this evaluation can identify the true cause or combination of causes that have led to drooping upper eyelids.
Cellulitis is a type of infection that usually affects the skin. This infection can occur anywhere on the body, including around the eyes. When cellulitis develops in the eye area, it is vital that an accurate diagnosis is obtained. Two types of cellulitis may appear to affect the eyelid: preseptal cellulitis and orbital cellulitis. To treat infection appropriately and avoid serious health implications, it is necessary to know which type of cellulitis has developed.
Preseptal cellulitis is localized in the skin of the eyelid. Usually, we see this type of infection in young children.
Orbital cellulitis affects the eye socket. This potentially serious condition can prevent eye movement and present a risk of death. Therefore, orbital cellulitis is typically treated with more aggressive means than preseptal infection.
What can cause cellulitis around the eyes?
Cellulitis often results from bacteria or fungus. Infection may originate with:
- A sinus infection
- An insect bite
- A scratch or other wound on the face (including incisions)
- Facial, head, or neck surgery (including dental work)
Signs of Cellulitis
It is critical that the symptoms of cellulitis be addressed right away. This type of infection tends to spread quickly. A medical examination should be scheduled if symptoms such as the following occur:
- Redness of the eyelid
- Eyelid swelling, including tissue around the eye
- Double vision or blurry vision
- Difficulty moving the eye
- Bulging of the eye
- Lethargy or general lack of energy
Diagnosis and Treatment
When you see a doctor for any of the above symptoms, a thorough physical examination will be conducted. The eyes will be an integral part of the evaluation. To determine the type of infection that has developed, imaging, tissue sampling, and labs may also be ordered.
Preseptal cellulitis that involves only tissue around and on the eyelid is usually treated with oral antibiotics and may begin to improve within a day or two (it is essential that the entire course of antibiotics is taken).
Due to the severe nature of orbital cellulitis, inpatient care is usually necessary. In the hospital, patients can receive adequate antibiotic dosing via IV. If necessary, fluid may be drained from the infected area.
Whether you see it coming or not, it can be incredibly difficult to outsmart a flying object. Injuries to the eye may occur during a sporting event, automobile accident, or fall. The good news is that the orbital rim, which surrounds the eye socket, protects the eyeball. The bad news is that the bone may be wounded more than you imagine. In many cases, orbital fractures are not an emergency that requires immediate surgical repair. In fact, some fractures do not need surgery at all. However, it is important to know when to see the doctor, and whom to see should trauma occur to the eye.
Symptoms of an orbital fracture include:
- This may occur around the eye only, or it may extend to the sinuses or even the teeth.
- The appearance of blood on the sclera, or white of the eye.
- Depending on pain tolerance, this can be a difficult way to gauge orbital fracture.
- Light sensitivity.
- Change in the appearance of the eye (sunken).
Why You Should See a Doctor for Facial Trauma
Sometimes, a bump or blow to the eye seems like “no big deal,” especially if the pain is tolerable and there is no bleeding or sunken appearance. Sometimes, it is the cheekbone that suffers the fracture. In any case, broken bone tissue around the eye could lead to the damage of nerves or blood vessels. In rare instances, a fragmented bone may puncture the eye. A medical evaluation after an eye injury minimizes the risk of unnecessary complication after the initial trauma.
Orbital fractures can be diagnosed via a thorough examination and x-ray or CT scan imaging to closely observe the condition of bone around and beneath the eye. Imaging enables us to pinpoint the location of the fracture, and also ascertain the severity of the injury. As a result, this information facilitates appropriate treatment planning for the most desirable outcome.