Eyelid Scarring and Retraction
Damage to the eyelids can prevent them from working properly to protect and lubricate the eye. When scars or injuries pull the lower eyelid downward (or the upper eyelid upward), it is called eyelid retraction and interferes with blinking, which can cause eye irritation, pain, blurry vision, tearing, and permanent damage to the cornea.
In addition to repairing initial eyelid traumas, Dr. Fante also perform revisional eyelid surgery to enhance the outcome in patients who have undergone previous eyelid repair or cosmetic surgery. Most patients with eyelid retraction are upset about their chronic dry eyes, tearing, blurry vision, and general discomfort. Most are also concerned about the poor appearance and facial deformity inherent in eyelid retraction, even if it is mild.
What Causes Eyelid Damage?
Damage to the eyelids can be caused by surgery nearby. Cosmetic and non-cosmetic eyelid or facial surgery, and skin cancer (Mohs) reconstruction are common causes of eyelid retraction. A traumatic injury (such as dog bite, car accident, or fistfight) can also lead to eyelid retraction. Due to the unique anatomy of the eyelid, a repair can be a challenge. However, it is crucial that the injured person receives proper treatment to address cosmetic and ocular concerns. Dr. Fante have extensive training in ophthalmic and oculoplastic surgery and has many years of clinical experience treating simple to complex cases of eyelid trauma.
Although previous damage from surgery or trauma accounts for most cases of eyelid retraction, Thyroid Eye Disease (Graves), and even old age itself will sometimes cause eyelid retraction. The symptoms are usually the same (eye irritation and tearing especially) but since they come on gradually, patients may not realize that something is wrong. Fortunately, treatment for age-related and thyroid-related retraction is available, just as it is for the traumatic and post-surgical types of retraction.
What Is Eyelid Scarring?
Eyelid or facial surgery or trauma can cause the eyelids to lose normal mobility and position. In some cases, this scarring may make it impossible to properly close the eye(s) so that drying, irritation, and infection can result. When the lower eyelid is affected, there is “too much white showing,” and the eye often alternates between feeling gritty and then watering excessively. Outpatient surgical repair can usually restore more normal appearance and function. Careful examination during your consultation with Dr. Fante will determine the exact details of the repair that will be required.
What Is Eyelid Retraction?
Eyelid retraction is a term that describes an abnormally high position of the upper eyelids or unusually low position of the lower eyelids. Usually, the lids should rest just above or below the iris, the colored part of the eye.
Eyelid retraction may result from poor surgical healing, trauma, old age, and thyroid eye disease. The latter, also called Grave’s disease, is usually responsible for upper eyelid retractions, but may also cause lower lid retraction depending on the degree of bulging. Lower eyelid retraction is a possible complication of cosmetic lower blepharoplasty. Genetics may also cause retraction of the lower eyelid, allowing too much sclera to show.
What Treatment Options are Available for Eyelid Scarring/Retraction?
Upper eyelid correction usually involves adjusting the levator muscle that lifts the upper eyelid. Adjusting this muscle allows the eyelid to close over the ocular surface.
Lower eyelid retraction surgery may be a bit more involved, depending on the condition of the skin and the degree of retraction. When possible, surgery is limited to the tightening of the lower lids with canthoplasty and adjustment of the tendons that hold the eyelids in normal position. However, in some situations, a midface lift or tissue grafting may be necessary to achieve the most desirable outcome.
Patients whose eyelid retraction is related to bulging eyeballs may also benefit from orbital decompression. This technique is performed as part of the complete rehabilitation of patients who need it, and before eyelid surgery so that we can observe how the eyelids respond when the eyes’ protrusion is reduced.
Are Non-Surgical Options Available?
Initially, treatment for eyelid scarring and retraction may center around controlling the symptoms of poor ocular protection and coverage. Conventional approaches include eye drops and ointment, bandages, and other methods of comfort. While these strategies can manage symptoms, they cannot correct the problem causing them. Only surgery can do that.
Will Surgery For Eyelid Retraction Alter My Vision?
It is very rare for eyelid surgery to affect vision adversely. In most cases, vision improves as a result of adjusting the eyelids.
What is the Recovery from Eyelid Scarring/Retraction Treatment?
To achieve optimal results from eyelid surgery, it is necessary to assess not only the tissue that has been damaged or is otherwise abnormal, but also to evaluate the eyeball, tear ducts, and orbital bones. Dr. Fante understand the complex nature of the eye area. He has obtained double board-certification and is a Fellow of the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Ophthalmology, and the American Society of Ophthalmic Plastic and Reconstructive Surgery.
Corrective eyelid surgery may be conducted in an outpatient setting, so patients usually return home the day of their procedure. Commonly, pain is so minimal that patients can return to most normal activities the day after their surgery. Any discomfort that does occur can be managed with oral medication. The eye may be covered with a patch for a few days, and patients should expect some bruising and swelling during the first week. These side effects typically disappear within two weeks.
A post-operative follow-up is usually scheduled a week to ten days after surgery, at which point stitches will be removed. After this visit, patients may be able to resume wearing makeup and contact lenses. More strenuous activity such as heavy lifting or intense aerobics can resume a few weeks after surgery.
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