Eyes are a mirror to our soul and are the focal point of our face. They are the most charismatic facial feature that attracts attention when someone looks at us. The first signs of ageing appear around the eyes. Dark circles, wrinkles, droopy eyelids, heaviness and hooding of eyelid skin, lower eyelid bags are some of these changes. The most common causes for these are our modern day lifestyle, irregular sleep habits and lack of good sleep, significant fluctuations in weight, heredity ageing, chronic sun exposure and pollution, smoking, certain medical conditions like thyroid and liver diseases. Unfortunately these signs of ageing greatly impact our appearance giving us a tired and depressed look. Recent advances in the field of medicine, now allow us to reduce and reverse these changes around the eyes by surgical and non-surgical methods giving us a youthful and rejuvenated look.
1. Ptosis or Droopy eyes
Ptosis is drooping of the upper eyelid. The eye appears smaller, there is difficulty opening the eye. Ptosis may occur in one eye or both eye. There is obstruction of vision and a sleepy and tired appearance.
There is a muscle in the upper lid that lifts or opens the eyelid called the levator. If the levator is not working normal either because of a birth defect or acquired problem, the eyelid droops.
In many patients who have ptosis since birth, the levator muscle is weak since birth. In patients where ptosis starts later in life, there may be multiple causes : injury, age related loosening of tissues around the eye, use of contact lens for many years, certain neurological conditions.
In a child, the ptosis may cause delay in the development of vision, and a lazy eye (amblyopia). This has to be corrected at a young age, and appropriate glasses and exercise started. Once the patient is older, vision correction cannot be achieved. It is extremely important to have an accurate assessment of vision in a child with ptosis.
For an adult, a ptosis can block part of the visual field, obstructing the vision. There can be strain by lifting the brow muscles to compensate. More and more people opt for ptosis correction to avoid looking tired, sleepy and unhappy.
The oculoplastic surgeon assesses the severity of ptosis and available strength in the levator muscle. Depending on these, either the weak levator is tightened via a lid crease incision or an implant or sling material is placed to connect the eyelid to the forehead thus allowing the patient to effectively use the forehead muscle to lift the eyelid.
After ptosis surgery, the final outcome is known at 4-6 weeks. 90% patients have the eyelid set exactly at the correct height, rest 10% may be little higher or lower and may require minor adjustments. This is because each person’s body heals in a slightly different way.
Usually the eyelid height is equal when the patient looks straight on, while there may be some difference is seen when the patient looks downward. First few weeks after surgery, there may be a small gap betwen the eyelids when the patient sleeps. This gets better as time passes by.
Entropion of the eyelid is a common eyelid condition causing inturning of the eyelid resulting in rubbing of eyelashes onto the eye surface and causing significant irritation, pain, redness and watering from the eye. There are many reasons why this could happen – most common being ageing-related loosening and weakening of the periocular tissues.
This can be easily corrected by eyelid surgery to tighten and rotate the eyelid to its normal position.
Ectropion of the eyelid is a common eyelid malposition in which the eyelid is turned outwards leading to watering, redeness and unsightly appearance for the patient. The most common cause is senile ectropion or ageing- related loosening of the periocular tissues. It can also be caused by scarring in the eyelids after previous trauma or surgery – also known as cicatricial ectropion; or sometimes in cases of facial nerve paralysis (paralytic ectropion).
Depending on the cause, eyelid surgery is performed from simple to complex repair may be undertaken to correct the eyelid deformity.
Lagophthalmos is condition where one is unable to completely close the eyes. This results in drying of the cornea and ocular surface making it prone to infections and loss of vision. It is commonly seen after facial nerve paralysis. Patients with this condition usually present with rednes, watering and constant irritation of the eye. In case of new onset facial paralysis, temporarizing measures to close the eyelid using a tarsorraphy or botulinum toxin injections and thereby prevent infections may be prescribed. A more permanent treatment involves placing a spacer graft or loading the upper eyelid with a gold weight implant into the upper eyelid to lower the eyelid and enable good closure of the eye.