Oculoplastic and Orbital Diseases

Disease/Condition

• Ptosis is the medical term for a droopy eyelid. There are many causes of droopy eyelid, such as aging or degeneration that results in loosening of the levator muscle responsible to elevate the eyelid (the most common cause). Aponeurotic ptosis can be treated by surgical tightening of the levator muscle.

  
  Other causes include long-term use of contact lenses, frequent vigorous rubbing of the eyes or, less commonly, other neurological diseases that might include myasthenia gravis, oculomotor nerve palsy or Horner’s syndrome. These neurological causes of ptosis can be potentially serious or even life-threatening. Therefore, it is important to find the cause of ptosis and treat it accordingly.

• Dermatochalasis refers to the excess skin and sagging of the eyelids, often due to aging. It can create a tired appearance and may obstruct peripheral or superior vision. Treatment typically involves blepharoplasty, a surgical procedure that removes excess skin and fat to rejuvenate the eyelids.
   

Symptoms

• A sense that the upper field of vision is being blocked at first.
• When the drooping eyelid covers the pupil of the eye, vision may become completely blocked.
• Children with ptosis may tilt their head up to help them see under the eyelid, or may lead to amblyopia (lazy eye).
• Tiredness, achiness and heavy feeling around the eyes.
   

Diagnosis

• A visual inspection
• Visual field testing with and without eyelid taping or elevation
• Phenylephrine Test (for Ptosis)
   

Treatment

• Upper Eyelid Surgery
  • The surgery can be performed under local anaesthesia, monitored anaesthetic care (MAC), or general anaesthesia (GA).
  • Incision is usually made in the natural lid crease of the upper eyelid, or sometimes over the conjunctival side without skin incision.
  • Removal of excess skin, fat or tightening of the muscles and tissues can be performed depending on individual situation.
  • Eyelid incision may be closed with removable and/ or absorbable sutures

Disease/Condition 

• Entropion is a condition where the eyelid turns inward, causing the eyelashes to rub against the eye. This can lead to irritation, eye pain, redness, and potential damage to the cornea. It is often associated with aging, scarring, or muscle weakness. Treatment usually involves surgical correction to reposition the eyelid.
• Ectropion is the outward turning of the eyelid, which can expose the inner eyelid and lead to dryness, irritation, and excessive tearing. This condition can result from aging, scarring, or paralysis of facial muscles. Treatment may involve surgery to restore the normal position of the eyelid.

Symptoms

• Entropion
  • Foreign body and gritty sensation.
  • Eye redness.
  • Eye irritation or pain.
  • Sensitivity to light and wind.
  • Watery eyes (excessive tearing)
  • Mucous discharge and eyelid crusting
• Ectropion
  • Excess tearing.
  • Dry eyes
  • Inability to close the eyelids completely
  • Eye and eyelid itching, burning, or crusting 

  • Blurry vision, sensitivity to light, and eye pain 

     

Diagnosis 

• Eye exam
• Assess eyelid's position, muscle tone and tightness

Treatment 

• Lower Eyelid Surgery
  • Incision is usually made along the skin lines
  • Correct an eyelid that turns in or turns out.
  • Removal of excess skin or tightening of the muscles and tissues.
  • Closing skin wounds with suturing

Disease/ Condition

• Nasolacrimal Duct Obstruction (NLDO) refers to a blockage in the nasolacrimal duct, which drains tears from the eye into the nasal cavity. This condition can lead to symptoms such as excessive tearing, discharge, and recurrent eye lid infections. NLDO can be congenital (present at birth) or acquired due to factors like age, trauma, or infections. Most cases may not have a cause.
• Dacrocystitis is an inflammation or infection of the lacrimal sac, often resulting from NLDO. It typically presents with pain, swelling, and redness in the area around the inner corner of the eye and surrounding face. Patients may also experience purulent discharge. Dacrocystitis can be acute or chronic and may require antibiotic treatment or surgical intervention to relieve the obstruction and infection.

Symptoms

• Watery eyes / Tearing / Epiphora (overflow of tears onto the face)
• If there is inflammation / infection of tear sac (nasolacrimal duct) :
  • Eye pain
  • Swelling of inner corner of eyelids
  • Redness or skin darkening around the affected eye(s)
  • An abscess / sore / discharge (pus) in the inner corner of eyelids
  • Fever 
     

Diagnosis

• Lacrimal Irrigation (i.e. Syringing and Probing)
• Nasal Endoscopy
• May sometimes need imaging like CT scan or MRI scan
   

Treatment

• Nasolacrimal massage
• Warm compress
• Oral Antibiotics, Antibiotic eye drops or ointments
• Surgery (i.e. Endoscopic Dacryocystorhinostomy (EDCR) - creating a new opening that allows tears to flow from the lacrimal sac to the nasal cavity)

Disease/Condition 

• A chalazion, is a red, swollen painless lump on the eyelid that forms when a Meibomian gland was blocked, which produces oil to keep the eye lubricated. It is not usually associated with infection and may resolve its own or require warm compress or minor procedure for incision and curettage.it may sometimes get infected and become swollen and painful.

Symptoms

• A lump in the eyelid
• Redness
• Swollen
• Sometimes tender to touch 

Diagnosis

• Physical eye examination

Treatment

• Seek early medical attention.
• Warm compress for chalazion.
• Removal of chalazion and small eyelid mass, lesion, reconstruction surgery
• Surgery can be performed under local anaesthesia (LA) and topical anaesthesia (TA), or general anaesthesia (GA).
• The lesion may be sent to pathology for further investigation.