EYELID SURGERY THE UK GUIDE. Everything you need to know about eyelid conditions and treatments

Transcription

1 THE UK GUIDE EYELID SURGERY Everything you need to know about eyelid conditions and treatments Jane M Olver BSc, MB, BS, DO, FRCS, FRCOphth American Academy Ophthalmology American Society Ophthalmic Plastic and Reconstructive Surgery European Society Ophthalmic Plastic and Reconstructive Surgery British Society Oculoplastic Surgery

2 Table of contents Introduction 1 Eyelid at a Glance 2 Which conditions do we treat? 3 Chalazion 3 Drooping Eyelids 6 Eye Bags 10 Blepharitis and Meibomitis 14 What tests will I have before eyelid surgery? 17 What happens on the day of surgery? 19 What happens on the day after surgery? 21 Why should I pay for private eyelid surgery? 23 Why should you choose me to treat your eyelids and do your eyelid surgery? 25 Final Word 27 Download all of our guides! 27

3 Introduction My name is Jane Olver and I am a Consultant Eye Surgeon at Clinica London. My special expertise is in eyelid and facial surgery. I have over 20 years experience in treating people with eye and facial contour concerns. After initially starting out as an NHS Consultant I chose to further enhance my patient s options by offering them more comprehensive solutions via my private practice. In this guide, I will tell you about the most common eyelid problems that I treat, both surgically and non-surgically, as well as provide answers to the most common questions and concerns my patients have. My personal ethos is to provide you with the best private eye and aesthetic treatment in the world. The reason that I created Clinica London was to be able to deliver upon this vision for excellence and I am confident that myself and my team can deliver the high level of care that you deserve. Best regards, Jane M Olver BSc, MB, BS, DO, FRCS, FRCOphth This guide was created out of conversations I ve had with patients. I ve recently sat down and answered similar questions on video so I could share this information online as well as here in written form. I hope you like the conversational and straight forward nature of this guide. 1

4 Eyelid at a Glance What is it? What is an oculoplastic surgeon? Eyelid surgery is delicate oculoplastic surgery of the eyelids in order to maintain good eyelid structure and function The surgery takes into account eye movements and must consider the full closing, opening and movements across the surface of the eye Most eyelid surgery is done simply with numbing of the area The care of the eyelids, whether by medical or surgical treatment, is called oculoplastics and is done by an oculoplastic surgeon An oculoplastic surgeon is someone who has trained as an eye doctor then specialised in eyelids and the surrounding area Oculoplastic surgeons do particularly delicate surgery on the eyelids, always maintaining the protection of the eye and the aesthetic appearance of the eye area as their priority What eyelid conditions do I treat? Eyelid lumps, drooping eyelids, eye bags and blepharitis Acute dacryocystitis Post enucleation socket syndrome (PESS) Ectropion Entropion Injuries Call us with any question on:

5 Conditions Treated Eyelid ptosis / Eyebags / Droopy eyelids Treatable Areas Upper and lower eyelid Practitioner Doctor Downtime The healing after blepharoplasty surgery will take a few weeks. Therefore, we advise 5-7 days off work. Your Specialists Which conditions do we treat? Chalazion A chalazion (also known as a meibomian cyst or an eyelid lump or cyst) appears as a lump on the eyelid. It is a very common eyelid condition which is benign and easily recognised and diagnosed. It is treated either medically or surgically. A chalazion typically presents as an inflamed swelling in the eyelid caused by a blocked oil duct (meibomian gland). Jane Olver Consultant Ophthalmic Surgeon Eyelid & Lacrimal Specialist Each eyelid contains over 25 of these oil secreting ducts (located in the tarsal plates) which open onto the eyelid margin and secrete oil into the tear film, helping to stop the tears evaporating. If just one duct gets blocked, oil accumulates and may cause a painful, inflamed lump. Very rarely, a chalazion may masquerade and in fact be a tumour, called a meibomian gland carcinoma or sebaceous cell carcinoma. Call us with any question on:

6 This tends to be the case particularly if the chalazion doesn t go away with incision and curettage surgery or appears solid at surgery, in which case a biopsy is taken. Treatment: Incision and curettage (I+C) This is done with numbing of the area. A small opening is made in the cyst, and the contents cleaned out. First the skin is cleaned and a drop of local anaesthetic is instilled onto the eye surface. Further local anaesthetic is injected into the skin around the chalazion. I place a small clamp and the eyelid is everted (you may feel some pressure or pulling but no pain). I incise the chalazion from the underside of the eyelid. Old inflammatory debris is drained from the cyst and the cavity is curetted (cleaned). An empty, clean meibomian duct is left after I+C. At the end of the procedure pressure is applied to the eyelid, antibiotic ointment applied and the eye is padded firmly for Call us with any question on:

7 up to 24 hours. Antibiotic ointment should be used 4 times a day for a week. FAQs Does the No, the eyelids are numbed. We conduct the treatment treatment hurt? under local anaesthetic How long does the treatment Only about 30 minutes take? What is the downtime after the treatment? Very brief - this is an out-patient procedure under local anaesthetic with a rapid recovery time. When will I see results? Very soon after swelling disappears. How long does the result last? It is unlikely that the chalazion will come back, but there are over 20 other meibomian ducts in each eyelid which could become blocked and cause a new chalazion in the future. What if I don t want surgery? You don t have to have surgery. There is a very good chance that with time (6 9 months) the lump will gradually settle and disappear. Surgery helps it disappear quickly. Alternative treatments: injections of a small amount of steroid or 5- fluoruracil into the eyelid around the lump to quieten the inflammation and help it settle faster. A small inflamed chalazion is often treated by a combination antibiotic steroid ointment for a week to 10 days and then surgery only considered if the lump fails to go away Call us with any question on:

8 When is a If the chalazion is already getting better and there is just a chalazion not very small lump that doesn t look as though it contains suitable for I+C? anything to drain. Drooping Eyelids Drooping eyelids are called ptotic eyelids. Eyelid ptosis in adults is usually a result of ageing that affects the muscles in the eyelid. These muscles are designed to lift the upper eyelid. Eyelid ptosis can also occur in younger adult patients, especially those who wear contact lenses, due to a continuous micro trauma from insertion and removal of the lenses. Eyelid ptosis in children can be due to weak muscles that make the eyelid drop. In rare cases, eyelid ptosis can be related to a neuromuscular disease. Eyelid ptosis can also occur with the use of some drugs, following eyelid trauma or with the extra weight of an eyelid lump such as a large chalazion or tumour. Call us with any question on:

9 The levator and Muller s muscles, which lift the eyelid, are shown below: Call us with any question on:

10 Treatment: Ptosis surgery I perform a full ophthalmic examination to check visual function, eye movement, the eyelids and the ocular surface, a full face examination and take photographs. I assess the surface of the eye and the lids using a slit lamp. I may use drops to dilate the pupil, whilst the surface of the eye is checked for signs of dry eye. I may find it necessary to do visual field test to check if the vision is impaired. The only permanent way to treat eyelid ptosis is with surgery. There are several possible surgical techniques. The type of ptosis found dictates the surgery that will be required. Surgery can be done through the upper eyelid skin crease where it remains hidden, called the anterior approach. Alternatively it can be done from the undersurface of the upper eyelid, called the posterior or conjunctival approach. I will advise which is preferred for your eyelid. Call us with any question on:

11 FAQs Does the treatment hurt? How long does the treatment take? I inject local anaesthetic into the eyelid, numbing it. This injection can sting slightly. I may give patients sedation before the injection to make them drowsy so they don t feel the injection. Most patients claim to feel little or no pain during surgery. You will be aware of some sensations such as pressure, although these do not cause discomfort. After the operation, the eyelid may ache for a few days. Painkillers such as paracetamol and ibuprofen will settle this. About 30 to 40 minutes. What is the downtime after the treatment? The recovery time is about 4 weeks. We advise you to take 3-5 days off work. When will I see results? It can take up to 6 months until you can see the final results, although swelling will be gone by 4-6 weeks after surgery. How long does the result last? The result of surgery is usually permanent. Call us with any question on:

12 Eye Bags Eye bags refer to an excess of eyelid tissue which can affect the upper and lower eyelids with age. Not only can eye bags look unsightly but they can also impair vision. I will ask the patient how the eye bags affect him, determine whether the problem is cosmetic or also affects vision. It is also useful for the patient to provide photographs taken prior to the eye bags becoming noticeable, for instance from two to five years younger, to aid in understanding the individual cases and to plan their blepharoplasty. The examination for eye bags includes making sure there is no dry eye, eyelid laxity or any other conditions that could be exacerbated by a blepharoplasty. The patient s entire face and eyelids are examined during the consultation. Treatment: Blepharoplasty Eyelid Surgery If indicated, I treat fine wrinkles with a gentle chemical peel or deeper wrinkles with Botulinum toxin (Botox) to compliment the effect of eyelid surgery. Upper eyelid blepharoplasty This is an eyelid lifting surgery to remove excess upper eyelid skin which makes the eyelids droop. I typically make the incisions in the upper eyelid skin crease, where they heal best and will remain well hidden, and remove the excess Call us with any question on:

13 skin overhanging the skin crease. The height of the skin incision above the eyelashes varies between six and eight millimetres but is commonly lower in Asian blepharoplasty patients who have a naturally low skin crease, unless Westernisation is requested. I remove an elliptical piece of skin and muscle very neatly. It is also possible to remove underlying fatty material during the process to get rid of upper bulges. Then I close the skin incision using delicate sutures and /or Tisseel fibrin adhesive. Subsequently I may recommend Ultherapy (microfocused thermocoagulation of the deep dermis) to raise and open up the area around the eyelids as adjuvant treatment. I also advise on general skin care around the eyes. Lower eyelid blepharoplasty Patients with only mild eye bags may not require a blepharoplasty. Instead, they may get a noticeable improvement from a combination of a chemical peel, Botox and hyaluronic acid gel (Restylane) in the tear troughs. To remove fatty bulges, I make the incision from the Call us with any question on:

14 inside of the lower eyelid, which leaves no scar visible on the outside. This is known as a transconjunctival blepharoplasty. If I remove skin from the lower eyelids during blepharoplasty, I make a fine incision (known as an infra-lash incision) close to the eyelashes. At the same time, I tighten the eyelid using an orbicularis muscle flap. I use discreet absorbable sutures to close the skin incision, which usually leaves little or no visible scar. A pinch blepharoplasty of the lower eyelid is an excision of just a small pinch of skin from either below the eyelashes or a little lower down the eyelid, without touching the orbicularis muscle. Punctal plugs I may insert punctal plugs at the same time as a blepharoplasty surgery with patients with dry eye, to reduce dry eye symptoms after surgery. Call us with any question on:

15 FAQs Does the treatment hurt? How long does the treatment take? What is the downtime after the treatment? There is mild discomfort and dry eye afterwards. Most people need only non-prescription pain relievers and lubricating eye drops. Narcotics are rarely necessary. Up to 2 hours, There will be some bruising and redness with swollen eyelids, particularly during the first few days. It will take a few weeks for the healing to complete. When will I see results? The results are seen immediately. After a few hours there is natural post-operative swelling and bruising, so you have to wait for the healing to be completed and all swelling and bruising to resolve before seeing the best results. How long does the result last? 5-10 years. The eyelids will continue to age, in line with the normal ageing process of the rest of the face. Some patients require a second blepharoplasty after 10 years because of continued skin laxity from ageing. Call us with any question on:

16 Blepharitis and Meibomitis Blepharitis is the medical term for inflammation of the eyelid margins. It causes redness, irritation, itchy eyelids and the formation of scales on eyelashes. Although uncomfortable, blepharitis is not contagious and usually does not cause any serious damage to the eye. It can be treated but not cured; if untreated it can sometimes lead to eyelid entropion from scarring. Blepharitis is often associated with acne rosacea and can form part of ocular rosacea. Call us with any question on:

17 There are two main types of blepharitis: 1. Anterior blepharitis: Occurs at the outside front edge of the eyelid where the eyelashes are rooted. 2. Posterior blepharitis: Affects the inner edge of the eyelid that is in contact with the eyeball and is called Meibomian Gland Dysfunction (MGD). In this the oily meibomian glands opening on the lid margins become blocked with inspicated meibomian secretions. The oil produced by the meibomian glands is thicker and has a milky appearance, rather than a clear oil. Treatment: Blepharitis Blepharitis is treated by a combination of: Heating Massage Cleaning Diet Skin advice Based on my examination of your eyelids I will advise you on the options appropriate to your degree of blepharitis. We will discuss these and agree on your treatment. Often I recommend that you start on a low level of treatment and depending on your response to treatment, gradually increase the intensity and range of options. Sometimes, if there is particularly bad dry eye associated, I advise on minor surgery consisting of insertion of punctal plugs. Call us with any question on:

18 FAQs Does the treatment hurt? How long does the treatment take? What is the downtime after the treatment? No, it is soothing. It takes 6 to 8 weeks for substantive improvement, therefore your perseverance is essential. Treatment can take up to 30 minutes each day, as 15 minutes morning and evening when treating blepharitis intensively for the first 8 weeks, thereafter, half that time. When will I see results? By 8 weeks, and progressively improving over several more months of dedicated treatment. How long does the result last? The results can last several months, then if the maintenance treatment is reduced or you are having a lot of stress, the blepharitis can re-appear. Will my blepharitis ever be cured? It can only be treated, not cured. Call us with any question on:

19 What tests will I have before eyelid surgery? After taking your history and hearing how your eyelid problem affects you, I do a full face, eyelid and eye assessment, in order to build an accurate picture and advise on the medical or surgical treatment options. Assessment includes: Measurements of your vision Eyelid measurements The tear film Exclude blepharitis at the eyelid margins Eyelid and eyelid tendon laxity Call us with any question on:

20 Photographs Examination of the eyelid and eye using eye drops Tests are done in the comfortable consulting room with the nurse present to assist. She will also do some tests if indicated, such as the peripheral vision test (visual field analysis). Call us with any question on:

21 What happens on the day of surgery? I do most eyelid surgery at Clinica London in our small day case operating theatre. On the day of surgery we get you up to the clinic one hour beforehand in order to go through the forthcoming surgery with the nurse and the surgeon. You will already have had the information sheet about your condition, and had a chance to ask questions, however, we like to go over all of that with you again so that it is fresh in your mind, and also so that you know what to expect after the surgery. We go through the post operative management, eyelid cleaning, insertion of eye drops or ointment, and use of ice or cooling Call us with any question on:

22 masks. We warn you what to look out for after surgery. We read through the consent form and discuss the possible common or significant side effects of surgery, and then, once we both agree, we both sign the consent form. The nurse then takes you through to the operating theatre. Because it is day surgery, you can wear your normal clothes as long as they are comfortable, and you must remove all jewellery. The day theatre has a very comfortable couch which allows you to lie flat, tilted or sitting up as necessary during the surgery. Light relaxing music is played at low volume during the surgery. I am assisted by the Clinica London nurse. After the surgery we move you to the day care recovery area for about an hour and give you refreshments. You can go home accompanied by family or friends in a car or taxi. Call us with any question on:

23 What happens on the day after surgery? When you arrive home you must sit and sleep propped up for the first 24 to 48 hours. If an eye pad has been placed after the eyelid surgery, this is usually removed the morning afterwards at home. We provide you with a postoperative eyelid cleaning materials and your Call us with any question on:

24 eyedrops and any tablets, from the clinic so you will have everything you need available. We always call you the day after surgery to ensure that everything is alright. You are also given an emergency telephone number to call us if you have any concerns. We will have instructed you on how to put the eyedrops in, told you your do s and dont s and arranged a follow up visit. Call us with any question on:

25 Why should I pay for private eyelid surgery? Having private eyelid surgery, whether you are self paying or paying via your private medical insurance company, gives you peace of mind that you will be treated quickly, appropriately and with exceptionally good follow through, from your first visit to discharge, by a dedicated and very experienced team. At Clinica London we aim to provide you with the highest level i We will give you the support of the whole Clinica London team and make sure that you get the best possible eyelid surgery result. Call us with any question on:

26 of eyelid surgery care and support you at every step. You will always have an opportunity to ask questions, give your views and work with us to get the best possible results. We will listen and advise you of the treatment options at all steps of the way. Call us with any question on:

27 Why should you choose me to treat your eyelids and do your eyelid surgery? What I can provide you is my experience and excellence based on 20 years as an Eyelid Surgeon. I have done many hundreds of eyelid surgeries. Currently I am doing around 300 operations per year. I was trained at one of the leading eye hospitals in the world and have visited and learnt from many international eye surgeons, as well as being an active invited teacher and lecturer internationally. My surgery has a low complication rate and I am experienced managing the eyelids after eyelid surgery. 25 Call us with any question on:

28 I work full time at Clinica London making my availability very good. I will always respect you and your views and needs and give you time to share those with me. I will listen to your worries about your eyelids, share the decision making with you and reassure you about your forthcoming surgery, making sure that you are well informed and prepared for it. We will give you the support of the whole Clinica London team and make sure that you get the best possible eyelid surgery result. The UK Guide to Diabetic Retinopathy Understand the things you need to know about Diabetic Retinopathy Click to download this patient guide Call us with any question on:

29 Final Word I know from experience that it is not always easy to decide - there are lots of things to consider and this guide can only give a general overview. That is why I recommend you to have a personal appointment with an eyelid surgeon to discuss your needs in detail. You will soon know if you feel comfortable. It is tremendously important that you are happy during the whole process, from first contact to saying goodbye after your eyelids have completely healed post surgery. Myself and my Clinica London nurses want to look after you professionally and to the highest standards. Your needs always come first. In order to simplify your decision to arrange an appointment, I want to conclude with 10 reasons to call Clinica London to arrange to see me: 1. I am a top London eyelid surgery specialist 2. I am very well respected as an International Eyelid surgeon 2. I perform a high number of eyelid surgeries each year 3. I offer personal and customised attention at every step 4. I work with a first class team of nurses and administrative staff 5. I have access to cutting-edge technology at Clinica London 6. My fees are fully covered by insurance and I have transparent pricing models for self paying patients 7. I am highly trained as a consultant ophthalmologist specialising in oculoplastic surgery 8. I have 20 years of consultant experience in London 9. You'll receive the best care, as an individual 10. My patients provide enthusiastic testimonials about their eyelid surgery If you would like to discuss your particular eye concerns please call us on to make an appointment. We'll explore the best treatment options for your. Call us with any question on:

30 Download all of our guides! The UK Guide to Eyelid Surgery Understand the things you need to know when pursuing Private Eyelid Surgery Click to download this patient guide The UK Guide to Aesthetic Treatments The UK Guide to Cataract Surgery Understand the things you need to know about Aesthetic Treatments Understand the things you need to know when pursuing Private Cataract Surgery Click to download this patient guide Click to download this patient guide The UK Guide to AMD Treatment The UK Guide to Glaucoma Treatment Understand the things you need to know when pursuing Private AMD Treatment Understand the things you need to know when pursuing Private Glaucoma Treatment Click to download this patient guide Click to download this patient guide 27