Ptosis is the medical term for droopy eyelids. The edge of the eyelid falls and covers the pupil causing a falsely tired appearance. The vision may be blocked. Ptosis occurs in adults as the tendon that lifts the eyelid stretches or separates from its normal attachment. Children can be born with ptosis due to poor development of the eyelid’s elevating muscle. It can also occur after cataract or retinal surgery. Adult and congenital ptosis are treated surgically.
Eyelid Skin Cancers
Skin cancer is a common malignancy, particularly in sunny climates such as Florida. Eyelid skin cancers are most prevalent on the lower eyelid. They typically appear as painless elevations or nodules along the eyelid margin. The eyelashes may be distorted or missing. Ulcerations, bleeding or crusting may be present. Basal cell carcinomas and squamous cell carcinomas are most common. After the skin cancer is removed, the defect is reconstructed. The goals of treatment are complete tumor excision, and functional, aesthetically pleasing reconstruction.
The eyelids are designed to protect the eye. If the eyelids are not in proper position, patients can experience redness, tearing, discomfort and blurry vision. Ectropion is a condition commonly seen where the lower eyelid is loose. The eyelid can dip down exposing the bottom of the cornea. In some patients, the lower lid flips forward exposing the pinkish/red tissue inside the eyelid. Ectropion is treated with a variety of surgical techniques.
Entropion is another common eyelid malposition. With this condition, the eyelid margin rolls inward causing the lashes to rub against the eye. The lid margin appears thickened. Patients complain of tearing, mucous discharge, foreign body sensation and redness of the eye. Entropion is corrected with an outpatient surgical procedure.
Tears are made by glands located under the eyelids and are eliminated by evaporation and drainage. As you blink, the eyelid spreads the tears over the surface of the eye and pumps the fluid into a duct, which drains into your nose. Irritation of the eye (from misdirected eyelashes) or eyelids (due to blepharitis) can cause excess tear production. Poor eyelid position can lead to inadequate pumping of tears into the duct. Blockage of the duct will cause the tears to back up and spill over the eyelid. As a multitude of problems can cause wet, tearing eyes, a thorough evaluation is needed to determine the causative factors. Medical and surgical treatments are available to alleviate these symptoms.
Blepharospasm and Hemifacial Spasm
Blepharospasm and Hemifacial Spasm are both conditions causing uncontrolled spasm of the eyelid, brow and cheek. Blepharospasm is a rare neurologic disorder affecting both eyes. Patients have frequent forced blinking and eye irritation which can be worsened with stimuli such as bright lights, fatigue, stress, wind and air pollution. The average age of onset is 56 years. Blepharospasm is more common in women. The cause of blepharospasm is unknown.
Hemifacial spasm is characterized by contractions on one side of the face. Hemifacial spasm may follow an episode of Bells Palsy. It may be caused by pressure on or irritation of the facial nerve.
Treatment for both conditions is most commonly botulinum toxin injection. The medication is injected in small quantities to the muscles causing the abnormal contractions. The toxin weakens the muscles for approximately three months at which time the injections are repeated.