Eye Lids - Upper and Lower

Ptosis

Mainly congenital but can be traumatic, neuroparalytic, myogenic and senile. Congenital is the main concern. Can be mild, moderate and severe. Important considerations for management are- amount of ptosis, LPS function, Bell’s phenomenon, Marcus gunn phenomenon, pre-existing strabismus. Accordingly, Fasenella Servat, LPS resection or a Frontalis sling procedure is to be performed. This case was a congenital simple, moderate ptosis with good LPS function and Bell’s phenomenon and LPS resection by skin approach performed and showed good result.

Tumours

Benign

They are easily managed by simple procedures. This case had a lid abscess which was drained and got cured in next 7-10 days time. Sometimes, inflammatory conditions mimic benign tumours but they respond well with conservative management.

Tumours

Malignan

Obviously, they have to be excised widely and generously and then required method of blepharoplasty is performed. This sebaceous cell carcinoma was excised and two stage Cutler Beard procedure was done with good result.

Trichiasis

Misdirected eye lashes cause constant irritation  and thereby causing non healing corneal ulcers and corneal opacities which in  turn lead to blindness. From manual epilation to electro-epilation to sometimes need much vigorous intervention as Cutler Beard two stage Blepharoplasty as was needed in this child. 

Distichiasis

The clinical condition where there is an extra posterior row of cilia is present usually in all four lids. Managed by splitting the lid into its lamina and cryopexy is done at and near follicles to destroy them completely. The results are not very consistant.

Entropion

Inward rotation of eyelid margin may be present in upper or lower lid. The basic mechanism is either lengthening of anterior lamina or shortening of posterior lamina constituted by a spectrum of causes. In this case because of senile changes anterior lamina i.e. skin and muscles are lengthen and lower lid retractors are weakened. The entropion is corrected by placation of lower lid retractors.

Ectropion

Outward rotation of lid margin may be present in upper or  lower lid. The basic mechanism is either shortening of anterior lamina or lengthening of posterior lamina constituted by a spectrum of causes. In this case acid burn caused cicaterisation of anterior lamina i.e. skin and muscles are shortened and therefore skin grafting was performed and the ectropion is corrected up to a greater extent after first surgery.

Scars

Scar over the lids again poses a problem. The total fibrous tissue has to be excised and proper blepharoplasty is mandatory. Many times it may need skin grafting. After skin grafting temporary tarsorrhaphy is must and graft should cover whole raw area generously.

Hordeoli

Stye or hordeolum externum is acute inflammation of gland of Ziess, managed by plucking out of the concerned cilia with hot compresses and antibiotics. Purulent or acute infection in the chalazion ( Chronic granulomatous Inflammation) is hordeolum internum. Hot compresses followed by incision and curettage is the management of choice. 

Lid Lacerations

Lacerations are caused by trauma. They are repaired after meticulous debridement of dead tissues from suturing by approximation to multiple Z-plasties to flap or graft. Results are quite gratifying if done meticulously.

Haemangiomas & A-V Malformation

Capillary haemangiomas are most of the times disappear by their own. Cavernous and some capillary haemangiomas need specific procedures to tackle them like injections of corticosteroids or boiling water or sclerosing agents intra-lesionally. Results of these procedures are quite gratifying.

A-V Malformations are usually post traumatic, uncommonly congenital. They are surgically repaired, usually assistance be taken by vascular surgeon.

Miscellaneous

A lot of other conditions are also not uncommon and most of them pose aesthetic and some functional concerns as well. Xanthelasma, Dermatochalasis, Blepharochalasis are effectively dealt with surgery with very satisfactory results.