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Oculoplastics

EYELID PTOSIS (Droopy upper eyelid)

This eyelid condition can be congenital (present at birth) or acquired later in life. It is generally corrected by eyelid surgery.

Congenital Ptosis

This condition is either inherited or an isolated birth defect and is already noticeable in very small babies. This is most likely due a weak levator muscle which raises the eye lid. Occasionally the vision on the affected side may be reduced. The child will need regular monitoring of his/her vision. Surgery can be carried out if the vision is not developing normally or to improve the appearance.

Acquired Ptosis

This could be due to:

  • Defect of the levator muscle tendon due to ageing or contact lens wear
  • Weakness in the eyelid muscles occurring in some rare muscle conditions
  • Problem with the nerve which controls the muscle of the eyelid
  • Mechanical defect caused by lid swelling/cyst

Treatment

This usually involves surgery. For children this can generally be performed from the age of 3-4 years under general anaesthesia (asleep). In adults, it is preferable to carry out the operation under a local anaesthetic with the patient awake but sedated. A co-operative patient allows the surgeon to set the eyelid height and shape more accurately at the time of surgery.
If both eyes are affected, the surgery is usually carried out on both sides at the same time. The type of operation depends on the cause of the Ptosis. This usually involves shortening and strengthening the levator muscle which opens the eyelid. Occasionally, the lid is raised by suspending it from the brow muscle. The tissue used for this may be man-made or harvested from the leg through a small cut above the knee.

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Ectropion

Eyelid ectropion refers to a sagging and outward turning of the lower eyelid. This can occur through trauma to the eye, previous eye surgery, or as a natural part of ageing. Corrective surgery involves shortening and tightening the eyelid to return it to its natural position, using just a few small stitches at the corners of the eye. These are removed within 7 to 14 days.

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Entropion

Eyelid entropion occurs when the eyelid begins to turn inwards. Again, entropion can be caused through trauma, previous eye surgery or as a natural part of ageing, but can also be caused by allergic reactions or certain illnesses. The condition can be cured effectively by tightening up the eyelid and its muscle, which gently returns it to its natural position.

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Watering Eye

Watering eye is a condition that can be caused by conjunctivitis, foreign bodies in the eye, or when the eye’s drainage channel becomes blocked. If the watering eye is caused by a channel blockage, the obstruction is removed with a type of surgery called dacryocystorhinostomy (DCR). Performed under general anaesthetic, DCR surgery involves creating a new tear duct to allow water to drain away fully.