Oculoplastics Program
Blepharoplasty
Upper Eyelid Blepharoplasty can be performed as elective for cosmetic reasons or functional when deemed medically necessary. The outer and upper parts of the visual field are most commonly affected and the condition may cause difficulty with activities such as driving or reading. This can be determined by performing a superior 36 degree Humphrey visual field. If 30% or 12 degrees of the visual field is compromised, confirmed by doing both taped and non-taped eyelids, then insurance may cover the cost of the blepharoplasty.
Post Op: typically no topical drops/ointment, Ice lids 15 minutes every hour for 1 week. Sutures (running and interrupted) and steri-strips are removed at 1 week.
Lower Eyelid Blepharoplasty is almost always done for cosmetic reasons, to improve the puffy lower eyelid "bags" and reduce the wrinkling of skin. This is done transconjunctivally leaving minimal scarring post op.
Post Op: Antibiotic/steroid ointment applied four times daily for 1 week. Ice lids 15 minutes every hour for 1 week. No sutures removed.
Ptosis Repair
In normal lid anatomy the upper lid margin is typically 4-5mm above marginal reflex. Marginal Reflex Distance (MRD)1 of 2.5mm or less is consistent with ptosis. The muscles used to retract the eyelid include Levator (skeletal muscle, CN3 innervation) and Mullers (smooth muscle, sympathetic innervation). Ptosis origins include involutional, prior trauma, myogenic, and neurogenic. In some cases of unilateral ptosis, we may proceed with bilateral lid lift due to Herrings law of equal innervation. Similar to blepharoplasty, 30% or 12 degrees of superior field loss must be affected.
Muller’s Muscle Conjunctival Resection (Mullerectomy)
Indicated for mild to moderate lid ptosis with good response to phenylephrine and has good levator function (>10mm). After local anesthetic the lid is everted, the palpebral conjunctiva with mullers muscle is measured, clamped, sewn together with excess conjunctiva/mullers muscle excised.
Post op: Antibiotic/steroid drops four times daily for 1 week. Ice lids 15 minutes every hour for 1 week. No suture removal needed. Lid measurements reassessed at 1 week. Lid measurements reassessed at 1 week.
Levator Advancement (external)
Treatment of choice for lid ptosis with poor response to phenylephrine or failed prior Mullerectomy with good levator function (>10mm). After local anesthetic incision is made along lid crease, levator aponeurosis is dissected and removed from tarsus and mullers muscle. Levator aponeurosis is re-attached to 2mm below superior border of tarsus.
Post op: Antibiotic/steroid ointment applied to lid excision four times daily for 1 week. Ice lids 15 minutes every hour for 1 week. Sutures removed at 1 week. Lid measurements reassessed at 1 week.
Internal Brow Pexy
Indicated for mild to moderate temporal brow ptosis. An incision is made along the superior lid crease for minimal scarring (similar to blepharoplasty). Dissection is performed 12-18mm superior to the superior orbital rim where a suture is placed through the periosteum then through subcutaneous skin the same distance from superior incision. The suture is pulled tight raising the brow 1-2mm.
Post Op: Antibiotic/steroid ointment applied to lid excision four times daily for 1 week. Ice lids 15 minutes every hour for 1 week. External lid crease sutures removed at 1 week.
Direct Brow Lift
Indicated for severe and medial brow ptosis with advantages of precise lifting and disadvantages of incisional scarring above brows. Excess skin and subcutaneous fat is excised and sutured together with both deep and superficial sutures.
Post op: Antibiotic/steroid ointment applied to lid excision four times daily for 1 week. Ice lids 15 minutes every hour for 1 week. External lid crease sutures removed at 1 week.
Lateral Tarsal Strip (Entropion, Ectropion, Floppy Eyelid Syndrome)
Treatment of choice for above horizontal eyelid laxity and can be performed on upper and lower lids. An incision is made at the lateral canthus (canthotomy) and is separated from the lid (cantholysis). A 5-10mm strip is dissected from the separated lateral canthus and is reattached to the lateral orbital rim.
Post Op: Antibiotic/steroid ointment applied to lid excision four times daily for 1 week. Ice lids 15 minutes every hour for 1 week. Sutures removed at 1 week.