Eyelid surgery (oculoplastic surgery)
(upper eyelid drooping due to excess skin)
The excess skin in the upper eyelid is linked to the loosening of the support tissue and is called dermatochalasis.
Dermatochalasis is easy to treat with superior Blepharoplasty
Excess skin may be resected or simply by an elliptical resection in the lid top fold, or triangular in the outer corner. It is most effective when combining a resection roughly similar in size to the underlying muscle: the orbicularis. It is a myocutaneous resection which is the treatment most often performed for dermatochalasis.
Ptosis (edge of the upper eyelid falling)
Ptosis is defined as a fall of the upper eyelid by more or less significant impotence of the levator muscle of the upper eyelid. Several mechanisms can be implicated: neurogenic damage (of nervous origin), myogenic damage (due to a deficit of the muscle), fascial (most often linked to age) or mechanical (after a trauma for example).
The goal of surgical treatment is twofold, both aesthetic and functional (allowing good vision) by lifting the eyelid which alters the upper visual field.
It is most often a traditional 48-hour hospitalization in children, usually reduced to a day hospitalization (ambulatory surgery) in adults.
There is no medical treatment without exception (myasthenic ptosis). Surgical treatment must first take into account the function of the levator muscle of the upper eyelid (quality of the muscle used to raise the eyelid), which partly conditions surgical indications, the techniques of which are varied.
There are essentially three types of intervention: surgery of the levator muscle of the upper eyelid, conjunctivo-Mullerian resection of the deep face of the upper eyelid and suspension of the eyelid to the frontal muscle.
In adults, most often, ptosis has appeared gradually with age and is linked to a disinsertion of the muscular attachment which it suffices to reinsert through a masked incision in the upper palpebral fold. A resection en bloc of the conjunctivo-Mullerian plane located on the deep face of the upper eyelid is sometimes indicated in case of moderate ptosis with satisfactory function of the levator muscle and positivity of the Neosynephrine eye drops test. More rarely, in myopathic ptosis for example, a suspension at the front may be indicated.
The immediate consequences are usually simple, characterized by edema and a possible hematoma resolved spontaneously, accompanied by difficulty closing the eyes. It takes about ten days before resumption of social or school life. Late consequences are generally limited to an inconsequential nocturnal malocclusion, a logical price paid for treatment
Ectropion or Entropion (Lower eyelid everted outward or inverted inward)
The loosening of the lateral tendons of the eyelid and the exaggerated hyperlaxity of the eyelid are responsible for anomalies in the statics of the eyelid:
- reversal outside the eyelid: the ectropion,
- turning inside the eyelid: entropion,
The cure for entropion, ectropion or abnormal scleral exposure as seen in the round eye is carried out by re-tensioning the lateral tendons of the eyelid or and by a cure for hyperlaxity of the eyelid in the form of a resection of the tarso-conjunctival part.
Lacrimation surgery (DCR, intubation of the lacrimal passages)
A major cause of patients with lacrimation is blockage (blockage) of the tear ducts. Indeed, the lacrimal passages are blocked at the bottom of their path and the tears can no longer be evacuated to the nose. Dacryocystorhinostomy (DCR) involves creating a passage between the lacrimal sac and the nasal cavity. Sometimes associated with a narrowing of a canaliculus. This then complicates the surgical procedure to be performed and decreases the chances of a good result.
Operative techniques and results: To treat this anomaly, three possibilities are currently offered, with in each the possible installation of a silicone probe which will be left in place for one to several months:
Perform a surgical dacryocystorhinostomy by the cutaneous route: It consists in putting the tear sac into communication with the tear sac with the nasal mucosa. During this procedure, a piece of bone is removed.
The intervention can be performed under associated local anesthesia, often reinforced, or sometimes under general anesthesia. The chances of success are great.
Perform a surgical dacryocystorhinostomy with endonasal approach: This heavier technique aims, among other things, to avoid a skin scar. Its principle remains the same: to achieve permanent communication between the lacrimal sac and the nose, but passing through the interior of the nose. It is only possible if your nasal cavities are suitable.
The chances of success are still variable, but seem, with experience, to obtain the same success rates as the dermal route.
Lacrimation pathologies are managed in conjunction with the Lacrimation Clinic (Sainte Elisabeth Namur), which is a multidisciplinary Ophthalmology - ENT management center for lacrimation
Source : SFO