Oculoplastics
What is a pterygium?
A pterygium is a fleshy triangular growth that develops when an eye is regularly exposed to bright sunlight and wind. It’s usually a harmless condition affecting the ‘skin’ of the eye (the conjunctiva- the white part of the eye), typically on the side closest to the nose. If it grows across the cornea or pupil (the coloured part of your eye), it can cause issues with your vision.
Signs and symptoms of a pterygium
- redness and swelling of the conjunctiva, mostly while the pterygium grows
- a yellow/red spot or bump on the white of your eye
- dry, itchy, burning, and foreign sensation in the eyes
- blurry or “distorted” vision
Treatment options for a pterygium
Depending on the severity of your pterygium your ophthalmologist will first start by suggesting lifestyle modifications such as wear UV protective sunglasses while outdoors and the regular use of lubricating eyedrops or eye gels to help with dryness and discomfort. The only way to remove a pterygium is by surgical means and your ophthalmologist will go through with you if this would be your best option
What is a chalazion/stye?
A Chalazion is an enlargement of oil glands (similar to a pimple) deep in the eyelid caused by an obstruction of the gland’s opening. Styes are usually infected eyelash follicles. (Inflammation of the edges of the eyelids). Some people may have one or two styes in a lifetime which could resolve spontaneously, but other people may develop them repeatedly.
Signs and symptoms of a chalazion/stye
A chalazion can develop gradually and they can include:
- A bump on the eyelid, sometimes becoming red and swollen
- Tenderness around the bump area
- Blurry vision, if the chalazion is large enough to press on the eyeball
Stye symptoms can include:
- A very painful red bump (almost like a pimple) along the edge of the eyelid at the base of the eyelashes. It may make the entire eyelid swell
- A small pus spot at the centre of the bump
- Feeling a foreign body sensation in the eye
- Itchiness around the bump site
- Being sensitive to light, especially if the bump starts touching the eyeball
- Crustiness along the eyelid margin
Treatment options for a chalazion/stye
- Warm compressions can help clogged oil glands open and drain out built up pus within a chalazion or stye
- Antibiotic eyedrops can also help if an infection has started to develop
- Surgery to drain out the chalazion or stye
What is a ptosis?
Ptosis is a drooping of the upper eyelid. The lid may droop only slightly, or it may cover the pupil or eye entirely. Ptosis can affect one or both eyelids. In some cases, ptosis can restrict and even block normal vision.
Signs and symptoms of a ptosis
- Drooping of one or both upper eyelids
- Watery eyes
- Interference with their vision if the ptosis is severe
Treatment options for a ptosis
Depending upon the cause of a ptosis, treatment options can vary vastly. If the ptosis causes a problem with vision, appearance, or both, it may need to be treated. The type of treatment depends on whether the ptosis is caused by a disease or by aging. Treating ptosis caused by aging usually involves surgery. If the cause is by a disease, then your ophthalmologist will first recommend treating the disease first, which could in turn help resolve a ptosis.
What is an ectropion?
Ectropion is a condition in which your eyelid turns outward. This leaves the inner eyelid surface exposed and prone to irritation. Ectropion is more common in older adults, and it generally affects only the lower eyelid. In severe ectropion the entire length of the eyelid is turned out.
Signs and symptoms of an ectropion
- Dryness or a feeling that you have sand or grit in your eyes
- Irritation, burning or stinging that causes the inside of your eyelids to turn red
- Light sensitivity from dryness and discomfort
- Red and watery eyes from tears that don’t drain properly as an ectropion pulls the lower lid away from your eye, preventing tear drainage
Treatment options for an ectropion
Eyelid ectropion tends to get worse over time and most people will need surgery. The type of surgery you have depends on the underlying cause. If your condition is due to aging, your ophthalmologist may shorten and tighten your lower eyelid. If you’ve experienced eye trauma or need a growth or tumour removed first, you may require a graft to lengthen the eyelid skin.
What is an entropion?
Entropion is a condition in which your eyelid, usually the lower eyelid, is turned inward so that your eyelashes rub against your eyeball.
Signs and symptoms of an entropion
- The feeling that something is in your eye
- Pain when blinking
- Eye redness
- Eye irritation or pain
- Sensitivity to light and wind
- Watery eyes (excessive tearing)
- Mucous discharge and eyelid crusting
- Decreased vision
Treatment options for an entropion
Artificial tears and lubricating ointments can help relieve symptoms of entropion. But usually, surgery is needed to fully correct the condition. If left untreated, entropion can cause damage to the transparent film covering in the front part of your eye (cornea), eye infections and vision loss.
What are eyelid cancers?
Eyelid cancer is a general term for a cancer that occurs on or within the eyelid.
Signs and symptoms of eyelid cancers
Symptoms of skin cancers that develop on the eyelid include:
- A bump that is smooth, shiny, pearly, or waxy, or firm and red
- A sore or lump that bleed or develops a crust or a scab
- A flat, flesh-coloured, or brown scar-like lesion
- A rough and scaly red or brown patch
- An itchy or tender flat spot with a scaly, crusted surface
- A stye that does not heal
- Loss of eyelashes
Any nodule or lesion on the eyelid that grows, bleeds, ulcerates, or does not heal should be evaluated.
Treatment options for eyelid cancers
Your ophthalmologist will usually treat tumours on the eyelid using microsurgery with frozen section control. In both procedures your ophthalmologist will remove the tumour and a small margin of skin around it in very thin layers, examining each layer for tumour cells as it is removed, ensuring the best removal of cancer and the least amount of healthy surrounding tissue, and decreasing the rate of recurrence. With early diagnosis and treatment using one of these surgical approaches, the prognosis for most eyelid cancers is good, with a low chance of recurrence. After the tumour is removed, they can often repair the site where the tumour was removed and achieve a very good cosmetic and functional result.
What is Thyroid Eye Disease ?
Thyroid eye disease (TED) is an eye disorder that causes inflammation (swelling) and damage to the tissues around the eye, including muscles, fatty tissue and connective tissue. TED is an autoimmune condition, or one that happens because your protective immune system attacks your body.
Symptoms of Thyroid Eye Disease
- Dry eyes
- Irritated eyes due to a gritty feeling
- Watery eyes
- Red eyes
- Eyes bludging out of eye socket
- Double vision
- Difficulty closing your eyes completely. This can lead to an ulcer on your cornea
- Pain behind your eyes and pain with eye movements
Symptoms normally affect both eyes, but sometimes you may only notice symptoms in one eye.
Treatment options for Thyroid Eye Disease
The most important lifestyle change you can make is to quit smoking if you smoke. It can decrease the effectiveness of treatment for thyroid eye disease. Lubricating eye drops to relieve dryness and irritation are generally non-prescription. You can buy them over the counter.
Surgical options include eyelid, eye muscle and/or orbital decompression surgery to relieve more severe symptoms.
What is Facial Nerve Palsy ?
Facial Palsy refers to weakness or loss of function of the facial muscles, mainly resulting from temporary or permanent damage to the facial nerve causing paralysis of the affected part of the face. The inability to make facial expression is not just a cosmetic issue but can cause significant eye health problems, particularly if the eyelids are unable to close fully.
Symptoms of Facial Nerve Palsy
- Sore, watery and red eyes
- Reduced vision in one eye
- Conjunctival or corneal infections/ulcers
- Lower lid out-turning (ectropion)
- Distressing facial asymmetry
- Mouth drooling
- Inability to fully blink
- Eyebrow droop
- Cheek drooping
- Lip biting
- Inability to smile on one side
Symptoms normally affect both eyes, but sometimes you may only notice symptoms in one eye.
Treatment options for Facial Nerve Palsy
Whether temporary or permanent, the main priority of treatment is protection of the eye surface by helping the eyelids achieve better closure.
Frequent eye lubricating drops and ointment, and ensuring the eyelid is closed at night time when you sleep with tape or padding of the eyelid are conservative treatments that may provide relief.
If eyelid closure is not recovering with conservative treatments, then surgical options may be explored. There are surgical techniques to protect the eye, including specific surgery to repair, transfer nerves and occasionally to transplant muscle or tendons to the face from other parts of the body. Unfortunately, often not one operation will fix all the problems that can be associated with facial palsy and a custom treatment plan will need to be developed to achieve the best outcome possible.
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