Functional eyelid surgery: reasons and categories

The following is a typical list of practical reasons for upper eyelid surgery.

• To remove loose top skin which is dropping down and impairing the vision for driving and other visual tasks.
• To remove droopy and bulky upper eyelid skin which is interfering with wearing glasses or contact lenses.
• To remove excess upper lid skin which is irritating the lashes and the excess folds of skin are rubbing together.
• To remove the top eyelid skin and let more light into the eye.
• To remove excess upper lid skin to help rid a troublesome frontal headache.
• To remove the excess skin to help stop raising the eyebrows consistently to see out.
• To improve the forehead discomfort experienced by people who have to overuse the muscles that strain during the day to try and lift the sagging skin up off the eyelid area.
• To remove upper eyelid hooding where there is substantial lateral hooding which is causing watering down the lateral canthus. There is often conjunctival chemosis at the same time, and that can be healed as well.

Functional eyelid surgery includes:

1. Upper eyelid blepharoplasty where it is interfering with the visual function or causing heaviness, tiredness and headaches.
2. Upper eyelid ptosis or eyelid droop where it is again interfering with vision.
3. Eyelid turning inwards which is called entropion, this is most common in the lower lid.
4. Eyelids are turning outwards which is called ectropion, and it is most common in the lower lid.

There are also other functional eyelid problems such as floppy eyelid syndrome where the eyelids are in a good position about the globe, but are very lax and do not function well. Such patients often have irritation, discomfort and watering.
Facial palsy is another indication for functional eyelid surgery. In facial paralysis, there can be

• upper eyelid retraction,
• lower lid sag
• lower lid laxity
• weakness causing lacrimal pump problems
• meibomian gland dysfunction
• exposure keratitis from lagophthalmos.

The correction of eyelid malpositions is part of functional surgery because the eyelids are crucial to the protection of the eyes and any abnormality of their contour, their strength or position, can dramatically affect ocular comfort and vision.
In particular, ptosis is a condition where the upper eyelids droop most commonly in an adult from thinning of the aponeurosis, which is the very delicate front part of the levator muscle which helps to lift the eyelid. Ptosis can also be congenital or have a neurological cause.
Dermatochalasis is where there is excess upper eyelid drooping from excess skin muscle and possibly fat and requires an eye lift called blepharoplasty. Both ptosis and dermatochalasis can interfere with peripheral vision and make it difficult to read or safely drive a car and hence we can demonstrate that there is a useful indication for eyelid surgery.
Entropion or turning in of the lower lid often associate with trichiasis, which is quite painful. That is because the eyelashes are rotating in towards the eyeball and rub on the surface of the eye particularly the very sensitive cornea and can cause redness, watering, irritation, corneal ulcer (keratitis) and requires surgery under local anaesthetic as an outpatient or day case.
Ectropion is where the eyelid is sagging away from the eye and also can cause a red watering irritated the sore eye. All these common forms of eyelid malposition can be corrected by the oculoplastic surgeon, Jane Olver at Clinica London, as an outpatient or day case surgical procedure.