Oculoplastic surgery

These include surgical interventions on tissue structures around the eyes, especially in the area of the eyelids and tear ducts. The most common diseases and malpositions are age-related and usually occur later in life. Congenital problems of the eyelids and tear ducts are much rarer.

Eyelid surgery with Dr. med. Armin Koestinger
https://www.srf.ch/play/tv/gesundheitheute/video/operation-durchblick-wenn-die-augenlider-erschlaffen

Malpositions of the eyelids

Dermatochalasis (drooping eyelids): Excess skin on the upper eyelid hangs down over the eye and in certain cases can restrict the visual field. The skin excess can be removed in a short surgical procedure.

Ptosis: The upper eyelid falls and leads to a restriction of the visual field. In most cases an age-related slackening of the tendon of the eyelid lifting muscle is responsible. This can be repaired in a short outpatient operation under local anesthesia and the eyelid lifted again. In rare cases, the muscle itself or its associated nerve may also be diseased. Other surgical methods must be used.

Electropion: The lower lid is rotated outwards. This can lead to a wetting disorder of the eye, which can cause inflammations and infections. Here, too, age-related changes in the eyelid structures are usually the cause. In most cases, relatively simple outpatient procedures can correct this deformity.

Entropion: The lower eyelid, very rarely the upper eyelid, is rotated inwards. The eyelashes rub against the eye and cause pain, inflammation, infections and sometimes serious injuries to the cornea. This deformity can also be corrected relatively easily and quickly by surgery.

Brauenptosis: A low level of the eyebrow. This very often neglected factor can aggravate the above mentioned dermatochalasis and should be corrected at the same time to achieve an optimal functional result.

Retraction: A high level of the upper and lower eyelids. It usually occurs in the context of an eye socket disease associated with thyroid glands, rarely after previous operations. In pronounced cases, an eyelid closure deficit occurs, which can lead to infection and severe corneal disease. A complete lid closure can be restored by an eyelid lengthening operation.

Facial palsy: Paralysis of the facial nerve can have many consequences. On the one hand, the weakened muscles are no longer able to close the eyelid completely. On the other hand the muscle slackening can lead to a paralytic ectropion (see above), with the already mentioned consequences. Also a brow ptosis with restriction of the visual field can develop. There are different possibilities to improve the closure of the eyelids and to correct the low eyebrow level.

Tumors of the eyelids

*The most common tumors of the eyelids are benign. Mostly they are simple warts, cysts, papillomas, birthmarks, so-called xanthelasmas and other harmless changes. Due to their size, they can cause minor problems in a few cases or cause cosmetic problems. These changes can easily be removed on an outpatient basis.

Malignant: Malignant tumours in the eyelid area also occur very rarely. The most common is the so-called basal cell carcinoma, also called basal cell carcinoma. Squamous cell carcinomas are much rarer, melanomas or other malignant tumours are even rarer. The therapy of choice is the complete surgical removal of these changes. In some cases, a lot of tissue has to be removed. The resulting tissue defect must then be reconstructed. The methods available for this are manifold and range from simple wound closure to the restoration of a lid by means of flaps and transplants. In many cases, the exact method can only be decided after the complete excision of the tumor has been confirmed. In rare cases, surgical intervention is out of the question. Then alternative therapeutic options must be discussed.

Diseases of the tear ducts

The draining tear ducts begin with the tear point on the nasal side of the upper and lower eyelid, extend over the tear ducts in the eyelid area, pour into the large tear duct inside the nose and end just below the lower turbinate in the nasal cavity. The lacrimal duct can be constricted or even completely closed at various points. This can occur spontaneously or after inflammation, infection or for other reasons. In isolated cases