Eyelid Surgery

An entropion is an in-turning of the eyelashes. There are many causes for this although the most common is laxity of the eyelid often associated with age. Other causes usually involve scarring to the eyelids

An entropion will cause the eye lashes to rub the eye which often causes irritation and can affect your vision (tap to enlarge).

What is the treatment?

The mainstay of treatment is surgery which is aimed at correcting the position of the eyelid. Whilst you are on the waiting list to have the surgery performed we advise that you tape your eyelid to the cheek (tap images to enlarge).

You can also use lubricants in the eye. These measures will help reduce the eye lashes irritating the eye.

We normally perform your surgery under local anaesthetic which is given in the operating room. Occasionally we can give sedation at the same time if you are uncomfortable about having a local anaesthetic on its own.

The surgery itself involves everting the eyelid and tightening it to prevent the entropion from returning. Tap to enlarge image.

The scar line runs underneath the eyelash line and there is a second small incision to the skin at the outer edge of your lower eyelid. These incisions are designed to be hidden within your natural skin creases. Tap to enlarge image.

The sutures we use are dissolvable but sometimes they still need to be removed in clinic.

The surgery normally takes about 25 minutes per eyelid but can sometimes take longer.

What happens before surgery?

Prior to surgery the team will see you in clinic and discuss the treatment options with you at this stage. If you are happy to go ahead with surgery we will normally consent you for the procedure and you will need to sign a form.

You may then need to be pre-assessed for the surgery whereby a nurse will ask you some questions about your general health should the doctor feel that this is necessary. On occasion we may take some blood tests and may ask you change your medications prior to surgery. The pre-assessment may take place on the day of your clinic visit, on a subsequent day or even over the telephone.

What are the risks of surgery?

The risks of surgery include postoperative bleeding, scarring to the eyelids and infection. We advise that you use an antibiotic ointment after the surgery (see below) to help reduce the risk of infection. Occasionally we may under or over correct the position of the eyelid. During the surgery we put some stitches near the bone on the outside of the eye socket, rarely patients can complain of tenderness in the area of this stitch. Most of these complications can be corrected if needs be with a second operation.

The most serious risk of any eyelid surgery performed is damage to your eyesight. Fortunately this risk is extremely rare.

What happens on the day of surgery?

On the day of surgery you will be told a time and place to come to the hospital. You will be met by the nursing team and one of the surgical team will also see you.

If you are booked for day case surgery you will need to make sure that someone can be with you on the evening of surgery. If you are coming to stay the night you will need to bring some overnight clothes and toiletries for the duration of your stay. We advise that you also bring in your medications with you when you come into hospital.

Sometimes you may have to wait for a few hours before your surgery is performed and this depends on your position on the operating list.

What can I expect after surgery?

The eyelid will often look quite tight for the first couple of weeks. This settles down as the eyelid relaxes into its normal position much like a leather belt stretching after you have worn it for a few days.

What do I need to do after surgery?

Normally we ask that you keep the wounds around your eye clean after surgery. You can clean the wound by allowing boiled water to cool and gently dabbing the wounds with a cotton bud.

We will give you some antibiotic ointment (usually Chloramphenicol) to apply to the wounds and to the eyes after the surgery to help protect against infection and to help lubricate the eyes for two weeks.

We normally advise that you apply ice compresses to the eyelids after surgery for three times a day for 5 minutes each time. This is to help reduce the bruising.

We normally see you 1-2 weeks after surgery to remove any sutures.

You should avoid any strenuous activity including lifting heavy objects for a least two weeks after surgery.

Eyelid surgery (blepharoplasty) is cosmetic surgery to remove excess skin or fat from the eyelids. The aim is to improve hooded or drooping eyelids or eye bags.

Before you go ahead, be sure about your reasons for wanting eyelid surgery. Bear in mind the cost, the risks, and the fact the results cannot be guaranteed.

It’s a good idea to discuss your plans with a GP first. There might be a medical condition affecting your eyelids or a reason why the operation is not appropriate for you.

What does it involve?

A blepharoplasty can be done under local anaesthetic with sedation or under general anaesthetic.

The surgeon will need to know if you are taking any medicines to reduce your risk of blood clots, such as aspirin or warfarin.

Surgery on the upper eyelids generally involves:

• making a cut (incision) along the eyelid crease in the natural skin fold of the eyelid
• removing excess skin, fat or muscle
• closing the incision – the scar will usually be hidden in the natural fold of the eyelid

Surgery on the lower eyelids generally involves:

• making an incision either just below the lower eyelashes or on the inside of the lower eyelid
• repositioning or removing fat from the bags under the eyes, and sometimes also a small amount of skin
• supporting the muscles and tendon of the eyelid if necessary
• closing the incision

The surgeon will usually apply thin, sticky strips called suture strips to support the eyelids after surgery. These are usually removed up to 1 week later.

An upper blepharoplasty may take about 1 hour. Surgery on the lower lid may take up to 2 hours. Most patients can go home the same day.

Recovery

It’s advisable to take about 1 week off work to recover from eyelid surgery.

It may be obvious for a little longer than a week that you’ve just had eyelid surgery.

You will not be able to drive for a number of days after the operation.

You will probably need to:

• prop your head up with pillows for a couple of days, when resting, to reduce swelling
• gently clean your eyelids using prescribed ointment or eyedrops
• hold a cold pack to your eye for a few days – try a packet of frozen peas wrapped in a tea towel
• wear sunglasses to protect your eyes from the sun and wind
• take paracetamol or another prescribed painkiller to relieve any mild pain

You should avoid:

• strenuous activity for a few days
• smoking, as smoke can irritate your eyes
• wearing contact lenses or rubbing your eyes

Side effects to expect

It’s common after eyelid surgery to temporarily have:

• puffy, numb eyelids that are difficult to close at night
• irritated, sensitive or watery eyes – this may last a few weeks
• bruising that looks like a black eye
• scars – these eventually fade to almost be invisible