Advanced Procedures

A consolidated list of symptoms and associated corrective procedures.

  • Benign & Malignant Skin Lesion
  • Pterygium
  • Chalazion
  • Eyelid Surgery (Blepharoplasty)
  • What you can expect from eye exam?
  • Ptosis (Eyelid Drooping)
Benign & Malignant Skin Lesion

Surgical excision is recommended for malignant (cancerous) and certain benign (non-cancerous) skin lesions. In most cases, curettage is performed after the lesion is numbed via freezing or local anesthesia. A small amount of surrounding tissue is removed as well to ensure that all malignant cells are excised.

Pterygium

Pterygium

Pterygium is a benign growth of the conjunctiva (lining of the white part of the eye) that grows into the cornea, which covers the iris (colored part of the eye). A pterygium usually begins at the nasal side of the eye. It can be different colors, including red, pink, white, yellow, or gray.

Patients with pterygium often first notice the condition because of the appearance of a lesion on their eye or because of dry, itchy irritation, tearing or redness. Pterygium is usually first noticed when it is confined only to the conjunctiva. At this stage it is called a pingueculum. Once it extends to the cornea it is termed a pterygium and can eventually lead to impaired vision.

Causes

Although the causes of pterygium are not entirely known, it is believed to be caused mainly by exposure to UV light. Another suspected risk is living in a dry, dusty, windy environment. People who live near the equator or play water sports such as surfing and fishing are thus more likely to develop pterygium. Prolonged exposure to these conditions causes the conjunctiva to thicken and the eye to become red and irritated. Collagen in the eye begins to deteriorate, and the eye weakens.

Studies show that there may also be a genetic predisposition to pterygium, with a higher prevalence in men than in women.

Signs and Symptoms

Sunglasses that block UV rays, particularly sunglasses that provide side coverage, are a good means of protection against pterygium. Wearing a hat with a brim to block sunlight is also helpful. In hot, dry climates, artificial tears (eye drops) should be used to help lubricate the eyes.

Prevention

Sunglasses that block UV rays, particularly sunglasses that provide side coverage, are a good means of protection against pterygium. Wearing a hat with a brim to block sunlight is also helpful. In hot, dry climates, artificial tears (eye drops) should be used to help lubricate the eyes.

Treatment

In most mild cases of pterygium, artificial tears can be used to reduce dryness and discomfort. Topical steroids may also be prescribed for redness and irritation.

For patients with severe cases whose vision has been affected, different types of surgery are available. Surgery is the only way to definitively remove a pterygium, but it is not a perfect solution; it requires long-term follow-up, and there is a risk that the pterygium will grow back.

Chalazion

Chalazions (“small pimples” in Greek) are cysts, or fluid-filled sacs, on the edge of the eyelid. Small glands in the eyelids called meibomian glands normally secrete a thick, fatty fluid called sebum into the hair follicles of the eyelashes. When these glands become chronically inflamed, chalazions – also called meibomian cysts – form.

Dr. Nguyen usually treats chalazions by prescribing antibiotic eye drops, antibiotic lid scrubs, and warm compresses. If the lesion is chronic and/or not resolving, she may also recommend a 5-10 minute minor procedure to release the sebum trapped inside the cyst.

Eyelid Surgery (Blepharoplasty)

Our eyelids begin to stretch and sag as you grow older.  In addition to age, there are other risk factors that may contribute to the sagging of eyelids, such as hereditary factors and sun exposure.  The drooping is caused by muscles weakening and excess fat deposits gathering above and below your eyelids.  As the eyelids droop they can form hoods and interfere with peripheral vision.  To correct this problem, and restore proper vision, our ophthalmologist may recommend eyelid surgery.

Blepharoplasty Before and After
Blepharoplasty Before and After

You might consider blepharoplasty if droopy or sagging eyelids keep your eyes from opening completely or pull down your lower eyelids. Removing excess tissue from your upper eyelids, lower eyelids or both can improve vision and make your eyes appear younger and more alert.  The surgery is minimally invasive and has a quick recovery time.

Blepharoplasty may be an option if you have:

  • Baggy or droopy upper eyelids
  • Excess skin of the upper eyelids that interferes with your peripheral vision
  • Droopy lower eyelids, which may cause white to show below the colored part of the eye (iris)
  • Excess skin on the lower eyelids
  • Bags under your eyes

There are 2 types of Eyelid Surgery: Functional and Cosmetic Blepharoplasty

Functional Blepharoplasty:

If the eyelids begin sagging into the field of vision, a functional blepharoplasty, or eyelid surgery, may become medically necessary. This procedure can be covered by medical insurance if it is visually significant. Our doctors can determine this by checking the peripheral visual field with an instrument called the Humphrey Visual Field (HVF) Analyzer.

The surgeon will make small incisions, which are hidden within the natural skin folds of the eyelid, and a calculated amount of skin and fat are removed in order to tighten the area around the eyelids and improve peripheral vision.

Cosmetic Blepharoplasty:

Cosmetic blepharoplasty can be performed on the upper or lower eyelid or both if the appearance of the eyelids (such as loose or sagging skin) does not impair peripheral vision.  If no skin needs to be removed, a transconjunctival blepharoplasty can be performed, in which the incision is made inside the lower eyelid and there are no visible external scars. This procedure is not covered by medical insurance, but offers a younger, more refreshed look that reflects across the whole face.

Candidates:

Good candidates for eyelid surgery are generally adult men and women who have healthy facial tissue and muscle and have realistic goals for improvements of their eyelid area. You should not have life-threatening illnesses or medical conditions that can impair healing. At your consultation our doctors will also review any eye conditions you may currently have or had, such as: glaucoma, dry eye or a detached retina. You should also share any other health conditions such as thyroid disorder, dry eye syndrome, Sjogren’s, Diabetes Mellitus, cardiovascular or high blood pressure or vision impairment and blindness or any history eye surgery such as LASIK.

Recovery and Results:

The recovery period for upper and lower blepharoplasty surgery is usually short, from a few days to a few weeks. You may experience some bruising or swelling for a while, but this should not last more than two to four weeks. The scars from the blepharoplasty procedure are usually well concealed and will fade with time until they are virtually unnoticeable. The incision is hidden in the crease of the eyelid in an upper blepharoplasty, and just below the lashes in a lower blepharoplasty.

You may also feel some eyelid numbness at the surgery site or dry eye symptoms including excess tearing, light sensitivity, or occasional blurry/double vision. However, these effects should be minimal and can be treated with an over the counter medication like artificial tears or lubricating eye ointment. You can also use ice or a cold pack to help with the swelling. Your doctor will explain how to deal with the small side effects during your consultation as well as before you go home after your eyelid surgery.

The results of blepharoplasty surgery are expected to be long lasting.  Patients report a more youthful appearance and improved vision, as well the added benefits of restored self-confidence.  While surgery cannot fix the signs of aging forever, many patients are satisfied with their appearance and the improvement in their vision and they do not seek to repeat the procedure.  However, on rare occasions, patient may want to have eyelid surgery again in the future due to excessive drooping of eyelids from the natural aging process of the eyelids.

What you can expect from eye exam?

An eye exam usually involves these steps:

  • You’ll be asked about your medical history and any vision problems you might be experiencing.
  • Your eye doctor measures your visual acuity to see if you need glasses or contact lenses to improve your vision.
  • You’ll be given numbing drops in your eyes. Then your doctor measures your eye pressure.
  • Your eye doctor checks the health of your eyes, possibly using several lights to evaluate the front of the eye and inside of each eye. To make it easier for your doctor to examine the inside of your eye, he or she will likely dilate your eyes with eyedrops.
  • Your eye doctor discusses what he or she found during the exam and answers questions you have about your eyes.

Part of the examination, such as taking your medical history and the initial eye test, may be performed by a clinical assistant.

Several different tests may be performed during the eye exam. The tests are designed to check your vision and to examine the appearance and function of all parts of your eyes.

Ptosis (Eyelid Drooping)

Ptosis is a condition in which the eyelid droops. It is caused by a weakness or separation of muscles deep within the eyelid. Ptosis does not involve excess skin or tissue in the eyelid (a condition called dermatochalasis). It is usually a result of aging, but some people develop ptosis after eye surgery or an injury. This procedure can be covered by medical insurance if it is visually significant. Dr. Nguyen can determine this by checking the peripheral visual field with an instrument called the Humphrey Visual Field (HVF) Analyzer. Patients who are also suffering from excess skin may choose to undergo blepharoplasty at the same time as ptosis repair. Please refer to Blepharoplasty above for more information.




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