The entire eye adnexa constitute a complicated and inter-cooperating mechanism. Without proper alignment of the eyelids in relation to the eye ball, the normal growth of eyelashes or the proper secretion and discharge of tears, we will not have a healthy eye ball. Abnormalities in any part of this apparatus result in the occurrence of troublesome symptoms and may lead to vision disturbances. Growing knowledge on the pathology and the mechanisms of aging of tissues allows to precisely plan and perform the appropriate treatment.
At MAVIT MC we perform a range of oculoplastic procedures, including the treatment of abnormalities in the ocular adnexa. Procedures are performed under a local anaesthesia. Duration of the procedure does not usually exceed an hour. Procedures aim to restore the correct alignment of the eyelids.
The types of disorders and methods of their treatment
Entropion is a disorder that mostly relates to the lower eyelid. Edge of the eyelid folds in the direction of the eye ball, which contributes to the irritation of the cornea by the eyelids and to a permanent occurrence of a foreign body sensation. It reveals also with the eye reddening and excessive tearing. In untreated cases it may lead to ulceration and corneal haziness, resulting in a permanent vision impairment. Depending on the case, we perform operations using the following methods: Jones'a, Wies'a, Quickert;a.
Ectropion is a situation in which the eyelid sticks out from the surface of the eye ball. The main symptom is excessive tearing, tendency to conjunctivitis and corneal diseases. We perform operations of ectropion using the following methods: plastics of palpebral ligaments, horizontal shortening of the eyelid, LAZY-T.
Ptosis relates to the upper eyelid and is mostly associated with the process of aging of tissues. A characteristic feature is the low alignment of the eyelid, which sometimes causes a significant reduction in the field of view. Ptosis gives the face a sad look and forces a special positioning of the head, which allows a better vision. We perform operations of ptosis using the following methods: shortening of the levator palpebrae superioris muscle or excision of a part of the superior tarsal muscle (Müller’s muscle).
Tumours of the eyelids – in most cases are benign or limited-malignant lesions. We perform the excision of the lesion with the reconstruction of surrounding tissue and histopathological examination of the neoplasm. Depending on the result of the morphological examination of the tumour, we implement an appropriate therapeutic procedure.
Lagophthalmos is caused by facial nerve paralysis. The main symptoms are: chronic conjunctivitis, tendencies to corneal erosion and ulceration. Facial nerve paralysis is usually permanent, and therefore there is a high risk of vision deterioration and, in extreme cases, even loss of the eye. One of the more effective treatment methods is implementation of an implant made of gold or platinum beneath the upper eyelid. The aim is to ballast the eyelid, thereby restoring the closing function of the palpebral fissure, while maintaining the ability of the eye opening. However, this does not result in restoring the function of the facial nerve damaged. The implants are of different weights from 1 to 2 grams. Individually selected implant is placed inside the upper eyelid after healing of the wound, it is virtually imperceptible to other people. The procedure is totally reversible, it may be combined with simultaneous plastics of ectropion in the lower eyelid. Implanted implants are medically certified, which means that there are no contraindications to perform magnetic resonance imaging.
Retraction of the upper eyelid is a disorder occurring as a complication of a thyroid disease, e.g. Graves’ disease. In addition to the poor appearance, which creates the impression of the face puzzled or frightened, there occur symptoms associated with dry eye syndrome. Sand sensation under the eyelids, eye burning, stinging and reddening are the typical symptoms associated with eyelid retraction. The procedure restores their proper function and correct alignment.
Dermatochalasis is the most commonly performed plastic procedure, mainly for cosmetic reasons. Excess of skin can cause or mimic ptosis and create the impression of constantly swollen and “tired eyes”. Excision of excess skin not only rejuvenates the appearance of the eyes, but at the same time, through the “slimming” of the eyelids out of the weight of the skin, improves their function.
Nasolacrimal duct obstruction – is characterised by the occurrence of excessive lacrimation and is mostly caused by a chronic inflammation. In case of acute dacryocystitis the symptoms are big pain, severe skin redness, swelling, increased body temperature, and malaise. Such condition requires urgent ophthalmological consultation and immediate treatment. These are the symptoms associated with formation of an abscess of the lacrimal sac.
A characteristic symptom is the appearance in the “corner of the eye” of a hard, painful “nodule”. If left untreated, an abscess of the lacrimal sac may “penetrate” the skin and evacuate spontaneously, which is usually accompanied by a reduction in pain. However, this does not prevent the possibility of re-inflammation.
The most effective treatment of nasolacrimal duct obstruction is the surgical treatment. It involves the creation of a fistula connecting the lacrimal sac with the nasal cavity. The operation aims to bypass the obstruction site, the removal of pathological deposits, polyps, fusions, etc. The procedure is performed under a general anaesthesia. The incision of the skin is made on the side of the nose and is about 20 mm long.
During the operation, in the lacrimal ducts there are placed special silicone probes that protect a fistula against atresia. A fragment of these probes (about 3–4 mm long) remains outside, in the medial angle of the eye. The probes connecting superior and anterior lacrimal points are transparent and virtually invisible. They usually cause no pain. They are mostly removed three months after the operation.
Constriction of the lacrimal point of the lacrimal duct. For the efficient discharge of tears out from the conjunctival sac there are responsible lacrimal points and ducts, lacrimal sac and nasolacrimal duct. With the accumulation of excess tears in the conjunctival sac there is related a tendency to many pathologies, inter alia: recurrent conjunctival infections, chronic blepharitis, corneal pathologies, deterioration of visual acuity. Nearly 30% of the cases of excessive lacrimation are associated with constriction of the lacrimal point. Effective treatment method for this disease is the implantation of special perforated plugs into the lacrimal points.
The procedure is performed in the ophthalmologist’s office under a topical anaesthesia. The two millimetre long implants implanted into the lacrimal point are aimed at broadening the lacrimal point and restoring its function. The “plugs” left in the lacrimal point do not cause any discomfort, they are invisible to other people and immediately reduce excessive tearing. The full effect of the treatment we achieve at 3 months after the removal of the implant from the lacrimal point.
Dry eye syndrome – currently it is now one of the most common ophthalmic ailments, for which more and more patients complain. It is not a single disease entity, but a group of symptoms leading to disturbances on the surface of the eye ball. Dry eye syndrome is associated with its abnormal lubrication by the lacrimal film, resulting in peeling of the conjunctival and corneal epithelium, leading to impaired immunological barrier, and consequently to the development of infections and inflammatory processes. In case when the dry eye syndrome is caused by insufficient production of tears, the treatment is performed by implantation of hydrogel plugs into the lacrimal points. They are designed to stop the tears on the surface of the eye ball and to reduce troublesome symptoms. The procedure is performed under a local topical anaesthesia, it is safe, reversible and painless.