Tumors AROUND the Eye | Ocular Tumors

Last article gave some basic information about  tumors and what it means to be a malignant tumor. I would like to start talking about some of the tumors we see around and in the eye.

Tumors of the Eyelid

The outer most structures of the ocular system are the eyelids. The skin around the eye can develop tumors (benign or malignant) and so can the deeper tissue, some which can be potentially deadly.

I strongly recommend that any new lesion (aka lump or bump) on the eyelids be evaluated by a doctor trained and comfortable evaluating eyelid lesions.  Most oculoplastic eye specialists should be very comfortable evaluating tumors of the eyelids or surrounding structures.

Basal Cell Carcinomas

Basal cell carcinomas are one of the most common type of skin cancers. The tumor arises from uncontrolled growth of the bottom layer of the skin. They are commonly occur on the lower eyelids as the lower lids receive more sun exposure than our upper lids.  These types of cancers are often seen in patients over 50.

The lesions are often raised red areas, with enlarged blood vessels around or in it, and an ulcerated center. If it is growing at the edge of the lid near the lashes there is often a loss of the lashes (called madarosis). These lesions are usually slow growing and rarely metastasize to other areas.

Basal cells are usually very superficial, but there can be extension under normal skin. The basal cell cancers are removed with surgery and often examined pathologically at the same time to ensure the entire lesion is removed. Depending on the size of the lesion removed various reconstructive techniques are used to repair the remaining healthy lid tissue.

Squamous Cell Carcinomas

Squamous cell cancers arise from uncontrolled growth of the skins upper layer of skin (epidermis). These are less common then basal cell carcinomas. They are also induced by chronic exposure to sunlight. The incidence of both squamous and basal cell cancers can be reduced by wearing sunscreen, hats, and sunglasses. These tumors appears as scaly red patches that can bleed if scratched. These lesions can grow and spread to deeper structures. The lesions needs to be completely resected (removed) and then the area reconstructed. Incomplete excision can lead to the lesion spreading down nerves and can lead to extensive disease and possible death.

Sebaceous Cell Carcinoma

Sebaceous cell carcinoma is a lethal eyelid tumor that arises from the glands around the eye. While they are rare these tumors can be misdiagnosed for benign conditions such as chalazions (styes). They can often start as a yellowish nodules and progress to a chronically red looking lesions. There is often eyelash loss in the affected areas. The cancer is usually not painful. These tumors can spread throughout the orbital area and even to other parts of the body (a malignant tumor). The treatment for this tumor is surgical excision, which can be very disfiguring and possible chemotherapy. Even with this treatment the prognosis is often poor for long term survival. Early examination and diagnosis is essential.

Tumors of the eyelids are not uncommon, especially in the south like Florida. If you have a concerning “lump or bump” on your eyelid or around your eye, make sure you see an oculoplastic surgeon like Drs. Abrams, Spoor or Levy.

In the next article we will talk about tumors that involve the inside of the eye.

 

Tumors of the Eye | Ocular Tumors

As a neuro-ophthalmologist/oculoplastic specialist,  I treat patients with various tumors around their eye.

Tumors of the eye can occur on the eyelids, the eyeball itself, the tissue around the eye (the orbital area) or even the optic nerve.

Any tissue can develop a tumor.  Different types of tumors in various tissues often have characteristic behaviors.  These tendencies help us decide the appropriate treatment.  These articles are to help you understand some of the tumors that are seen around the eye.

Tumor and Cancer NOT Synonyms

Most people use the term tumor and cancer interchangeably but these do not mean the same thing. A tumor or neoplasm is an abnormal growth of tissue.  This can be any tissue in the body. Some tumors are benign and some are malignant.  The difference is based on the way the tissue act.

Benign tumors are tumors which do not spread, or metastasize, to other parts of the body.  Though a benign tumor does not spread, it can still cause damage.  For instance, large benign tumors of the optic nerve can cause loss of vision by compressing the nerve.

Depending upon the size, rate of growth and potential to blind, these tumors may be watched (i.e. left alone) or removed surgically.

Malignant Tumors

Malignant tumors can spread to other parts of the body.  There are different ways for the tumors to spread.  Parts of the tumor can spread through blood, lymphatic system, or directly invade surrounding tissue.  Often, malignant tumors are difficult to treat because they spread by multiple ways; not just one.

Treatment for malignant tumors can include surgery, chemotherapy and/or radiation.

Tumors Affecting the Eye

There can be either malignant or benign tumors around the eye. The tumor can be formed from local tissue (called a primary tumor) or have spread from other areas (called a metastasis). Sometimes in office examination , radiology imaging, or surgical biopsy with pathologic examination is needed to help determine the origin, type of tumor and then treatment course.

In our next article we will discuss some of the specific tumors we see around the eye and ways to diagnosis and or treat them.

The doctors here at Sarasota Retina Institute have special training dealing with tumors around the eye. Drs. Abrams, Spoor and Levy are part of a small group of surgeons in the country who work both on tumors of the eyelids and orbits. Using state of the  art techniques and equipment they are able to offer our patients care the rivals large academic centers around the country.

Eyes Squeezed Shut

Blepharospasm

Do you ever have a problem where your eyes want  to squeeze shut uncontrollably?   Do people accuse you or winking at them? Do you feel your lid twitching?

If you answered  yes to any of these you could be having blepharospasm.

What Are Blepharospasm

The eyelids have a muscle that goes around in a circle in both the upper and lower lids, called the orbicularis. This muscle is responsible for closing the eye. In patients with blepharospasm the muscle squeezes involuntarily.  This muscle over powers the muscle that opens the eyelid, the levator muscle, and causes the eye to shut.

 Causes of Blepharospasm

The spasms are caused by over stimulation of the muscle or the nerve that controls the muscle.  Sometimes this can be a tumor, trauma, dry eyes, or even an abnormality of a blood vessel. These are actually the rarer causes of blepharospasm. Most often there is no specific reason for the spasms, and this is called benign essential blepharospasm (BEB). This is a really fancy way of saying we do not know the true cause, yet it’s not due to a disease.

Treatment For Blepharospasm

30 years ago had you walked into your doctors office with blepharospasm the main treatment would have been sedating oral medications or surgery to remove the muscle, which was often very disfiguring. In the late 70s early 80s an ophthalmologist, Dr. Alan Scott, figured out that injecting botulinum toxin (Botox) into the muscle would temporally relieve the spasms.

Botox Preferred Treatment for Blepharospasm

And such Botox was created.  It was not until almost 12 years later that the use of Botox for cosmetcs was discovered.  Today injecting a botulium toxin (Botox/Xeomin/Myobloc)  for blepharospasm is still the preferred treatment.

 Botox Covered by Insurance

About 10 sticks per eye with a tiny needle is often all that is needed to reduce or eliminate the problem.   Treatment may be repeated in 3 months if needed. This is a medical problem and is paid for by most insurance plans.

If you or someone you know is suffering with blepharospasm call on of our neuro-ophthalmologsit at 941-921-5335 to get help.

 

 

 

Jody Abrams, MD, FACS
Oculoplastics/Neuro-ophthalmology
Sarasota Retina Institute
Sarasota, Florida 34239

Parkinson’s Disease and the Eye

What an incredible weekend. Saturday October 12 I had the honor of presenting at the Neuro Challenge Foundation conference on how Parkinson’s disease affects the eyes. I was amazed at the turn out, over 200 people. I presented a power point presentation (the one shown below) and then was able to answer audience questions.  What a wonderful conference. Dr. Sutherland and the entire staff of Neuro Challenge Foundation should be given a standing round of applause for the work they do.

I hope you enjoy the power point presentation.

If you or a loved one are affected by Parkinson’s disease and would like to learn more about it affects your eyes please call 941-921-5335 and schedule and appointment to speak with one our or doctors.

In the next few days I will send out what Drs. Levy, Torres and Rivero presented over the weekend.

 

 

Jody Abrams, MD, FACS
Oculoplastics/Neuro-ophthalmology
Sarasota Retina Institute
Sarasota, Florida 34239

Snoring May Blind You

Eyelid Problems with Sleep Apnea

When I was an Ophthalmology resident at LSU, I was taught about a certain eyelid condition, called Floppy Eyelids, associated with sleep apnea.

This is a condition where the lids become loose against the eyeball which in turn causes dry eyes, excessive tearing, foreign bodies (e.g. hairs and fibers), exposure of the surface and corneal scarring.

People with sleep apnea may rub their eyes a lot when trying to start breathing again and the chronic rubbing causes the tissue to become chronically stretched.  Over the years, I have been able to diagnosis sleep apnea on some patients by just examining their eyelids.  Once the sleep apnea is treated the eyelids can be fixed by an outpatient surgical procedure to tighten them.

Optic Nerve Problems and Sleep Apnea

When I finished training 7 years ago, sleep apnea was not associated with vision loss, but that has since changed.

A new emerging area for neuro-ophthalmology is damage to the optic nerve caused by sleep apnea.  I see many patients referred for problems of the optic nerve not explained by normal causes such as glaucoma.  Often the patient will have a “negative workup,” meaning tests like MRIs and blood tests are normal.

Until recently, there was no further workup, yet we’d have no idea about the cause of the vision loss.  Now I am sending many of our patients for sleep testing looking for evidence of sleep apnea.  I do this for all patients in whom I suspect sleep apnea and not just the typical overweight patients who have sleep apnea.    I diagnose optic nerve damage due to sleep apnea in all shapes and sizes and old and young.

Why Does Sleep Apnea Damage the Eye

In short, I’m not exactly sure how sleep apnea causes optic nerve damage, but there are some very convincing theories.

During sleep apnea the oxygen level in the blood decreases since the person is not breathing normally.  Perhaps this decreased oxygen level is damaging to the optic nerve, a tissue highly sensitive to variation in oxygen levels.

The optic nerve is a very active part of the body and such it needs a lot of oxygen. When the oxygen level decreases this causes stress and damage to the nerve which over time can cause vision loss.  Sleep apnea also causes changes in the blood vessels which can also decrease the oxygen delivered to the eye.

If the thought of high blood pressure, strokes and or heart attacks is not enough to get you checked for sleep apnea, then possible blindness might be.  To learn more about this call 941-921-5335 and make and appointment to talk with one of our doctors.

 

 

Jody Abrams, MD, FACS
Oculoplastics/Neuro-ophthalmology
Sarasota Retina Institute
Sarasota, Florida 34239

Lumps and Bumps of the Eyelids

EYELID TUMORS

Growths on the eyelids may be totally benign or vision and life threatening.  Accurate diagnosis and treatment is essential.  As a doctor in training  we joked that every growth on the lower eyelid was a basal cell carcinoma (skin cancer) until proven otherwise and every growth on the upper eyelid was a chalazion (acute or chronic sty) until proven otherwise.  This is not a bad rule but is certainly not inclusive.

Why Do The Lower Eyelids Get Cancers More Often?

The lower eyelids get much more direct sun exposure than the upper eyelids which are protected from direct sun exposure by your overhanging eyebrows and by usually being open in direct sunlight.  Subsequently, tumors caused by sun exposure are much more common on the lower eyelids and the region between the eye and the nose (medial canthus).

What Do You Do With Bumps on The Eyelids ?

Eyelid tumors, especially basal cell carcinomas, are very treatable if diagnosed early and excised completely.   A surprisingly large amount of lower eyelid may be removed and the eyelid repaired with minimal cosmetic and functional defects.  If the tumor is allowed to grow and involve the entire eyelid or adjacent structures the visual and functional results are not as good or as predictable.  Bottom line- have those bumps on the lower eyelid evaluated and treated.  If basal cell skin cancers are diagnosed and completely excised they are cured.  Its worth the effort to get them evaluated. The most dangerous four words in medicine are “it will go away”.

Squamous Cell Skin Cancers

Squamous cell skin cancers are also sun induced and more prevalent on the lower eyelids.  They are also very treatable; but these tumors have a tendency to spread along the nerves and invade the brain.  These are potentially much more dangerous and need to be excised more aggressively and also completely.  These tumors can kill you very dead and very unpleasantly.

Colored Eyelid Tumors

Pigmented tumors anywhere on the eyelids or for that matter anywhere on your body are worthy of respect.  Pigmented growths are malignant melanomas until proven otherwise and any pigmented lesion needs to be either excised and examined by a skilled dermato-pathologist or serially observed by a physician experienced with melanomas.  These are usually dermatologists and it is my opinion that they should be involved in the care of most any patient with a suspected melanoma.  These tumors are well known to spread through out the body (metastasis) and can also kill you very dead.

What Can Be Done To Prevent Eyelid Cancers

All three of these eyelid tumors we discussed can occur on any skin surface that is exposed to sunlight and are directly related to sun exposure.  The take home point is to use your sun block (spf 15 or greater), wear a visor and sunglasses.  Your eyes and your eyelids will be much happier and healthier for your efforts.

Eyelid Sty / Chalazion

What about the upper eyelids?  As I mentioned they are partially protected from sun exposure by the fact that they are open and that the overhanging brow protects them from direct sun exposure.  The most common mass on the upper eyelid is the chalazion, often called a sty.  This is benign and is caused by blockage of a tiny gland in the upper eyelid (there are over a hundred per eyelid).   The blocked gland becomes infected.  If the infection is treated it usually resolves with no lasting damage to the eyelid.  Untreated, the body tries to form a barrier around the infection to contain it.  This forms a nodule of inflammatory tissue that may require excision and drainage to resolve and may cause some eyelid dysfunction.  This is benign but may be a bit of a nuisance.

Recurrent Chalazions

Problems arise when presumed chalazions recur and are not biopsied.  This is known as the masquerade syndrome.  What was initially thought to be a chalazion was really a cancer of the sebaceous glands (sebaceous cell carcinoma).   This is a rather rare tumor and not seen by many eye MDs, hence it is often misdiagnosed as either a recurrent chalazion or if the biopsy and pathology examination was inadequate a basal cell carcinoma.  Remember that basal cell carcinomas are very uncommon on the sun protected upper eyelids and that diagnosis should always be suspect and a better biopsy and pathologic study done to diagnoses sebaceous cell carcinoma which is potentially lethal disease and needs to be treated more aggressively.

It is important to have any new or old lesions evaluated by a doctor who is trained in eyelid tumors. At Sarasota Retina Institute Drs. Spoor, Abrams, and Levy are specialist in diagnosing and treating tumors of the eyelids. If you have a lesion you need checked call 941-921-5335 for an appointment.

 

Tom Spoor, MD
Oculoplastics and Neuro-ophthalmology
Sarasota, Florida

Tom Spoor,MD
Oculoplastics and Neuro-ophthalmology
Warren, Michigan

Jody Abrams, MD, FACS
Oculoplastics/Neuro-ophthalmology
Sarasota Retina Institute
Sarasota, Florida 34239

Lower Eyelid Bulges

Patients often come into my office wondering what is going on with their lower eyelids. They notice bulges in the lower lids that were not there a few years ago. Often they will even notice the prominence of the bulge changes depending on the time of day, dietary  intake, and use of certain medication. I have even had patients approach me worried this was a bad tumor. While this could be a tumor, the majority of the lower lid bulges I see are from fat. Yes the bad word that most of hate to hear, fat.

Lower Eyelid Fat

The bulges of the lower eyelids is fat from around the eye pushing forward. The eye is naturally surrounded by fat, which is there to help cushion the eye. As we age the tissue that holds the fat back behind the lids gets weaker and the fat starts to move forward causing the bulges. The fat can swell and shrink some through out the day depending on the position of the body, the salt intake, and multiple other small factors. While the fat bulging is not dangerous to the eye, it is often seen as an unappealing appearance by patients.

Lower Eyelid Surgery

There are some over the counter and prescription medications to help the lower lid bulging, but their effect is usually very limited. The most effective treatment is to surgically remove the fat, a lower lid blepharoplasty. Unlike an upper lid blepharoplasty where skin is removed, the lower lid blepharoplasty removes mostly fat and little if any skin. The fat is removed by going through the back side of the eyelid so usually no scar is created on the skin. There fat is carefully removed by cutting and cauterizing it. Care must be taken to avoid a muscle that moves the eye, and to control bleeding so there is no damage to the optic nerve. Once adequate removal of fat is preformed the inner eyelid tissue, the conjunctiva, is closed with a few sutures and the patient is then sent home. I rarely remove skin because when the fat is removed more skin is needed to keep the lid in position then when there is a bugle.

After the surgery the patient is sent home to use ice packs on the lids and relax. Usually the lids are black and blue for about 2 weeks and then can have minimal swelling for a month or more.

The surgery can be done with the patient awake in a twilight sleep or under general anesthesia.

Who Pays for Lower Lid Surgery

Lower lid surgery is a cosmetic surgery which means it is not covered by insurance. I often combine the cosmetic surgery with another insurance covered procedure, like a lid tightening procedure or upper eyelid surgery. When this is done we can often do the lower lid procedure at a lower cost to the patient.

If you are interested in learning more about eyelid surgery upper or lower call Dr. Abrams at 941-921-5335 to schedule an appointment.

 

Jody Abrams, MD

Oculoplastics and Neuro-ophthalmology

Sarasota Retina Institute 

Sarasota Florida 

Jody Abrams, MD, FACS
Oculoplastics/Neuro-ophthalmology
Sarasota Retina Institute
Sarasota, Florida 34239

Why Do My Eyes Bother Me?

Dry eye and tearing are not a natural part of growing older.  They are conditions that are treatable when diagnosed accurately.

Where Do Tears Come From

Tearing is rarely the result of excessive formation of tears.  This is a very uncommon condition.  Tears may be produced by the tear gland.  These are reflex tears that are produced secondary to noxious physical or psychological stimuli.  Crying resulting from eye irritation or sorrow is very normal. Tears are also produced by the conjunctiva-the mucous membrane surrounding the white of the eye.  These are basic tears and are essential for proper visual function.  They are being constantly produced and are essential for proper visual function.

Where Do Tears Go

Tears are drained from the eye into the nose.  When the eyelids blink they pump the tears from the eye into a drainage hole in each eyelid called the punctum.  The punctum opens into a tube called the canaliculus which serves as a conduit to drain the tears from the punctum to the tear sac.  The tears flow thru the tear sac into the nose via the naso-lacrimal duct.  If this drainage system is interrupted at any point pathologic and symptomatic tearing will likely occur. This can be easily determined by a competent examination of the tear drainage system.

Eyelid Rolling Forward

If the punctum (the tear drainage hole) is not inthe appropriate postion the tears cannot be properly drained and tearing will occur. This abnormality may be very obvious be also might be very subtle.   Tearing may also result if the eyelids are just too weak to pump the tears into the punctum even if it is in the appropriate position.   This is called eyelid laxity and results from aging or trauma.  In addition to tearing these patients may also have a uncomfortable, chronic scratchy feeling in their eyes with or without a ropey discharge.  This is known as floppy eyelid syndrome and is readily diagnosed with special stains. This is a very common finding in people with sleep apnea and can even lead us to the diagnosis of sleep apena in some patients.

All of these eyelid abnormalities are easily diagnosed and treated if the eye doctor is aware of them, looks carefully and uses special stains to facilitate the examination.  Surgically tightening the eyelids is a minimally invasive procedure and very successful in skilled hands.

Tear Duct Blockage

Blockage of the canaliculus may be more of a problem.  The canal may be blocked by infection (canaliculitis), a foreign body (punctual plug previously placed for dry eye) or lacerated by trauma.  All these problems are treatable, some easily and some with great difficulty.  Patients with blockage of only one canaliculus may be asymptomatic.  Blockage of both upper and lower canaliculi invariably causes symptomatic tearing. The tear sac or tear duct may be scarred by infection, blocked by stones (dacryoliths), injured by trauma or invaded by tumors.  A blocked tear sac or duct is a set up for infection (dacryocystitis).  This is painful and if inappropriately treated may spread infection to the orbital contents causing orbital cellulitis a potentially blinding or lethal infection. Treatment entails incising the skin and sac and draining the infection.  Followed by a course of systemic antibiotics.   The tear drainage system can be later reconstructed by rerouting the lacrimal sac to drain into a different area of the nose.

In summary, you do not have to tolerate abnormal tearing (epiphora).   Doctors with expertise in this area of ophthalmology can usually easily manage these problems either in the office or in an out patient surgical center.  Dr. Spoor, Dr. Abrams, and Dr. Levy  are very experienced in dry eye and tearing problems. Drs. Spoor and Abrams have shared there expertise with other ophthalmologists by teaching courses at the American Academy of Ophthalmology.  Dr Abrams is available in all the SRI offices.  Dr. Spoor is available in the Sarasota office and in his office in suburban Detroit.

Please contact our office at 941-921-5335 to make an appointment to come in and start down the path of relief.

 

Tom Spoor, MD

Oculoplastics and Neuro-Ophthalmology

Sarasota, Florida

Detroit, Michigan 

 

 

Half Mast Eyes

Eyelids can look closed or droopy from either dermatochalasis or true droopiness of the eyelid, called ptosis. Ptosis is a downward deviation of any part of the body, but in this case the upper eyelids. These are the the eyes that appear to be half closed and the person has to really struggle to lift them up.

How the Upper Eyelid Works

The upper eyelid is made of a combination of skin on the front side, 3  muscles, fat  and a supporting structure called the tarsal plate in the middle, and the smooth wet layer on the back side called the conjunctiva. The front and back layers protect the eyelid structures and the eyeball behind it. There has to be enough extra of both for the eye to open and close for blinking to keep the eye healthy and protected. The orbicularis muscle is just under the skin and helps close the eye. Behind it is some fat and then the levator muscle. This is the main muscle responsible for lifting the eyelid. It attaches to the tarsal plate and when it contract it lifts the eyelid. Behind the levator and in front of the conjunctiva is Mueller’s muscle. This is a small muscle that give a small amount of lift to the eyelid.

Causes of Droopy Lids

There are multiple causes of the lids drooping. One of the main causes is aging. Often the levator muscle can slip off the tarsal plate so it can not grasp the lid as well and lift it. This can occur from natural aging and stretching of tissue. This can also be seen in patients with long term contact lens use or recent eye surgery since both of these can stretch the muscle and pull it off the tarsal plate. There are neurologic causes of droopy lids such as myasthenia gravis, brain strokes, cranial nerve 3 damage,  other neuromuscular disorders.It is important to see your eye doctor for evaluation of droopy eyes to rule out some of these causes.

When to treat Droopy Lids

I see patients all the time with droopy eyelids, and they usually ask when is it time to have the lids raised. Well this is a questions the patient must actually answer. I tell the patient that when they are watching to lift their lids with a finger and see if this makes a difference. Often the patient is amazed at how much this improves the light coming in and opens up their visual field area. If there is no improvement then raising the lids is more of a cosmetic procedure (not covered by insurance)  not a functional procedure (covered by insurance). That is why we often ask if the lids are noticeable in the patients vision and test this with visual fields. Once it is determined to do lid surgery the two most common procedures are a blephroplasty or a levator advancement.

Droopy Eyelid Surgery

In a levator advancment the eyelid itself is actually raised by moving the muscle forward and giving it a stronger pull on the tarsal plate. The surgery is done with the patient awake but the eyelid is numbed up with a local injection. The patient is then covered to keep the area clean, and an incision is made through the skin. Both the tarsal plate and levator muscle are exposed. A suture is then passed through both to pull the muscle onto the plate. After this is done on both sides the patient is then sat up and asked to open the eyes. This allows adjustments to be made for both lid height and contour for adequate elevation and symmetry. Once this is accomplished the sutures are tied in place and the skin is then closed. The patient is then sent home to use ointment and ice. There is often bruising for about 1-2 weeks and some swelling that can last up to 1-2 months. The sutures are often removed in 2 weeks in the clinic.

 

Droopy eyelids can be a cause of significant loss of a patients visual field. It is important to have a trained eye care specialist evaluate them and recommend the proper fix. This is often done with surgery but even then there are multiple ways to fix it and each fix needs to be right for that patient.

 

Jody Abrams, MD 

Oculoplastics/Neuro-ophthalmologist

Sarasota Retina Institute

Sarasota, Florida 

 

Jody Abrams, MD, FACS
Oculoplastics/Neuro-ophthalmology
Sarasota Retina Institute
Sarasota, Florida 34239

Dermatochalasis (extra eyelid skin)

Dermatochalasis refers to the redundant or extra skin of the eyelid. This is often a normal occurrence in aging and can also be brought on by lots of weight loss, recurrent swelling of the eyelids.  Gravity is usually the main cause of the stretching of the skin as we age.  Dermatochalasis is most often seen in the upper eyelids but can be seen in the lower eyelid.

Patients often complain of :

  • Decreased vision in the upper fields
  • Decreased peripheral vision
  • Having to lift their lids to read
  • Chronic irritation of the upper eyelid skin
  • Heaviness of the upper eyelids

Treatment

The treatment of dermatochalasis is surgical, called a blepharoplasty. This is most often preformed in an outpatient surgical center but occasionally be done in the office. The patient is given some IV medications to help them drift of into a twilight sleep and during this time the lids are injected with a numbing agent. The patient is then allowed to remain awake during the procedure, but can be given medications in the IV to help remain relaxed throughout the surgery. In the operating room towels and covers are placed around the face after it is washed to keep the area sterile. Measurements and marks are then made to determine the incision areas and the skin to be removed. The skin is then incised with no pain to the patient only the slight feel of pressure. During this time the fat pad on the inside corner of the eyelid can often be thinned out to give less bulk to the eyelid. Once the skin is removed it is then reapporximated with suture. After both sides are done the patient is then sent to recovery and then home. During the post operative period it is important to use ice and ointment as prescribed. The eyelids will be black and blue looking for about a week and the swelling can be present for a month or more, but this all varies by the patient and most heal quickly. The sutures are often removed in one to two weeks.  It is important to have a trained oculoplastic surgeon preform the surgery to prevent too much skin from being removed and the eye being damaged.

Who pays for the surgery. insurance or the patient?

Most people believe that a blepharoplasty is a cosmetic surgery, and while this can be the case, most of the time the surgery is functional and is covered by insurance. This is true for most insurance plans including Medicare. To prove that the eyelids are indeed causing visual problems and functional nature special test must be done including extensive photos and visual fields.

 

Jody Abrams, MD

Oculoplastic Surgeon/ Neuro-Ophthalmologist 

Sarasota Retina Institute

Sarasota, Florida