Medical conditions and diseases like cancer, injuries and trauma can cause lid repair and reconstruction surgery to be necessary for some patients. Whether it is an eyelid malposition like ectroption or entropion, oculoplastic reconstruction after cancer removal and treatment, post-Mohs procedure reconstruction, or a medically necessary tarsorrhaphy, Dr. Gal is skilled in rebuilding lids to improve function, vision and aesthetics.
Eyelid Malpositions – Ectropion, Entropion
The most common lid repair surgeries are to correct the positioning of eye lids. Ectropion (where the eyelid turns outward and away from the eye) and entropion (where the eyelid turns inward and towards the eye) are two such examples.
Ectropion
Ectropion is a progressive outward rotation or turning of the eyelid margin. Patients may experience symptoms due to ocular exposure and inadequate lubrication. Symptoms-such as blurry vision, severe discomfort, redness, watering, burning, itching, corneal defect are caused by continual overexposure to air and environmental factors without lubrication and protection from the lids and blinking. Temporary treatment includes frequent lubrication with artificial tears, artificial tear gel, or ophthalmic ointment, wiping lids up and in versus down and away from the eye and taping even patching to keep eye closed and covered. Surgical intervention is the only permanent resolve for ectroption.
Entropion
Entropion is a progressive inward rotation or turning of the lower eyelid margin. This causes continual irritation of the
ocular surface from the misdirected lashes. Symptoms—such as blurry vision, severe discomfort, foreign body sensation, redness, itching, burning, excessive tearing, and discharge—are caused by cilia and keratin rubbing against an unprotected globe. This may result in a persistent epithelial defect, corneal ulceration, and in the worst cases, globe perforation. Although conservative treatment with ocular lubricants (over the counter and prescribed drops, gels and ointments are typically used), taping, or botulinum toxin injections can produce temporary relief, surgical intervention is required to permanently restore proper anatomic positioning.
Tarsorrhaphy
Tarsorrhaphy is a surgical procedure in which the eyelids are partially sewn together to narrow the eyelid opening. It may be done to protect the cornea in cases of corneal exposure. It is one of the safest and most effective procedures for healing difficult-to-treat corneal lesions. Tarsorrhaphy is most commonly performed to protect the cornea from exposure caused by inadequate eyelid coverage, as may occur in Graves disease or facial nerve (CN VII) dysfunctions such as Bell palsy. It can also be used to aid in the healing of indolent corneal ulceration sometimes seen with tear-film deficiency, herpes simplex or zoster, stem cell dysfunction, or CN V dysfunction (neurotrophic lesions), Möbius syndrome or after corneal graft surgery. Tarsorrhaphies may be temporary or permanent; in the latter case, raw tarsal edges are created to form a lasting adhesion. They may be total or partial, depending on whether all or only a portion of the lid is fused and which part of the eye is therefore is occluded.
Skin Cancer Excision and Eyelid Reconstruction
The eyelids and skin around the eyes are not immune to skin cancers. Fortunately, most of the eyelid cancers we see are of the Basal Cell variety. Basal cell cancer spreads locally and once it is “out”, it is gone. For everything but the small localized growths, we utilize the services of a Mohs surgeon to completely excise the cancer using serial microscopic analysis.
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