Friday, August 11, 2017

A hyperthyorid patient with eye protrusion and severe dry eyes.

Hyperthyroidism is associated with ocular changes which can cause eye protrusion and severe dry eyes. This patient developed hyperthyroidism three years ago. Despite medical control of the condition, she noticed her eyes were becoming more protruded with eyelid retraction and frequent tearing that cause blurring of vision.  The tearing was a reflex response to dryness as a result of ocular exposure. In order to reduce the exposure, the lateral aspects of the eyelids were closed surgically (lateral tarsorrhaphy). The operation was performed as followed:

Hyperthyroid patient with ocular exposure due to eye protrusion 
and lid retraction.

Before surgery, the amount of lid closure was determined by closing 
the upper and lower lid laterally.

Before surgery, the amount of lid closure was determined by closing 
the upper and lower lid laterally.

The amount of tissue needed to be removed was marked.

The amount of marked tissue was incised.

The anterior lamella of the eyelid was split to take out the anterior lamella.

The picture showed the tissue removed with the lateral anterior lamella.

The angle of the eyelid was formed with 6/0 vicryl.

The posterior lamella was closed with 6/0 vicryl.

The orbicularis muscle was closed with 6/0 vicryl before the skin 
also with 6/0 vicryl.

Immediately after the procedure.

At two weeks postoperative. The exposure was reduced.





Saturday, July 29, 2017

A Patient with Upper Lid Swelling from Unknown Filler Injection

This man had had injection to his upper lid in a beauty saloon with an unknown filler resulting in upper eyelid swellings and occlusion of his visual fields. Examination revealed severe puffiness and hardness of the skin. Hyalase (enzyme to dissolve hyaluronic acid) was injected but the swelling failed to resolve suggesting some sort of permanent filler such as silicone might have been given. 
He underwent upper blepharoplasty with removal of the skin, fat and repositioning of the lacrimal glands.
Severe upper eyelid swelling after filler injection, 
right lid more puffy than the left.

Proposed height of the skin crease was shown to the patient. 
Black arrows shows prominent puffiness of the lateral upper 
eyelids indicating there may also be lacrimal gland prolapse.

The skin to be excised was marked and the skin crease was set 

The marked area was incised. 

The under surface of the excised eyelid showed the filler 
as shinny substances (arrowed).

The orbital septum was removed to show the fat.

The lacrimal gland (1) and levator aponeurosis (muscle that 
open the eye, 2) were found below the fatty tissue.

The fat that formed part of the upper lid swelling was excised.

The lacrimal gland contributed to the lateral puffiness. Removal 
is not recommended as this may cause dry eye.

Instead the lacrimal gland is repositioned using 5/0 ethilon 
to the orbital roof.

The lateral puffiness was abolished after lacrimal repositioning.

At the end of the surgery.




Thursday, July 13, 2017

A Patient with Headache and Blurred Vision.

This patient who had had cataract surgery 5 years ago complained of increasing blurriness of vision and headache. Examination did not show any opacities of the posterior capsule or any retina diseases, however, refraction showed high astigmatism of 2.00 D. In addition, she had excessively high eyebrows. The symptoms were attributable to droopy eyelids: astigmatism can occur when the droopy eyelids press on the globe and the headache due to constant use of the forehead muscle to elevate the eyebrows in an attempt to open the eyes.
After consultation, bilateral ptosis (droopy eyelid) surgery was done using the posterior approach. After the operation, her vision improved due to reduction of the astigmatism to -0.75 and the headache disappeared when the eyebrows returned to normal height.
Headache due to constant excessive use of forehead 
muscle to open the eyes.


One day after ptosis (droopy eyelid) operations.


Normal eye opening two weeks after droopy eyelid surgery.