We all experience watery eyes occasionally, and it’s normal if you’re outside in the cold or wind or a piece of debris gets in the eyes. Sometimes, it can be due to an allergy or an infection like conjunctivitis. If you’re experiencing prolonged eye tearing and other symptoms, it is often due to a blocked tear duct.

Your tear system keeps your eyes lubricated and comprises three sections – your lacrimal glands, puncta, and nasolacrimal ducts. Each plays a role in ensuring tears can drain away effectively. Tear fluid also contains antibodies that fight against both bacteria and viruses.

The lacrimal glands are located inside the upper eyelids, and the tears flow from the glands to lubricate the eye surface before draining into the puncta. These are the openings in the inner corners of your eyelids. The nasolacrimal or tear ducts are the passage from the puncta to your nose. When your tear ducts become blocked, fluid cannot normally drain from the eye.

What causes blocked tear ducts?

A congenital tear duct blockage is relatively common in babies and maybe because the tear duct is not fully developed or a thin membrane covers the duct. More than 6% of newborns have a blocked tear duct in either one or both eyes.

In adults, infections can lead to scar tissue build-up, which blocks the tear duct. Trauma to your nose, face, or eye can cause swelling. Tumours or growths, either benign or cancerous, can cause blockages in your tear ducts. Tear stones, or dacryoliths, can form when tear fluid collects and hardens. If these are big enough, they can block a tear duct.

Age-related changes to the tear duct system can cause the puncta to narrow. It can also narrow as a result of infection or inflammation. Uveitis, a condition where the blood flow to your retina is impacted, narrows your puncta, as do some types of glaucoma treatment eye drops.

Previous surgery on your eye, eyelid, nasal passage or sinuses can result in a blocked tear duct due to scarring. Blocked tear ducts may also occur as a side effect of cancer treatments such as radiotherapy and chemotherapy.

What are the symptoms of blocked tear ducts?

Blocked tear ducts can present in several ways, including:

  • Constant and/or excessively watery eyes, known as epiphora
  • Swelling and pain
  • Redness
  • Blurred vision
  • Recurring eye infections
  • Crusting and discharge or pus that builds up on your eyelids or in your eyelashes
  • Itchiness in and around the eye
  • Fever

How are blocked tear ducts treated?

Ophthalmic and Oculoplastic Surgeon Dr Nick Koutroumanos will first diagnose the cause of a blocked tear duct. This will be based on the symptoms you’re experiencing and a physical examination of the eye and tear duct. He may then order diagnostic tests.

A blocked tear duct is very treatable. A blocked tear duct typically improves within the first year without any medical intervention in babies. Antibiotics will be prescribed if an infection is related to a blocked tear duct. Applying firm pressure to the inner corner of the eyelids several times daily can help clear the blockage.

One treatment option is a technique called dilation, probing and irrigation. The puncta is dilated, and then Dr Koutroumanos will probe the blocked part of the tear system with specially designed tools that can remove the cause of the blockage if possible. The final stage is irrigating the tear duct with saline fluid.

Other approaches are balloon dilation, stenting or intubation or a surgical procedure known as a dacryocystorhinostomy (DCR) that creates a new path for tears to drain between your eyes and your nose. This can be performed through the nose known as Endonasal DCR (Scarless Tear-Duct Repair) or External DCR.

Functional Oculoplastic Surgery with Dr Nick Koutroumanos

London Ophthalmic and Oculoplastic surgeon Dr Nick Koutroumanos is an expert in ophthalmic plastic and reconstructive eyelid surgery including upper and lower blepharoplasty.

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A blocked tear duct is common and generally harmless in babies but may signify serious health issues in adults. If you have a blocked tear duct, it’s vital to seek immediate medical help. Some cases may resolve with non-invasive treatment, while others will require an oculoplastic surgeon. Here’s an overview of the main symptoms of a blocked tear duct and how to fix the condition.

What Is A Blocked Tear Duct?

A blocked tear duct is precisely what the name suggests. When your tear ducts are blocked, the tears can’t drain normally. Blocked tear ducts will leave you with a teary eye and irritation and stem from various factors. The prevalent causes include congenital blockage (in infants), age-related changes, infection and inflammation, injury, trauma, tumors, and treatments.

Tears come from the lacrimal glands inside the upper lids above your eyes. The tear flows over your eyes and drains into the puncta (openings inside the corner of the eyelids). From the puncta, tears flow to the canaliculi (small canals) then to a lacrimal sac reservoir on the side of the node. The tears then flow to the nasolacrimal duct, from which it drains into your nose and is reabsorbed.

Blockage can occur anywhere along the drainage system, from the puncta to the nose. Risk factors such as age, chronic eye inflammation, past surgeries, glaucoma, and cancer treatment increase the likelihood of blockage. A blocked tear duct will affect most drainage system parts, including the conjunctiva (transparent membranes over your eye). The blockage can lead to inflammation or infections.

Symptoms of Blocked Tear Duct

A watery eye or excessive tearing is the main symptom of a blocked tear duct. The condition is almost always treatable and temporary, but some cases require a professional eye doctor to resolve. Apart from excess tears, you may experience the following symptoms:

  • Redness of the Eye: The white part of the eye may become red and irritated because of excessive tearing and the inflammation of the clear membranes covering it.
  • Pink Eye: You may experience recurring eye inflammation and infections like conjunctivitis or pink eye.
  • Blurred Vision: Your vision may become blurry because of excessive tearing, infections, or inflammation.
  • Pain and Swelling: Painful swelling is common among those with a blocked tear duct because the blockage puts excess pressure on the glands. The pain and swelling are often near the inside corners of the eye.
  • Crusting Eyelids: The excess tears and inflammation usually lead to crust forming on or around your eyelids.
  • Mucus/Pus: You may experience mucus or pus discharge from the eyes and eyelids.

Watery eyes may develop alongside a cold, a sinus infection, or an eye infection not related to a blocked tear duct. Symptoms such as swelling and redness may also stem from injuries to the eye, not necessarily affecting the tear ducts. Some teary eyes develop because of bacterial infection, in which case you may experience other symptoms like fever. Exposure to wind, dust, and bright light may also trigger excessive tearing, so professional diagnosis is vital.

Blocked Tear Duct Symptoms in Babies

Babies don’t start producing tears until they are a few weeks old. You won’t notice the symptoms of a blocked tear duct straightaway. Once they begin producing tears, you may see the following symptoms, which suggest a blocked tear duct:

  • Redness: The eye surface will become red, usually because your baby is frequently rubbing the eye area.
  • Unusual Drainage: Tears will drain down the cheek instead of the usual corner of the eye.
  • No Drainage: Tear may pool near the corner of your baby’s eye without draining.
  • Discharge: You may notice a yellowish discharge, mucus, or pus in the baby’s eye.

A blocked tear duct is harmless for babies but may cause distress for you and your baby. If you notice these symptoms in your baby, seek an immediate diagnosis. Popular tests include tear drainage assessment, eye imaging, irrigation, and probing. Treatment may include medication, dilation, probing, flushing, stenting, balloon catheter dilation, and snip punctoplasty.

What to Do For a Blocked Tear Duct

In babies, blocked tear ducts will resolve in a few weeks or months without treatment. As the tear duct and glands mature, they’ll naturally remove the blockage. Your post-natal doctor may suggest a special eyelid massage to open the tissues for optimal tear flow. In adults, blocked ducts may resolve naturally or require treatment, such as massage.

Other cases may call for surgery from an oculoplastic surgeon. It’s vital to wash your hands thoroughly and frequently and avoid rubbing your eyes. If you wear contact lenses or glasses, follow all cleaning recommendations from your eye care specialist. You should also schedule an appointment with your doctor for a professional diagnosis.

When to See an Oculoplastic Surgeon

There’s no home remedy for adults. It’s crucial to seek medical assistance to identify the underlying cause. Conditions arising from bacterial infections can resolve using antibiotic eye drops and pills.

If the cause is a narrow punctum, the doctor will use a small probe to increase the opening and irrigate the tear duct with a saline solution. Diagnosis will determine whether you need an oculoplastic surgeon for operations like dacryocystorhinostomy.

Dr Nick Koutroumanos specialises in eyelids, eye socked, and peri-ocular surgery. You can get a professional diagnosis, treatment, and surgery if necessary to restore normal tear drainage.

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Teary eyes can be uncomfortable and embarrassing. Why it happens vary with age. Some of these problems will go away on their own, some may resolve with medication, and others may require eyelid surgery. Keep reading to learn more about potential causes and treatments for teary eyes.

What Causes Teary Eyes?

Common ailments like allergies or sinus infections can cause watery eyes. This is caused by a narrowing of your tear duct due to infection or swelling. Most people have experienced this kind of watery eyes. Persistent watery eyes are usually attributed to an ongoing problem.

Blocked tear ducts are one of the main causes of watery eyes. Tear ducts act as channels to drain tears from your eyes into your sinuses. Tears overflow along your eyelid when these channels become blocked. This causes watery eyes and mucus discharge.

Blocked tear ducts are common in infants and young children but happen in adults too. Babies born with a blocked tear duct have congenital nasolacrimal duct obstruction. This usually clears up on its own within the first year of life. However, if it doesn’t get better your pediatrician may recommend your child visit an eye surgeon for further evaluation.

Watery eyes are due to one of two ailments in older adults. One common problem related to age is the eyelid sagging away from the eyeball, which lets tears leak out. The other common problem is narrowing tear ducts. This is caused by inflammation, injury, or ageing. Such narrowing can lead to a blocked tear duct.

Ophthalmologists can diagnose these ailments and refer you for further treatment. You may be referred to an eye surgeon, who can provide you with information about eyelid or tear duct surgery.

Less Invasive Solutions for Teary Eyes

Treatment for watery eyes will depend on the route cause. There are some non-invasive methods to repair a blocked tear duct.

For tear ducts blocked due to infection, the first course of treatment will be a prescription to treat the underlying illness. This could be in the form of an eye drop or oral medication. Medication may also be prescribed to relieve blockage from swelling or inflammation.

A special massage technique can encourage a baby’s blocked tear duct to open. Parents can be taught this technique to help open their children’s blocked tear ducts. Sometimes this works, sometimes not, which is why observation is a critical tool in solving tear duct blockages.

It is important to continue observing tear duct blockages to see if they resolve on their own or will require further medical attention. In infants especially, tear duct blockages often resolve on their own before one year of age. For adults with injuries or swelling that caused their tear duct blockage, you may also be asked to wait and observe if the blockage improves as your injury heals.

Eyelid Surgery and Other Procedures

If you have a severe blockage you may not be a candidate for the procedures in the previous section. Your doctor may recommend other procedures if less invasive methods do not work. Most of these procedures are performed by a surgeon while you are under general anesthesia.

Dilation and Flushing
Your eye surgeon will insert a small probe into your tear duct and dilate it. They will then flush your tear duct with a high-pressure saline solution. You may also see this referred to as irrigation. It is not always a permanent solution but can help clear a blockage.

Another option to help give relief for blocked tear ducts is to place a stent. A stent is another name for a very small tube. These tubes create a passage for tears to drain properly into the sinuses. They are generally not permanent but may cause irritation.

Eyelid Surgery
Eyelid surgery is called dacryocystorhinostomy and is abbreviated as DCR. This surgery makes a shortcut for your tears that bypasses any narrow or blocked passages in your tear ducts. In our practice, more than 90% of patients see a reduction in their watery eyes after the procedure.

There are two types of DCR, one called external DCR, and one called endonasal or keyhole DCR. The method your surgeon uses will be based on the severity and location of your blockage. The main difference is the location of the incision. For external DCR your surgeon will make a tiny incision on the side of your nose, and for endonasal DCR your surgeon will make an incision within the nasal cavity. Dr Koutroumanos’ practice nearly exclusively uses the endonasal approach which results in absolutely no scarring.

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Eyelid surgery is a standard cosmetic procedure for improving the symmetry and appearance of the eye area. If you’ve undergone an eyelid procedure, it’s essential to follow your surgeon’s recommendation. Post-surgery recovery can take 2 two 4 weeks, but each case is different. Here’s an overview of how long you should rest after an eyelid operation:

What to Expect After Eyelid Surgery

Those who undergo eyelid procedures like blepharoplasty, brow lifts or droopy eyelid surgery need time to recover before getting back to daily activities. Most clinics have a recovery room where patients will remain until they are stable. Individuals may experience the following:

  • Blurred vision because of the lubricating ointment
  • Numb, sore and puffy eyelids
  • Slight pain and discomfort around the eye area
  • Swelling and bruising similar to a black eye

Once the subject is again comfortable, they can have someone pick them from the clinic. It’s also advisable to get help for the first night after surgery. You’ll continue to use the antibiotic ointment to lubricate the eyelid the wound.

How Long Will the Recovery Take?

Recovery begins once the surgery is complete, and patients may take varying durations to recover fully. It’s essential to notify the surgeon about developing symptoms and follow through with all recommended appointments. Some operations require several weeks to heal, but you’ll see much progress before full healing. Still, you should not skip any check-up appointments.

Most people can go back to work just a few days after surgery. The recovery has three main parts: bruising, swelling and incision/scar maturation. Bruising can take a couple of weeks to go away and is your first recovery phase.

Swelling is more variable, and the diminution is gradual. It can take some time to heal naturally.

Eyelid operations will leave incision scars and wounds requiring up to a year or more to reach full maturity. Scar maturity refers to maximum improvement or healing. Following the best post-surgery recovery methods can ensure proper healing and skin reconstruction during the maturity period. You should combine doctor recommendations and best self-care practices. Dr Koutroumanos’ surgical techniques will nearly always lead to scarless results. If this is not to be expected, it will be discussed with you prior to the surgery.

What to Do After Eyelid Surgery

There are various things to do after a surgical operation on your eyelid. You should prepare to take time off from work, school and daily activities immediately after the surgery. Preparation is essential to ensure you get the best rest during recovery.

You can appoint someone else to handle daily responsibilities like taking the kids to school or stocking the kitchen supplies. Your surgeon will also suggest various self-care practices to aid the recovery process. Popular recommendations include:

  • Using ice packs (or even a bag of frozen peas wrapped in a clean towel) constantly for the first 2 days after surgery
  • Cleaning the eyelids gently
  • Using prescribed eye drops and ointments
  • Sleeping with the head raised above the chest for the first few days after surgery
  • Visiting the surgeon to remove the stitches and discuss ongoing recovery

Eye surgery recovery is all about staying patient and having realistic expectations focusing on the end goal. The eyelids will be puffy and sore, and the incisions will look red. Swelling and bruising will also result in something close to a black eye. There’s no need to rush the healing process or feel stressed because it’s taking longer for the swelling/scarring to heal.

Eyelid surgeons recommend sleeping soundly. A good night’s sleep can speed up the healing process. If you feel tired or pressured, relax and focus on the recovery. It’s also essential to protect your eyes from wind, dust and sunlight. Use a hat, dark sunglasses and recommended sunscreen if you must go out and follow all instructions from the surgeon.

What to Avoid After Eyelid Surgery

You should avoid rubbing your eyes for the first couple of weeks after an eyelid operation. Eyelid surgeries require subjects to stop smoking and avoid medications like Aspirin, Ibuprofen (Advil) and Naproxen. Medications and supplements, such as vitamin E, fish oils and cranberry extracts, are also ill-advised.

Such compounds increase bleeding and slow down the healing process. Your surgeon will explain everything you should avoid before and after the procedure. Make sure you get the approval of your surgeon before using any painkiller. You should also avoid straining your eyes through reading and watching TV and strenuous activities that increase blood circulation.

Working With A Reputable Ophthalmologist

Eyelid surgery recovery requires a qualified ophthalmologist with experience in the procedure. The priority should remain to find a reputable, experienced ophthalmologist with a growing reputation and a senior recognised NHS position.

Book Your Consultation

Ready to explore how eyelid surgery can enhance and rejuvenate? Book a consultation with Dr Nick Koutroumanos:

Plastic and oculoplastic surgeons are closely related but have some distinctions worth mentioning. Oculoplastic surgery mainly deals with the eyelids and structures around the eye, while standard plastic surgery covers the entire body. Here’s an overview of the main differences between oculoplastic (eyelid) surgery and general plastic surgery.

Plastic and oculoplastic surgeons are closely related but have some distinctions worth mentioning. Oculoplastic surgery mainly deals with the eyelids and structures around the eye, while standard plastic surgery covers the entire body. Here’s an overview of the main differences between oculoplastic (eyelid) surgery and general plastic surgery.

Plastic and Oculoplastic Surgeon Education

An oculoplastic surgeon must complete training and internship and needs more extensive training than general plastic surgeons. The Oculoplastic surgeon must graduate from medical school and complete nine years of internship and residency in ophthalmic surgery.

Candidates must also complete two years of additional fellowship training. They’ll undergo scientific research and oral/written examinations. Oculoplastic surgeons must also perform 500 surgeries before they begin specialised training in ophthalmology.

Plastic surgeons need to graduate from medical school and complete several hours of training and internship. A plastic surgeon will begin a residency in general surgery immediately after completing medical school. The training focuses on general treatment for various body parts.

Candidates training to become plastic surgeons will also complete fellowship training in plastic surgery. The training involves treating and operating on all parts of the body. On average, plastic surgeons will complete at least 150 surgeries before specialised training.

Oculoplastic Surgeries and Treatments

Oculoplastic surgery focuses on the eyelids, eye sockets and facial structures around the eye area. It’s a highly specialised surgical procedure combining ophthalmology and plastic surgery. The surgeries are also delicate and involve operating on incredibly fine structures.

The procedure also comes by other names, including oculofacial surgery, ophthalmic plastic surgery and ophthalmic reconstructive surgery. Oculoplastic surgery can be cosmetic or reconstructive or both.

Certified surgeons can treat conditions affecting these structures, including watery eyes, injuries, drooping eyelids, skin cancers and thyroid eye disease. Popular oculoplastic surgeries include blepharoplasty and ptosis repair:

  • Blepharoplasty – refers to a type of eyelid surgery used to treat patients with excess upper eyelid skin that folds over the eyelashes or lower eyelid wrinkling, bags or dark circles.
  • Ptosis Repair – involves correcting an upper eyelid that droops over the pupil because the eyelid lifting muscle is weak or slipped.

Oculoplastic surgeons can also offer non-surgical procedures for patients with cosmetic and functional issues. Other treatments include skin care to enhance the appearance of facial skin. The surgery combines microsurgical skills and aesthetic and soft-tissue skills.

Microsurgical operations are part of an ophthalmologist’s work. The aesthetic and soft-tissue operations are from general plastic surgery. Oculoplastic surgeons may specialise in specific procedures, such as peri-ocular surgery or eyelid surgery.

Plastic Surgeon Operations and Treatments

Plastic surgery involves restoration, reconstruction or alteration of the skin and musculoskeletal tissues. A plastic surgeon can perform the procedure on all parts and extremities of the body, including the head and face, neck, chest, abdomen and back.

Anti-Wrinkle Injections, Juvederm, Xeomin and Volbella are typical plastic surgeries for addressing wrinkles, fine lines, ageing and more. Plastic surgery falls into two primary categories: cosmetic and reconstructive/functional.

  • Cosmetic Surgery – Focuses on enhancing appearance. It is the most commonly sought plastic surgery and suits those looking to reverse ageing or alter appearance.
  • Reconstructive Surgery – Also known as functional surgery, reconstructive surgery focuses on restoring or improving function. It suits people who have an injury or condition requiring reconstruction to regain normal function.

Popular plastic surgeries are further grouped into different categories based on the body part. Popular types include head, face and eyes, mouth and teeth, breast, abdomen, hand and upper limb and skin. Here are examples under each category:

  1. Head/Face Surgeries: Includes facelift, forehead/brow lift, eyelid lift, ear reshaping, hair replacement, nasal surgery and nose reshaping. Chin, cheek and jaw reshaping, lip augmentation, cleft lip/palate and craniosynostosis are also standard head plastic surgeries.
  2. Mouth and Teeth Surgeries: Maxillofacial and oral surgeries are the two famous mouth and teeth plastic surgeries. They involve reconstructing and enhancing the teeth, jaws and mouth.
  3. Breast and Abdomen Surgeries: Breast surgery includes breast augmentation, reconstruction and reduction (for Gynecomastia) and breast lift. Abdomen surgeries include a tummy tuck (abdominoplasty) and liposuction.
  4. Hand and Limb Surgeries: Chase hand and limb centre are the standard procedures under this category. They mainly involve cosmetic enhancements but may also suit functional reconstructions.
  5. Skin Plastic Surgeries: You’ll encounter several skin surgeries, including chemical peel, Anti-Wrinkle Injections, dermabrasion and injectable collagen fillers. Other examples include glycolic and laser peels, vein removal, scar revision and tattoo removal.

Other Key Differences Between Plastic and Oculoplastic Surgeons

Oculoplastic surgeons begin with fine touch obtained from ophthalmology training. The surgeons focus solely on the eyes and facial regions and are specialists in such operations.

Plastic surgeons begin with large touch, big body and bowel manipulations obtained from general surgery training. A plastic surgeon will cover many body parts, including the head, neck, arms/limbs, chest, abdomen and more.

You’ll encounter fantastic plastic and oculoplastic surgeons, but the latter has a slight edge when it comes to aesthetic facial surgery. Plastic surgeons are big sculptors specialised in chipping away unwanted parts to produce beautiful results.

Oculoplastic surgeons use delicate, small and precise movements to produce the most beautiful outcome. They will learn precision and finesse in ophthalmology and oculoplastic fellowships.

Oculoplastic surgeons suit eyelid and facial plastic surgery where attention to detail is vital for better surgical and aesthetic outcomes. Some plastic surgeons can still achieve a great job performing eyelid surgeries but won’t be nearly as good as oculoplastic surgeons.

Who Should I Visit for Eyelid Surgery: Plastic or Oculoplastic Surgeon?

Oculoplastic surgeons are arguably plastic surgeons, albeit specialised in the eyelid, eye socket and facial structures surrounding the eye area. If you need eyelid surgery, peri-ocular surgery, ptosis repair or general ophthalmologic services, you should visit an oculoplastic surgeon.

General plastic surgeons can handle various procedures to treat different areas. An oculoplastic surgeon can only operate on the eye and facial area, while plastic surgeons work on all body parts. You can visit a plastic surgeon for head, neck, chest, arm and abdomen surgeries.

Since oculoplastic surgery is plastic surgery, experienced plastic surgeons can perform eyelid operations and other facial procedures. Patients should review each surgeon keenly to choose the right professional for their needs.

Oculoplastic surgeons offer better precision and finesse for delicate eye surgeries and ophthalmological procedures.

Eyelid Surgery with Dr Nick Koutroumanos: Your Solution to Rejuvenated Eyes

London Ophthalmic and Oculoplastic surgeon Dr Nick Koutroumanos is an expert in ophthalmic plastic and reconstructive eyelid surgery including upper and lower blepharoplasty.

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Oculoplastics in the News: What is eyelid ptosis? What is a droopy eyelid and what can be done to correct this in London?

Published: 04/08/2021

The clinical nuances involved in recognising ptosis are very important when it comes to considering the condition, how it’s caused and options regarding repair.

Leading ophthalmic and oculoplastic surgeon, Dr Nick Koutroumanos speaks to Top Doctors about these issues as well as the difference between ptosis and hooded eyes, and the management of ptosis in children.

What is ptosis?

When people refer to droopy eyelids, they may be describing a number of different things which, in clinical practice, actually vary. They vary both in terms of what causes them and more importantly, how they ought to be repaired.

Eyelid ptosis or blepharoptosis, is in a sense a true eyelid droop, and it refers to the condition when one or both upper eyelids sit in a position lower than normal, whatever this normal might be for every different person. By eyelid, here we refer to the curved edge of the upper lid where the lashes are found and the area which wipes the eye’s surface every time we blink.

What causes ptosis?

The causes of ptosis form a long list and a vital part of the assessment with an oculoplastic specialist is working out which of these actually causes someone’s droopy eyelid. Individuals can be born with a droopy eyelid on one or both eyes. In these cases of congenital ptosis, it is actually quite common for both eyes to be affected but to a different degree.

If you are not born with eyelid ptosis but have instead developed it later in life, chances are you have what we refer to as aponeurotic (or involutional) ptosis, which in effect refers to the gradual stretching and slipping of the little muscle which controls the eyelid position. This is common and is easily addressed by day case surgery. Correction is proven again and again to be associated with significant improvement in people’s quality of life. A droopy eyelid can of course affect one’s vision if severe enough but even in milder cases, headaches may develop due to the constant eyebrow lifting and of course, confidence is frequently affected.

A very small proportion of individuals will develop eyelid ptosis due to an underlying medical condition or injury and though these cases are uncommon, it is vital that they are identified and, when necessary, managed promptly.

What is the difference between ptosis and hooded eyes?

This is a good question because this distinction is very important to make. Hooded eyes, or dermatochalasis, is when the upper lid’s curved edge, (lash line) is sitting on an appropriate and symmetric position in front of the eye but the skin above it, is excessive. This can have many appearances, from skin hooding, hiding part of or the whole eyelid, to a bulging, bulky swelling giving a swollen eyelid appearance and so on. People describe puffy, hooded, droopy or fatty eyelids. Much like with eyelid ptosis, hooding can be distressing and disfiguring. Individuals are often thought of as being tired and can appear more aged than they feel.

When more severe, dermatochalasis or hooding can cause headaches or reduction of peripheral vision. Upper eyelid blepharoplasty surgery, when carried out by eyelid specialists is safe and rapid, a day case or sometimes in-office procedure which can dramatically improve one’s youthfulness and appearance.

What is the best treatment option for ptosis?

As mentioned previously, the first and most vital bit here is making an appropriate diagnosis. Ptosis can be missed during your average non-specialist aesthetic assessment and this sometimes leads to blepharoplasty surgery being carried out inappropriately with disappointing results.

When eyelid ptosis is picked up, certain measurements carried out will define the suitability and need for surgery but also the ideal technique. If not all, the vast majority of eyelid ptosis carried out in my practice is done via a hidden incision or no incision at all, meaning that no scar is visible after surgery. An assessment of the eyeball and the eye surface will decide how safe ptosis surgery is. The need for one or both eye surgery will be assessed so that symmetry can be optimised.

Though any surgeon’s main focus will be the safety of the eye and its function, detailed attention should be given to restoring and improving symmetry and youthfulness.

What are the complications of ptosis surgery?

When ptosis and its causes are suitably worked out and the correct management plan is offered, ptosis repair surgery is a very safe procedure. Most often, it is carried out under local anaesthesia with an administration of a relaxant to ensure that the procedure is pleasant. Down time is usually about a week.

A very small proportion of patients, in the range of 5 to 10 per cent, may be offered some adjustment for refinement of the symmetry or the resulting eyelid position. Dry-eye sensation can be encountered for a number of days or weeks after surgery and a very small proportion of cases may experience longer periods of dryness. This, however, is very uncommon.

How is ptosis managed in children?

Ptosis repair in children can be both more challenging but also often more beneficial.

Depending on the severity of the droopy eyelid, the effect it causes on the child’s vision, head posture and psychosocial wellbeing, surgical correction can be offered. Congenital ptosis repair is an area of medicine of particular interest to me, given not only the technical precision required to deliver a precise result but also the incredible effect this intervention can have on a child’s quality of life and development.

A variety of surgical techniques are available all of which are carried out under general anaesthetic. The choice of technique is based on the child’s age, severity of ptosis and the strength of the eyelid muscle. Maintaining the safety of the eyes and providing a lasting natural and functional outcome is kept central to any treatment carried out.

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