Vision Scotland : Better vision for life

Oculoplastics

Vision Scotland specialises in oculoplastics – plastic and reconstructive surgery of the periorbital and facial tissues.

Vision Scotland | Better vision for life

Oculoplastics

Vision Scotland specialises in oculoplastics – plastic and reconstructive surgery of the periorbital and facial tissues.
Mr Ross discusses cataract surgery

Ectropion

An ectropian can affect one eye or both and is where either part, or all of the lower eyelid turns outwards from the eye. It often affects both eyes but can occur in one eye alone This can cause the inner lining of the eyelid to become sore, irritated and watery. Damage can also because to the cornea if the eye isn’t able to close properly. There are many causes of this condition but the most common is ageing. The condition is not usually serious but causes the sufferer some discomfort. Apart from affecting how the eye looks, the drooping eyelid may disrupt the drainage of tears and so cause the inner lining of the eyelid to become dry, sore, and watery. If the eye cannot close properly, it can also cause damage to the cornea.
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Entropion

An entropion is when the eyelid rolls inwards, it usually affects the lower eyelid but can also affect the upper lid. The condition can be present from birth but is more commonly infection or age-related. The main symptom of entropion is a discomfort caused by irritation from the eyelashes. This is because the inwards roll of the eyelid results in the eyelashes rubbing against the eye. Severe entropian can be quite painful and can cause damage to the cornea due to the irritation, occasionally resulting in vision loss. Eye drops can prevent the eye from becoming dry and may relieve symptoms but surgery is usually required to permanently correct the condition.
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Eye close up post surgery
Mr Sanjay Mantry preparing for cataract surgery in scrubs

Surgery for ectropion & entropian

Surgery is usually required to correct the effects of ectropion / entropian. The operation ‘tightens’ the skin and muscles around the eyelid. The best results are obtained if the condition has not become too severe. However, in more severe cases, further surgery may be required. This is a relatively small operation and requires being in hospital for 3-4 hours, and a 30 minute operation, usually performed while you are awake. Local anaesthetic is gently used to numb the treated area. If you are taking aspirin or warfarin or any other blood-thinning agent it is quite important that you continue to take it, but please discuss this with your surgeon at your first appointment. After surgery, you will have some bruising and swelling and will be asked to apply antibiotic cream to the treated area several times daily for 2 weeks. Beyond this, we encourage you to use a moisturizer to the healing skin for 3 months in order to achieve the best results. Bruising and swelling can be minimized with regular cold packs, arnica cream and tablets, and sleeping more upright with extra pillows for the first few days. A short course of ibuprofen may also reduce swelling and discomfort.
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Ptosis

Eyelid ptosis affects the muscles in the eyelid that are designed to lift the upper eyelid. It causes drooping of the upper eyelid. Ptosis occurs due to a dysfunction of the muscles or nerve supply that control the raising and lowering of the eyelid. It can affect one eye or both. The drooping may be worse after being awake longer, when the individual’s muscles are tired. It is possible to be born with ptosis but more common to develop with ageing.

It can also be caused in contact lens wearers who are in continuous contact with the eye when removing / inserting lenses. Ptosis can, on rare occasions be caused by neuromuscular disease. Eyelid ptosis can also occur with the use of some drugs, following eyelid trauma or as a by-product of an eyelid lump such as a large chalazion or tumour. If sever and left untreated, ptosis can cause other conditions such as amblyopia or astigmatism. In rare cases where children suffer from the condition, it is important that ptosis is treated to prevent onward development of vision.

A full ophthalmic examination is performed to check visual function, eye movement, the eyelid condition and the ocular surface. A full face examination is performed where special eyelid measurements are taken and a phenylephrine test is performed to assess the degree and type of ptosis. This helps decide the specific surgery that may be required. The only permanent way to treat eyelid ptosis is with surgery. Occasionally, injection treatments or eye drops can be used to temporarily rectify minor upper eyelid ptosis.

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Diagnostic testing for RLE surgery at Vision Scotland
Eleanor, Optometrist at Vision Scotland

Ptosis patient journey

Upper eyelid ptosis surgery is used to treat age-related drooping of the eyelids, contact lens-related drooping of the eyelids or eyelids which have been droopy from early childhood. Because the eyelid position is fine-tuned during surgery, it is quite important that you are awake throughout this procedure and can cooperate with the surgeon’s instructions.

You should expect the procedure to be slightly uncomfortable during the initial anaesthetic injections and also when the eyelid muscle is actually tightened. Afterwards there will be some bruising and swelling, and the eyelid stitches will need to be removed after approximately 10 days

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Blepharitis

Blepharitis is inflammation of the rims of the eyelids, which causes them to become red and swollen. Symptoms can include; burning, soreness or stinging in the eyes, crusty eyelashes or itchy eyelids. It is commonly caused by bacterial infection or can be a complication of a skin condition. Blepharitis will often be treated by your GP but occasionally, referral to an Ophthalmologist is required.
Vision Scotland Optometrist Cat talking to a patient

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