Oculoplastic Surgeon Blair Armstrong MD specializes in cosmetic and medical procedures in eye and facial areas. While oculoplastic surgery improves your appearance, some procedures may be considered medically necessary if vision is impaired. Make a consultation appointment with Dr. Blair Armstrong to learn about surgery options and answer all your questions. Click here to view Dr. Blair Armstrong’s biography.
Eyelid and Eyebrow Surgeries
Upper Blepharoplasty (Upper Eyelid Lift)
With time and gravity, the thin skin around the eyes can become loose and may sag. Sometimes the excess tissue droops over the eye, blocking vision. Excess skin and fatty tissue can be removed through a surgery called blepharoplasty. Surgery may be done in the operating room or in the office.
Ptosis (Droopy Eyelid Surgery)
The upper eyelid is opened by two muscles. In some patients, these muscles become weak or the attachment becomes loosened. The eyelid can droop and block the vision. Ptosis can be corrected by surgery to tighten these muscles. This may be performed through an incision on the front surface of the eyelid or through the underside of the eyelid for a “scarless” surgery. Your surgeon evaluate which procedure is right for you.
When the eyebrows droop or sag over time, it can contribute to a slack appearance and may block vision. There are various surgeries to lift eyebrows, including an internal approach, where an upper eyelid incision raises and tightens the soft tissue. A direct approach involves an incision above the eyebrow itself. At your consultation, the surgeon determines which approach is best in your case.
Lower Blepharoplasty (Eyelid bag surgery)
Noticeable lower eye bags are often caused when fat pockets from behind the eye pushes it forward. This can contribute to a tired appearance. A lower blepharoplasty can be performed through the inner side of the eyelid, called the transconjunctival approach. If done through the eyelid skin, surgery involves removal or repositioning of the fat pockets and sometimes removal of extra eyelid skin.
Ectropion/Entropion (Eyelid turning out/Eyelid turning in)
The lower eyelids can become loose with time. Sometimes this results in a position that can cause irritation or injury to the eye. An ectropion is where the eyelid hangs away or down from the eye. An entropion is when the eyelid rolls inward towards the eye, causing problems when the eyelashes rub against the surface of the eye. These eyelid problems can be corrected with outpatient surgery.
Trichiasis (Eyelash removal)
Sometimes the eyelashes become misdirected and can poke into a patient’s eye. Other patients may have an extra row of eyelashes. These conditions can be treated by various techniques in the office, including permanent lash removal using an electro-cautery system. In some patients, surgery may be required to fully treat the problem.
Bell’s Palsy/Gold Weight Surgery
The closing of the eye is controlled by a nerve that also controls the muscles of the face. In conditions such as Bell’s Palsy, this nerve can become weak and the eye is unable to close properly. The eye’s surface then becomes very dry and is at risk for infection. A surgery to place a weight in the eyelid, usually made from gold or platinum, can help to facilitate closure and protect the eye
Eye-Area Skin Surgery
Eyelid Lesion Removal
Lumps or bumps can develop around the eye and can cause irritation. Although most of are benign (non-cancerous), skin cancer can occur around the eye. Most of these growths can be removed by a simple in-office procedure under local anesthesia. If there is concern for skin cancer, tissue can be sent to a pathologist for further testing.
Eyelid Reconstruction after Skin Cancer
When skin cancer occurs around the eyelid, it is most often treated with excision of the cancer and affected surrounding soft tissue. This is often done in conjunction with a dermatologist or Mohs surgeon. The eyelid must be carefully reconstructed to allow for continued function and protection of the eye. This is done through a variety of techniques including flaps or skin grafts
Lacrimal (tear drain) Surgeries
The tear, or nasolacrimal, duct can become blocked. For adults, the tear drain can be evaluated by a simple in-office procedure of tear duct probing, irrigation and intubation. Liquid is flushed through the system to detect a blockage and determine where it exists. Treatment options are:
- Punctoplasty – If the opening to the tear drain (puncta) is small, it may block tears from flowing out of the eye. An in-office procedure can be used to enlarge the puncta opening.
- Dacryocystorhinostomy (DCR) - If there is a blockage to the tear drain that cannot be opened with conservative measures, surgery is usually recommended. A DCR surgery constructs a new opening to bypass the blockage. This can be done externally through a small incision on the face, or endoscopically through the nose. Temporary tubes or stents are usually inserted after surgery.
- Canalicular Obstruction or Traumatic Repair – The tube or canaliculus that carries tears from the eye to the nose can become blocked or torn as a result of trauma to the eyelid. If this is detected close to the time of injury, it can be carefully repaired with the placement of a stent to help prevent scarring. If there is a blockage detected long after trauma occurs, a different procedure may be performed in the office or operating room to open the blockage or scar tissue.
- Jones Tube/Conjunctivodacryocystorhinostomy (CDCR) – The canaliculi, or fine tubes in the eyelid that carry tears to the nose, can become so blocked that they cannot be opened with more conservative measures. In these cases, a surgical procedure called a Jones Tube may be recommended. This involves the placement of a glass tube from the corner of the eye into the nose to allow for tear drainage. This procedure is performed in the operating room.
Orbital (eye socket) Surgeries
Thyroid Eye Disease
Systemic thyroid dysfunction such as Grave’s disease affects the eyes in about 30% of these patients. This usually causes swelling of the tissues around the eye and can cause bulging eyes or retraction of the eyelids. Sometimes it can cause blindness. Treatment of thyroid eye disease consists of careful monitoring and surgery to reconstruct the eye socket, eyelids or eye muscles if necessary.
The eye socket or orbit is made of bone. Trauma may cause these bones to break or crack. This can affect the soft tissues around the eye such as the muscles that move the eye, or it can cause the eye to sink down or back into the skull. Depending on the size and location of the bony fracture, it may need to be surgically repaired, either right after the injury or at a later time.