Eyelids are a very significant part of the structure of the eyes. They not only cover the cornea but also help the tears to get eliminated and distributed. The eyelid distributes the tears and pumps them out through the tear duct. In absence of proper closure provided by the eyelids, the cornea may get scarred, develop epithelial defects or get infected or inflamed.
The problems in the eyelids can range from self resolving, benign processes to tumors, inflammation or even structural problems like blepharoptosis, ectropion or entropion. Although, most disorders of the eyelid do not threat vision or life, they may causes symptoms such as infection, foreign-body sensation, burning etc.
It is very important that the exact problems are recognized so that the treatment can be initiated accordingly. Various types of treatments like excision, laser treatment, warm compress etc may be required to cure the condition.
Eyelid retraction is the condition in which the upper eyelid displaces upward or the lower displacement of the lower eyelid causes the white portion of the eyes, also known as sclera, to be exposed. This condition causes abnormal opening of the eyelids, which not only causes an abnormal stare but also leads to dryness in the eyes.
Eyelid retraction is most commonly caused due to thyroid opthalmopathy; therefore the thyroid levels of a patient should be checked. Thyroid Eye Disease or TED may cause formation of excessive tissue in the retractor muscles of the eyelids which causes the retraction. The other causes may be tumors, blepharoptosis, and damage to the lower eyelid during cosmetic treatment of the eyes. TED is also known as Grave’s opthalmopathy and it is a type of inflammatory disorder which affects the orbit of the eye. In this case, the patient’s immune system itself produces antibodies which attack the thyroid gland which may eventually result in overproduction of hormones. In almost 10 out of 100 patients of hyperthyroidism, the tissues around the eyes will also be affected.
Symptoms and signs
In the mild TED, the patient may only experience dry and irritated eyes. Eyelid retraction is a classic symptom which gives the patient the characteristic stare. The degree of the retraction of eyelids may vary and in some cases it may flare thereby giving the “stare” a more pronounced look in the patient. This causes in poor protection of cornea and incomplete closure of the eyelids. In severe cases, loss of vision may occur to exposure of cornea and ulceration.
It is important o consult a physician or a specialist to get the level of thyroid under control. The symptoms generally come under control once the thyroid problem has been resolved. As the eye disease is indirectly related to the thyroid, the changes in the eye may still be present and may even progress in some cases.
The treatment of the condition is generally done in two phases. The main focus, primarily, is on preservation of the eyesight and treatment of the inflammatory disease. Artificial tear supplements may be given during the primary phase of treatment. There are a number of reconstructive procedures available to deal with the aesthetic aspect of the problem of eyelid retraction.
In the surgical treatment, the upper eyelid as well as the lower eyelid can be repositioned. The patient is given anesthesia but is kept alert during the procedure so that changes can be made in the eyelid position even intraoperatively. To minimize the risk of asymmetry following the surgery, the adjustments are made during the surgery itself. In only 10-15% of cases, additional surgeries may be required. Mild cases of the eyelid retraction may be considered cosmetic.
A treatment known as LPS(Levator Palpebrae Superioris) muscle recession is done in cases where over correction of blepharoptosis takes place. The procedure is carried out under local anesthesia and the height of the eyelids is gradually decreased. All this is done with the patient sitting up on the operation table so that the final eyelid level is achieved. The procedure is simple and effective for overcorrected blepharoptosis.
The surgery may lead to temporary irritation in the eyes, bruising, changes in the contours of the eyelids and even some follow up surgeries. In extremely rare cases, vision loss may occur.
However, one very important thing to be kept in mind is that the results and risks vary from person to person. Patients are required to stick to the post-operative instructions given by the doctor to obtain the most optimal result out f surgery.
Symptoms such as excessive bleeding, pain, inflammation etc are uncommon. It is important for the patients to have someone to take care of them, for the first day after the surgery. Improper care or inadequate closure of the eyelids may cause the scarring of the cornea or infection in the eyes.
As much as the physician and the surgeon, the patient also has a role in the recovery post the surgery. It is very important to communicate with the doctor, regarding any concerns to minimize the possibility of unexpected events post a surgery. The patients have to be regular with their follow up procedures and the care instructions given to them for full recovery after the procedure has been performed.
Once eyelid retraction and its functional and cosmetic sequelae develop, it is imperative to consult the best oculoplastic surgeons like Dr. Debraj Shome and get it treated.