Low Vision options

Functional Oculoplastics

A number of changes can occur to the eyelids and the areas around the eyes due to age related processes, medical/autoimmune disease processes, trauma and scarring. Often times these changes can result in changes in vision, discomfort and even disfigurement or loss of sight if left untreated. Personalized surgical and medical management of these changes can be tailored to optimize vision and comfort. As they are performed to improve or protect visual functional these procedures are typically covered in part by insurance.

The upper eyelids may become ‘droopy’ due to a number of factors including age related changes, neurologic conditions, trauma or even inflammation/infections. When this drooping affects vision it can be repaired by surgically addressing the factors that make the eyelids droopy.

Ectropion is when the eyelids turn outwards. Entropion is when the eyelids turn inwards. These changes commonly result from age related changes of the eyelid. They can also result from scarring from trauma or previous surgery, neurologic conditions or inflammation around the eye. When these changes affect vision or cause exposure or ocular surface irritation they can be repaired surgically to return the eyelids a more natural position.

Ranging from sweat gland and sebaceous cysts to chalazion/styes to “moles/warts”, these lesions common, but can show changes in size and shape, thus causing concern in patients. Examination with a special microscope will often reveal the benign nature of these lesions. A simple excision procedure in the office with a local anesthetic is often all that is needed to remove these lesions.

Facial Nerve Paralysis can be a result of a temporary reduction in impulses to the nerves that move the muscles of the face, which spontaneously resolves, or may be a permanent process as is the case with strokes or after removal of certain neurologic tumors. A Facial nerve palsy weaken the muscles that close the eyes, putting them at risk for exposure and infections. Treatment is geared towards maximizing the reduction of symptoms in the near term and long term and often includes surgery to improve eyelid position to protect the eyes.

Blepharospasm is an uncontrollable, rhythmic, organized involuntary closure of both eyelids. It can be associated with neurological conditions such as Parkinson’s disease or be idiopathic without a known cause. Hemifacial Spasm is similar to Blepharospasm in that it is an uncontrollable, rhythmic, organized involuntary contracture of the facial muscles. Unlike Bleparospasm, however, Hemifacial spasm can also affect muscles of the face including the cheek, lip and jaw, and as it’s name implies, it is limited to one side of the face. No specific cause is usually found, but neuro imaging is recommended to rule out a causative lesion. Both processes can result in severe deficit for patients because it sometimes becomes difficult for them to keep their eyelids open when they are doing activities such as driving, reading or even when talking to someone else. Treatment involves reduction of environmental stimuli that can induce or exacerbate spasms, as well as Functional Botox therapy to alleviate the spasms temporarily. Associated involutional eyelid changes can also be addressed surgically to elevate heavy eyelids or improve closure from malpositions.

Thyroid Eye Disease (TED) refers to anatomic and functional changes to the eyes, eyelids and orbit resulting from antibodies commonly found in patients with Grave’s Disease. These changes may occur at the same time as thyroid disease, may precede it, or may come long after thyroid disease occurs. These changes involve enlargement of the tissues in the eye socket and surrounding the eye which results in a bulging or staring eye appearance. These changes can cause functional issues such dry eye exacerbation, double vision and rarely optic nerve damage when very severe. The active inflammation that causes these changes last from 1-3 years, but can cause disfigurement that is cosmetically unacceptable and pain and double vision that can be difficult to treat. A thorough and thoughtful evaluation of your thyroid eye disease is important to determine the severity and activity of disease and tailor a medical and/or surgical treatment plan according to your needs. If you have or think you may have thyroid eye disease, please contact us to make an appointment.