Eyelids and the periocular region
In infants and small children, we encounter different congenital eyelid abnormalities, from incomplete development to problems with position and function.
Congenital drooping of the upper lid (ptosis) is usually caused by incomplete development of the levator muscle (the muscle that elevates the upper lid). This condition can impede the development of normal vision on the side of the affected lid. The decision regarding the timing and method of ptosis correction depends on the degree of ptosis in relation to the visual axis (pupil), the strength of the levator muscle and the age of the child.
Acquired ptosis (developed during life) is most frequently caused by the weakening of the insertion of the levator mucle. This condition usually presents together with a relative „surplus“ of upper lid skin (dermatochalasis). Downward descent of the eyebrows (brow ptosis) may add to the overall problem.
Besides the obvious problem with vision, one may experience a feeling of heaviness in the eyebrows and forehead headaches, due to the compensatory action of the frontal muscle.
Surgical correction of the upper lid position and the removal of excess skin are performed at the same time.
Ptosis of the upper lid can also be caused by trauma or neuro-muscular disorders.
In general, there are two basic surgical techniques of ptosis correction:
- Shortening (resection) of the levator muscle
- Frontal (eyebrow) suspension of the upper lid.
The latter method is performed with the use of synthetic material (sliicone, PTFE) or the patients own connective tissue (fascia lata).
Inversion (entropion) or eversion (ectropion) is most frequently encountered in the lower lid, as a consequence of eyelid instability, caused by stretching of its tissues with age. Less often is it caused by trauma or inflammatory diseases, followed by scarring of the skin and / or mucosal lining of the eyelid.
Entropion causes the eyelashes to rub over the eye, which causes significant discomfort and may lead to an infection. In an ectropion, the mucosa of the lid is constantly exposed to the environment, causing it to dry and become inflammed.
Tumours of the eyelids and periocular region can be benign and malignant. In children we, most frequently, encounter benign lesions like hemangioma or dermoid cysts. A chalazion is an inflammatory cyst of the sebacious glands (Meibomean) in the eyelid.
Benign tumours usually create only an esthetic problem, however, by size and location, they can compromise the normal function of the eyelid and, consequently, the eye.
Malignant tumours have the tendency to destruct the normal tissue of the eyelid, and to infiltrate deeper structures of the orbit, thus endangering the globe of the eye. Some have the ability to disseminate to the regional lymph nodes, or by blood to distant organs such as the liver or lungs.
It is very important that the tumours be identified and operated in an early stage. The aim of surgery is complete removal of the tumour, after which the eyelid / periocular region has to be reconstructed in order to preserve its function.