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Ptosis


Ptosis Surgery (Drooping Upper Eyelid Lift) by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

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Ptosis


Ptosis Surgery (Drooping Upper Eyelid Lift) by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

PTOSIS (DROOPING UPPER EYELIDS)

Ptosis is the medical term for drooping upper eyelids. Ptosis can occur in one or both upper eyelids. The most common cause of ptosis is a loosening of the connection between the muscle that raises the eyelid (the levator palpebrae), and the rigid support structure of the eyelid (the tarsus). Ptosis can also be caused by muscle and neurological disorders, a history of eye surgery, trauma, and even long-term contact lens use. For information about treatment of childhood ptosis, click here. 

THE PROCEDURE

Our doctors have had extensive training in ptosis repair and have performed hundreds of these procedures. There are several ways to correct ptosis. Most commonly, an incision is made on the eyelid crease so that it is well hidden and no visible scarring is noticeable. The levator palpebrae muscle is then located and permanent internal sutures are placed into the loose tendon of the muscle to produce a tighter connection to the eyelid support structure (the tarsus). Adjustments are made during the surgery to position the eyelids at the desired height. 

In some patients, an internal approach may be optimal, in which the incision is made inside the eyelid, sparing the skin.

Ptosis surgery is often performed in conjunction with upper eyelid blepharoplasty and/or lower eyelid blepharoplasty, and even brow lift depending on each patient's needs and wishes. 

Our doctors will discuss his assessment with you and go over your personal plan and what to expect after surgery during your preoperative visit. 

RECOVERY AFTER SURGERY

You may expect to go home on the day of surgery. There is usually minimal to no pain after ptosis surgery and most patients resume their normal daily activities the following day. Heavy lifting should be avoided for 1-2 weeks. You may experience mild discomfort, which is controlled with oral medication. Swelling and bruising significantly improves after a few days and usually is minimally noticeable after 2 weeks, however healing time can vary between individuals. Sutures are removed on the first post-operative visit, usually 7-10 days after surgery. Eyelid make-up and contact lens use may usually be resumed 1-2 weeks after surgery. 

SPECIAL CONSIDERATIONS

Our doctors will perform a thorough eye exam prior to any eyelid surgery. If you have a history of dry eyes, you should be treated appropriately prior to surgery because ptosis surgery may worsen dry eye symptoms. Sometimes surgery is postponed or determined to be inadvisable if symptoms are significant enough. A history of prior eyelid surgery may put you at risk for inadequate eyelid closure or dry eyes after surgery. It is important to see an eyelid specialist to coordinate a surgical plan that will not only give the most aesthetically natural appearance but more importantly, maintain vital eye health. 

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Eyelid Malpositions


Eyelid Malposition Surgery (Entropion and Ectropion Surgery) by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

Eyelid Malpositions


Eyelid Malposition Surgery (Entropion and Ectropion Surgery) by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

EYELID MALPOSITIONS
(ECTROPION AND ENTROPION)

A normal, healthy eyelid should have a natural tension that allows it to cover and protect the eyeball. Occasionally, as a result of aging, sun exposure, trauma, or scarring, eyelid tension can become unbalanced, causing the eyelid to turn outward or inward. When the eyelid turns outward, that is called ectropion. The out-turned eyelid may become red and irritated, resulting in discomfort, tearing, or eye infections. When the eyelid turns inward, it is called entropion. The in-turned eyelashes can irritate the eye, resulting in discomfort, redness, and corneal damage.  

THE PROCEDURE

Depending on which problem you have, there are various ways to repair the eyelid malposition. Our doctors will perform a careful evaluation, discuss their assessment with you, and go over which procedure is right for you during the preoperative visit. The procedure may be performed under local anesthesia or sedation. 

RECOVERY AFTER SURGERY

You may expect to go home on the day of surgery. There is usually minimal to no pain after entropion or ectropion surgery and most patients resume their normal daily activities the following day. A patch will be placed over the eye and usually is kept in place for 1-2 days. Heavy lifting should be avoided for 1-2 weeks. You may experience mild discomfort, which is controlled with oral medication. Swelling and bruising significantly improves after a few days and usually is minimally noticeable after 2 weeks, however healing time can vary between individuals. Sutures are removed on the first post-operative visit, usually 7-10 days after surgery. Eyelid make-up and contact lens use may usually be resumed 1-2 weeks after surgery. 

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Eyelid Skin Cancer and Reconstruction


Eyelid Skin Cancer and Reconstruction by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

Eyelid Skin Cancer and Reconstruction


Eyelid Skin Cancer and Reconstruction by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

EYELID SKIN CANCER AND RECONSTRUCTION

Skin cancers and benign tumors often occur on the eyelids. Because of the thin skin of the eyelid and it's complicated anatomy, oculofacial plastic surgeons are the most trusted physicians involved in removing cancers and benign tumors of the eyelids, and reconstructing the remaining defect. 

Cysts, skin tags, bumps, chalazions (stys) and other benign lesions of the eyelids can be removed or drained in the office under local anesthesia. There is usually no downtime after these procedures.

The most common skin cancers that occur on the eyelids are basal cell carcinoma and squamous cell carcinoma. It is important to have any new eyelid bumps examined because skin cancers can often masquerade as benign lesions. 

EYELID RECONSTRUCTION

Eyelid skin cancer must be excised by surgeons who specialize in eyelid surgery, such as oculofacial plastic surgeons. Care must be taken to ensure that all margins have been cleared of cancer. Mohs surgeons are also qualified to remove some eyelid lesions, and our doctors sometimes work with Mohs surgeons to reconstruct defects after Mohs surgery. After the skin cancer is removed, a defect of varying size remains in the eyelid. There are various methods used by oculofacial plastic surgeons to reconstruct eyelid defects depending on the size and location of the defect. Smaller defects may be closed simply, but larger defects may involve complex reconstructions that may take multiple steps and require tissue or skin grafts. 

Our doctors will discuss their assessment with you and go over your personal plan and what to expect after surgery during your preoperative visit. 

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Chalazion, Stye, Skin Tags


Chalazion, Stye, and Skin Tag Surgery (Benign Eyelid Lesions) by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

Chalazion, Stye, Skin Tags


Chalazion, Stye, and Skin Tag Surgery (Benign Eyelid Lesions) by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

BENIGN EYELID LESIONS
(Chalazion, stye, skin tags)

Cysts, skin tags, bumps, chalazions (styes) and other benign lesions of the eyelids are very common. Cysts and skin tags can be removed or drained in the office under local anesthesia. There is usually no downtime after these procedures.

Lesions that involve the eyelashes or eyelid margin, may require a slightly more extensive procedure called a wedge resection, in which a small section of the eyelid surrounding the lesion is removed, and the edges of the defect are sutured together. This procedure is usually performed in the operating room under sedation. 

Chalazions, also known as styes, are bumps that develop at the eyelid margins. They are caused by a blockage in the meibomian glands, specialized glands in the eyelids that produce oils that are an important component of tears. They often resolve spontaneously in 1-2 weeks. Warm compresses and eyelid scrubs may help. If they do not resolve after about 2 weeks, a simple in-office drainage may be performed with local anesthesia. 

Larger lesions may require a more complex reconstruction. Our doctors will discuss their assessment with you and go over your personal plan and what to expect after surgery during your preoperative visit. 

 

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Tearing and Lacrimal System


Tear Duct (Lacrimal, Tearing) Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

Tearing and Lacrimal System


Tear Duct (Lacrimal, Tearing) Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

TEARING AND LACRIMAL SYSTEM
(TEAR DUCT) 

Tears are produced by the lacrimal gland, located above the eye. The tears constantly wash over the eye to keep it lubricated, and drain into the tear duct - or lacrimal drainage system - which is a series of ducts that allow tears to flow from the inner corners of the eyelids, and into the nose. A functional tear duct is the reason why you have to blow your nose when you cry - the tears drain into your nose and it becomes runny. 

Excessive tearing is a very common problem and may be due to many different causes.

Over-production - An overproduction of tears is often reflexive tearing due to dryness and irritation of the eyes - or a blockage of the drainage system of the tears. Treating the dry eyes, sometimes by simply using artificial tears, will stop the reflexive tearing.

Blockage of the lacrimal drainage system - When any part of the tear drainage system is blocked or narrow, the tears well up in the eyes and flow over onto the cheek. Picture your eye as a bathtub in which the faucet is constantly running. A blockage of the tear drainage system is akin to plugging the drain. Eventually, the water overflows onto the floor. 

TEARING TREATMENT

If tearing is cause by reflexive tears due to dry eye, eye lubrication can help. Punctal plugs can be placed into the opening of the tear ducts (called the punctum), to keep tears in the eyes to help with lubrication. 

If tearing is due to a blockage in the tear duct, depending on the location and nature of the blockage, there are different methods to correct the tearing problem. 

If tearing is due to narrowing of the openings of the tear duct (called the punctum or canaliculus), placement of a silicone tube in the office, or in the operating room under sedation, can correct the problem. The tube is placed into the duct to stretch the duct open, allowing the tears to drain.

More commonly, tearing is due to a complete obstruction of an area of the drainage system called the nasolacrimal duct. Treatment for this problem involves surgically bypassing the blockage by creating a new opening that connects the tear drainage system to the nose. This surgery is called dacryocystorhinostomy, or DCR. Our doctors perform DCR surgery endoscopically, so there is no visible scar. Endoscopic DCR has an excellent success rate - tearing resolves in 90-95% of patients after this surgery. 

Rarely, tearing is caused by a complete obstruction of the upper lacrimal drainage system. In this case, the entire drainage system must be bypassed by a new opening. The new opening is created by surgically inserting a small glass tube called a Jones tube into the corner of the eyelid. This procedure is called a conjunctivorhinostomy (CDCR). A Jones tube allows tears to drain directly into the nose. A CDCR procedure with placement of a Jones tube is only performed if other surgical options are not possible. 

Our doctors will discuss their assessment with you and go over your personal plan and what to expect after surgery during your preoperative visit. 

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Eyelid Retraction


Eyelid Retraction Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

Eyelid Retraction


Eyelid Retraction Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

EYELID RETRACTION

When the lower eyelids sit too low on the eye, or have a rounded appearance, that is called lower eyelid retraction. This condition may be caused by previous lower eyelid surgery such as blepharoplasty, scarring due to long-term sun exposure or trauma, or thyroid eye disease. Upper eyelid retraction is when the upper eyelid sits too high on the eye and is usually caused by thyroid eye disease or scarring. 

THE PROCEDURE

There are various ways to surgically position the retracted eyelid in a more natural position. Often, a canthoplasty, which is a procedure that repositions and secures the outer corner of the eyelid, is performed. A spacer graft such as Alloderm may be placed inside the eyelid to replace lost volume. Sometimes a skin graft is necessary if any scarring is present. 

RECOVERY AFTER SURGERY

You may expect to go home on the day of surgery after eyelid retraction repair. There is usually minimal to no pain and most patients resume their normal daily activities the following day. A patch will be placed over the eye and left in place for 1-2 days. Heavy lifting should be avoided for 1-2 weeks. You may experience mild discomfort, which is controlled with oral medication. Swelling and bruising significantly improve after a few days and usually are minimally noticeable after 2 weeks, however healing time can vary between individuals. Sutures are removed on the first post-operative visit, usually 7-10 days after surgery. Eyelid make-up and contact lens use may usually be resumed 1-2 weeks after surgery.  

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Thyroid Eye Disease


Thyroid Eye Disease (Graves') Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

Thyroid Eye Disease


Thyroid Eye Disease (Graves') Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

THYROID EYE DISEASE
(GRAVES' DISEASE)

Thyroid disease, also called Graves' disease, may cause several eye deformities including:

Eyelid retraction - the upper eyelids rest too high, and/or the lower eyelids rest too low on the eye

Proptosis (Exophthalmos) - the eyes bulge forward

Lagophthalmos - eyes cannot close all the way

Graves' disease is an autoimmune disease. We do not know what causes it. Seeing an endocrinologist for management of thyroid hormone levels is important. However, normalizing thyroid levels does not necessarily result in an improvement of the eye deformities caused by Graves'.

THYROID EYE DISEASE TREATMENT

There is usually an active phase of thyroid eye disease, when the deformities worsen. Eventually, the disease will plateau and "burn out". If the disease causes enough swelling, it can compress the optic nerve, resulting in blindness if untreated. In this situation, strong anti-inflammatory medications may be given, or emergent surgery performed to decompress the orbit. 

If the vision has not been effected, the optimal time to treat thyroid eye disease is after it has passed the active phase and "burnt out", and the deformities have stabilized. Mild symptoms may be managed conservatively with topical eye drops and lubricants. About 20% of patients may require surgical treatment. Surgery for thyroid eye disease is usually performed in a step-wise fashion, first treating the proptosis (eye bulging), then any eye-motility problems (strabismus), and then treating eyelid problems such as eyelid retraction. 

Orbital decompression is performed in the operating room under general anesthesia. Bone is removed from the orbit (eye socket) and excess orbital fat is removed to allow the eye to sink back into a more natural position. Patients usually stay overnight in the hospital for observation, and go home the following morning. 

Eyelid surgery such as eyelid retraction repair and treatment for lagophthalmos are performed under sedation. You may expect to go home on the day of surgery. 

Our doctors will discuss their assessment with you and go over your personal plan and what to expect after surgery during your preoperative visit. 

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Eye Removal (Enucleation)


Eye Removal (Enucleation) by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

Eye Removal (Enucleation)


Eye Removal (Enucleation) by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

EYE REMOVAL (ENUCLEATION)

Enucleation is a surgery in which the eye is removed while leaving the eye muscles and orbital contents intact. Removing an eye may be necessary when a tumor has been discovered in the eye, if a blind eye has become painful, or in the case of severe trauma. Sometimes, removing an eye is the only remaining solution to eliminate pain associated with a blind eye. After the eye is removed, an ocular prosthesis is worn in it's place. Ocular prostheses - also known as artificial eyes -  nowadays are so well-made, that many people will not notice that you have a prosthetic eye. 

THE PROCEDURE

Enucleation surgery is performed in an operating room under general anesthesia. After the eye muscles are carefully isolated, the eye is removed, and a spherical implant is placed into the eye socket. The eye muscles are attached to the implant to allow motility. A specialized pain pump is the placed behind the implant, and the orbital tissue is sutured closed to cover the implant. A patch is placed over the eye socket, which will be worn for 3 days. You will be give pain medicine to administer at home via the pump. This eliminates most of the pain that is associated with enucleation surgery. Most of our patients are surprised as to how little pain they experienced after surgery. 

RECOVERY AFTER SURGERY

After 4-6 weeks of healing, you will see an ocularist, a specialist who fabricates ocular prostheses, sometimes known as an "artificial eye". The ocularist will match the coloring and characteristics of your other eye. Once the prosthesis is in place, you may leave it in indefinitely and do not have to remove it for cleaning. The prosthesis will move along with the other eye, although to a lesser degree. 

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Prosthetic Eye - Eye Socket Surgery


Prosthetic Eye and Eye Socket Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

Prosthetic Eye - Eye Socket Surgery


Prosthetic Eye and Eye Socket Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

PROSTHETIC EYE & EYE SOCKET SURGERY

Sometimes after an eye has been removed due to a tumor located in the eye, severe eye trauma, or severe pain due to a blind eye, the eye socket may undergo changes such as scarring, loss of volume, or shifting of an orbital implant, that make it difficult to wear an ocular prosthesis - also known as an artificial eye. An oculofacial plastic surgeon may be able to reconstruct the eye socket to allow the ocular prosthesis to fit comfortably and function well. 

EYE SOCKET RECONSTRUCTION

Many different techniques may be used to reconstruct the eye socket to allow a prosthetic eye to fit well. These include:

Mucous membrane grafting - this procedure consists of taking a piece of the lining of the mouth, and grafting it into the eye socket to replace tissue that has shrunk due to scarring. The lining of the mouth is ideal because the tissue is similar to the lining of the eye socket. The procedure is performed under general anesthesia and there is minimal discomfort afterwards. 

Dermal fat grafting - This procedure consists of taking a piece of fat and overlying dermis (the layer just underneath the surface of the skin) from a hidden area of the trunk, and grafting it into the eye socket. A dermal fat graft replaces lost volume and lost surface area due to scarring. The procedure is performed under sedation or general anesthesia, and has minimal discomfort afterwards. 

Amniotic membrane graft - Processed amniotic membrane may be used to replace lost surface area in the eye socket due to scarring. 

Replacement of orbital implant - If imaging shows that an indwelling orbital implant is too small, it may be replaced with a larger one. 

Reconstructive eyelid surgery - Eyelid deformities may occur with volume loss or scarring in an eye socket. Eyelid deformities may be addressed surgically, usually after the eye socket issue has been resolved. 

Our doctors will discuss their assessment with you and go over your personal plan and what to expect after surgery during your preoperative visit. 

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Congenital Ptosis and Pediatric Conditions


Congenital Ptosis Surgery, Pediatric and Congenital Eyelid, Eye Socket, Orbital Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

Congenital Ptosis and Pediatric Conditions


Congenital Ptosis Surgery, Pediatric and Congenital Eyelid, Eye Socket, Orbital Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

PEDIATRIC AND CONGENITAL CONDITIONS

Oculofacial plastic surgeons specialize in the treatment of all pediatric and congenital eyelid, eye socket, and tear duct disorders. The most common include: 

Congenital ptosis - Children are sometimes born with drooping of one or both upper eyelids. Most commonly, there is a problem with the muscle that raises the eyelid. If the eyelid(s) droop enough that they cover the pupil, they can block vision, and since the visual system in children is still developing, this can result in permanent blindness (amblyopia). If congenital ptosis is determined to be effecting vision, ptosis repair surgery should not be delayed. If the eyelid drooping is mild and does not block vision, surgical repair may be delayed until the child is older. Ptosis in children should be followed closely by a pediatric ophthalmologist along with an oculofacial plastic surgeon to determine the proper course of action. 

Congenital tear duct obstruction - A tear duct obstruction in infants may present as constant tearing, discharge, or even an infection of the tear duct (dacryocystitis). Unlike in adults, tear duct obstruction is usually due to a membrane that blocks the outflow of tears into the nose. This often resolves spontaneously as your child grows. Massage and warm compresses may be enough to alleviate symptoms. If the symptoms continue past the age of 1, probing the tear duct under anesthesia is usually curative. Probing is a non-invasive, 15 minute procedure performed in the operating room.

Epiblepharon - This is a common condition in Asian children. The skin and muscle in the lower eyelid override the eyelid margin, causing the lashes to turn in and scratch the eye. As children age, this problem may spontaneously resolve, however surgical correction is sometimes necessary, especially if there are signs of corneal damage. 

Orbit disease - Orbital (eye socket) disease is uncommon in children, but it does occur. Infections in the orbit are called orbital cellulitis. This is often the result of spreading inflammation from the sinuses. If untreated, it can cause blindness and even be life threatening. Intravenous antibiotics must be administered immediately. 

Orbital tumors occur rarely, and when they do, they are most often benign. Vascular malformations are the most common growths. Sometimes called strawberry or capillary hemangiomas, they are lumpy red growths that may be seen on the eyelids, or even extend into the eye socket. They often will spontaneously resolve by the age of 6-8 years. If the growth is blocking vision, it can be treated with medications (propranolol), and only very rarely requires surgery. 

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Orbital Tumors


Orbit and Orbital Tumor Treatment and Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

Orbital Tumors


Orbit and Orbital Tumor Treatment and Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

ORBITAL TUMORS

Various types of tumors may arise from the orbit, also known as the eye socket. The most common ones include vascular tumors such as cavernous hemangiomas, orbital lymphoma, lacrimal gland tumors, cysts, and metastases that have spread from other parts of the body. Some inflammatory processes such as sarcoidosis or idiopathic orbital inflammation may mimic the signs and symptoms of a tumor. 

Orbital tumors may present slowly over months or years, with bulging of the eye, or a subtle change in the eye position due to pushing from the tumor. Some tumors present rapidly and are very painful, this presentation is typical of malignant tumors and should be evaluated by an oculofacial plastic surgeon without delay. Tumors may cause compression of the optic nerve, resulting in vision loss. Imaging such as a CT scan or MRI may be obtained if a tumor is suspected. 

Management of orbital tumors should be done by a physician who is qualified to treat orbital disease, such as an oculofacial plastic surgeon. Dr. Silkiss and Dr. Eliasieh have both received extensive specialty training in orbital surgery and the management of orbital disease. 

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Facial Paralysis (Bell's Palsy)


Facial Paralysis (Bell's Palsy) Treatment by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

Facial Paralysis (Bell's Palsy)


Facial Paralysis (Bell's Palsy) Treatment by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

FACIAL PARALYSIS (BELL'S PALSY)

Facial paralysis occurs when the facial nerve, which controls the facial muscles, stops functioning or weakens. Facial paralysis has many possible causes, the most common include Bell's palsy (unknown cause), stroke, previous brain surgery, infection, trauma, or a tumor. When the facial muscles around the eye become weak or paralyzed, the health of the eye may be compromised. Typical findings and management of facial paralysis include:

Brow drooping - Brow drooping may be corrected surgically with a brow lift, which may be performed several different ways. 

Incomplete eyelid closure (Lagophthalmos) - When the eyelids can't close all the way, the cornea (clear, central part of the eye) will become dry and may develop scarring and infections, leading to blindness if not treated. Incomplete eyelid closure may be treated initially by lubricating drops and ointment. If that is not enough, surgical intervention is warranted. The outside corners of the eyes may need to be sutured together to allow for more closure. This procedure is called tarsorrhaphy. Our doctors perform a type of tarsorrhaphy that can stay in place indefinitely, while at the same time can be undone at any time. Other eyelid procedures may also be performed to aid eyelid closure. 

Poor or absent blinking - If there is some blink still intact, a gold or platinum weight may be surgically implanted into the upper eyelid. The weight may allow for improved eye closure. 

Lower eyelid laxity, ectropion, and retraction - Lower eyelid weakness may result in a lower eyelid that is loose, turns out, and/or rests lower on the eye (eyelid retraction). Surgery is required to tighten the eyelid, and return it to a normal position. Ectropion repair or retraction repair may be required. 

Patients with facial paralysis may have some or all of these problems depending on the severity and duration of the paralysis. Our doctors will discuss their assessment with you and go over your personal plan and what to expect after surgery during your preoperative visit. 

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Benign Essential Blepharospasm


Benign Essential Blepharospasm, Hemifacial Spasm, Eyelid Spasm Treatment by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

Benign Essential Blepharospasm


Benign Essential Blepharospasm, Hemifacial Spasm, Eyelid Spasm Treatment by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

 

BENIGN ESSENTIAL BLEPHAROSPASM (EYELID SPASM)

Benign essential blepharospasm is a rare condition that causes increased blinking, involuntary spasms of the muscles surrounding the eyes, and an intermittent inability to open the eyes. The condition usually starts with twitching and progresses to more severe spasms. We do not know what causes this condition. Patients with this condition may eventually be unable to read, drive, or perform normal daily activities because they cannot open their eyes sufficiently. 

TREATMENT

The treatment of choice for benign essential blepharospasm is periodic injections of Botox. Botox is a powerful drug that blocks the connection between nerves and facial muscles. It is injected in strategic locations in the eyelids and forehead. Botox can significantly reduce or resolve spasms, but it works temporarily and must be repeated about every 3-4 months. 

Some patients may not have an adequate response to Botox, or have a diminishing response over time. If this is the case, and the spasms continue to cause a significant disruption, then surgical myectomy may be an option. A surgical myectomy consists of surgically excising some or all of the orbicularis oculi muscle in the upper eyelids, the muscle that causes the eyelids to close. This procedure has been shown to significantly improve blepharospasms. The risks include incomplete eyelid closure, and postoperative bruising and swelling. 

If there is any drooping of the upper eyelids or excess upper eyelid skin, ptosis repair or upper eyelid blepharoplasty may help improve visual disability. These procedures may also be performed along with a partial surgical myectomy. 

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Trauma (Orbital Fractures, Eyelid Lacerations)


Orbital Fracture Surgery, Eyelid Laceration Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

Trauma (Orbital Fractures, Eyelid Lacerations)


Orbital Fracture Surgery, Eyelid Laceration Surgery by Dr. Rona Silkiss in San Francisco, Oakland, Palo Alto, Corte Madera, Walnut Creek, San Leandro, Fremont. 

TRAUMA (ORBITAL FRACTURES, EYELID LACERATIONS)

Trauma to the eyelids and/or orbit (eye socket) should be examined thoroughly by an ophthalmologist and oculofacial plastic surgeon. The eye is often involved in this type of facial trauma so a careful eye examination should be performed without delay.

Trauma to the eyelids may result in lacerations (cuts to the skin) that may involve the entire thickness of the eyelid margin (where the lashes are located), and/or the tear duct system. Inadequate surgical intervention for these types of injuries may result in eyelid deformity, incomplete eyelid closure, or tearing problems. Oculofacial plastic surgeons have had extensive training to treat these injuries and ensure proper healing. Eyelid lacerations may often be surgically reconstructed in the office under local anesthesia. More complex eyelid trauma, especially when involving the tear duct system, may require reconstruction in the operating room under sedation. 

Blunt trauma to the eye from an assault, a fall, or a sports related injury may result in a fracture of the eye socket, also known as an orbital fracture. The most common type is a fracture of the floor or medial wall (the wall located between the eye and the nose) known as a "blow-out" fracture. A blow-out fracture results in sinking of the orbital contents through the bony defect, which can cause the eye to sink back into the orbit, a condition called enophthalmos. Orbital fracture repair is performed to prevent the eye from sinking back into the orbit. If enophthalmos is already present, surgical fracture repair and orbital reconstruction may be performed to move the eye back into a normal position.

The decision to perform a fracture repair surgery depends on the appearance of the fracture in a CT scan, and the clinical examination. A fracture repair surgery generally involves making an incision behind the eyelid (this spares the skin so that there is no scarring). Once the fracture is located, a piece of titanium mesh (sometimes combined with a biocompatable material called Medpor) is placed over it to cover the defect. The surgery is performed under general anesthesia, and patients may expect to stay for 1 night in the hospital for observation.