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TEAR DUCTS and EYELIDS                     

TEAR DUCT AND EYELID SURGERY

Constant tear production: This is caused by obstruction of the tear duct, alteration in the tear film malposition of the palpebral structures. The different techniques we use for the rechannelling of the tear duct include the following: Probing, Dacryocystorhinostomy and Conjunctivo- dacryocystorhinostomy. For which we tend to use endoscopic technology and laser, thereby avoiding cutaneous scarring and associated risks (aesthetic and infectious).

Malposition of the palpebral edge (everted outwards or Ectropion; inverted towards the eyeball or Entropion): said condition affects not only aesthetic appearance, but also prevents the eyelids from protecting the eyeball and conducting the tear to the lacrimal collecting system. Corrective surgical techniques are applied to reorientate the palpebral edge and restore its function.

Palpebral ptosis (“drooping eyelid”): Drooping of the upper eyelid which can come to affect the visual axis, thereby reducing the patient’s field of vision and preventing the correct development of the visual function in the case of paediatric patients. Different techniques can be applied according to age, type and degree of palpebral ptosis: Frontal Suspension, Repositioning or Resection of the Aponeurosis of the Levator Muscle, Conjuntivo- Müllerctomy (Putterman Technique)

Flaccid Eyelid: Condition associated with OSAS (Obstructive Sleep Apnea Syndrome), in which patients with nocturnal breathing difficulties have excessively flexible eyelids, nocturnal erosions and accentuated peaks of pain in the mornings. For its correction, a horizontal reduction of the upper eyelid is performed in order to prevent the latter from everting during sleep at the slightest contact, thereby preventing the eyeball from rubbing against the bedclothes. 

Palpebral neoformations: These include malignant tumours (Basocellular Carcinoma, Spinocellular Carcinoma; Melanoma, Lymphoma) and benign tumours (warts and cysts). These lesions require a specific type of resection for each case and, occasionally, the reconstruction of the secondary defect.  

Blepharospasm and Hemifacial Spasm – involuntary contraction of the periocular and facial muscles. The non-invasive approach involves the periodical use of Botox (muscle relaxant). In resistant cases, surgical weakening of the periocular muscles may be applied.  

Facial Paralysis – The inactive face muscles remain “hanging”. Moreover, the patient may have difficulty closing his/her eyelids, placing the integrity of the eyeball at risk due to exposure and constant tear production. To permit complete palpebral occlusion, the implantation of a gold weight and palpebral transfixion incision may be employed.

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