Other Eyelid Surgery

We have extensive experience performing all types of eyelid surgery and it is one of the mainstays of our practice. Justin is both an ophthalmologist and specialist in oculoplastic surgery, and this combination of specialist skills allows him to expertly examine the health of the eye as well as that of the eyelid, assessing and treating them holistically to achieve the best possible result.

Treatments are usually performed as day procedures, under sedation and with local anaesthetic administered by our carefully selected team of highly skilled and compassionate anaesthetists, who help make the surgery experience a calm and positive one for each patient.

There are several upper and lower eyelid conditions that we can correct with surgery. These include:

• Ectropian (turned out lower eyelid)

• Entropian (turned in lower eyelid)


• Ptosis (droopy upper eyelids)


• Dermatochalasis (excess upper eyelid skin that disturbs normal vision)


• Chalazion (persistent stye or infected cyst of the eyelid) and eyelid lumps and bumps.

◦ These can often be diagnosed and treated during the initial consultation.


• Skin cancer of the eyelids

◦ A diagnosis of skin cancer on the eyelids can be very confronting. However we are highly experienced in excision techniques and in restoring the normal function and appearance of the eyelid. In some cases, we may involve dermatologists trained in Mohs (skin cancer) surgery to assist with excision of the skin tumour.

A drooping lower eyelid that falls away from the eye is known as ectropion of the eyelid. It causes an unsightly redness and symptoms such as irritation, dryness and/or eye watering.

Entropion is when the lower eyelid curls in on itself and the eyelashes rub against the eye, which causes eye irritation and discomfort. Often the eye can be red with watering.

In most cases it is due to changes associated with ageing, namely a loss of tightness of the skin around the eyes and of the eyelid tissues. Sometimes it can occur because the skin below the eyelid becomes tight (from heavy sun exposure) and pulls the eyelid down. Chronically sun-damaged skin tends to contract with age.

Eye drop lubricants may provide some relief in the short term, but eyelid surgery is recommended for ongoing symptoms. It has excellent results and minimal recovery time.

Surgery involves tightening and strengthening the lower eyelid muscles and may require a skin graft in some cases.

/ The surgery is done as a day case procedure with a twilight anaesthetic (intravenous sedation) and local anaesthetic, making the procedure painless.

/ Most procedures take 30 to 60 minutes.

/ Often dissolving sutures are used.

/ An eyepad is worn for a few hours or until the next day. If a skin graft is used, the eyepad is worn for 5 to 7 days.

/ Bruising of the eyelid can be very obvious for the first week.

/ Patients can resume driving 24 hours after the surgery (if they are no longer wearing an eyepad) and can return to their usual routine after several days.

/ It may be a week to 10 days before active exercise (swimming, lifting weights) is resumed, but light exercise (eg walking) is encouraged from the first day.

Most people do very well after surgery with excellent results.

/ There are some cases in which the eyelid is not fully restored to its original position.

/ Bleeding, chronic pain and infection of the eyelid is quite rare, but some patients will have watering and discomfort for the first two weeks.

/ It would be rare to have any scarring, although the wounds may take some weeks, and occasionally months, to heal completely. If a skin graft is required the eyelid can appear bumpy for up to 3 months.

/ The main risk is a recurrence of the eyelid condition recurred, requiring further surgery, which is uncommon.

Ptosis (pronounced ‘toe-sis’) refers to drooping of the upper eyelid. Common symptoms are heaviness and tiredness of the eyelids, reduced vision, diminished field of vision, and altered cosmetic appearance. It can involve one or both eyelids, and often unequally.

The most common cause is changes to the muscle and tendon that open the eye, which can be caused by ageing. However there are a number of possible other causes that need careful consideration, such as nerve problems, muscle problems, injuries, and congenital causes(born with a drooping eyelid). A thorough assessment of the patient’s history, a physical examination, and sometimes further testing are required to determine the cause.

In the vast majority of cases it is eyelid surgery. There are some rare forms of ptosis, which may require medication.

Surgery involves tightening of the muscle and tendon (levator muscle) that opens the eye.

/ The surgery is done as a day case procedure with a twilight anaesthetic (intravenous sedation) and local anaesthetic, making the procedure painless.

/ A skin incision is made in the skin crease of the upper eyelid, but sometimes surgery can be done from inside without the need for an eyelid skin incision.

/ In some cases, excess skin excision (blepharoplasty) can be combined with ptosis surgery.

/ Most procedures take 30 to 60 minutes.

/ Often dissolving sutures are used.

/ An eyepad is worn for a few hours or until the next day

/ Bruising of the eyelid can be very obvious for the first week.

/ Patients can resume driving 24 hours after the surgery (if they are no longer wearing an eyepad) and may be able to return to their usual routine after several days.

/ A period of 5 to 7 days off work is recommended after the surgery.

/ Post operative visits usually occur at one week and one month after the surgery.

/ It may be a week to 10 days before active exercise (swimming, lifting weights) is resumed, but light exercise (eg walking) is encouraged from the first day.

Most people do very well after surgery with excellent results, however there are some risks to consider.

/ Bruising of the eyelid can be very pronounced in the first week but will always get better within a few weeks.

/ Bleeding, chronic pain, dry eye and infection of the eyelid is uncommon.

/ If a skin incision is used, it would be rare to have any permanent scarring, although the wounds may take some weeks and occasionally months to heal completely.

/ The main risk of surgery is an unsatisfactory result that requires consideration of a further procedure. This may be due to the eyelid being too high, low, or uneven compared with the other side, the eye no longer fully closing, or a change in shape.

/ A change or damage to vision would be extremely rare.

The eyelid contains vertically arranged glands called meibomian glands. These glands produce oil, which is an important part of the tear film that lubricates the surface of the eye when blinking. The opening of these glands is just behind the eyelashes along the edge of the eyelid. When a small infection occurs at the opening of the glands, it is commonly referred to as a ‘stye’. An infection that begins deeper in the glands or the eyelid is called a ‘chalazion’. A stye can progress to become a chalazion. The chalazion contains trapped oil and an inflammatory cell reaction or small abscess. Other names for a chalazion are hordoleum, tarsal cyst or meibomian cyst.

The exact cause of a chalazion in an individual is hard to identify, but is most likely due to the oil glands producing ‘sludgy’ oil, in combination with a small infection from the normally healthy bugs that live in our eyelashes and on the skin.

The following conditions are associated with an increased risk of chalazion:

/ rosacea (a facial skin problem causing redness)

/ blepharitis (inflammation of the eyelid margins, resulting in dry eye and irritation symptoms)

/ stress

/ smoking

/ diabetes

Modifying these conditions can often reduce the likelihood of a further chalazion occurring.

A chalazion will either occur suddenly with discomfort and/or pain, or slowly, over time, with no pain. The good news is that a chalazion is likely to disappear within the first two weeks.

/ The recommended treatment when a chalazion first appears is repeated warm massage of the lump, in the direction of the eyelashes.

/ A warm cloth is used to ‘melt’ the oil, as well as to widen the gland opening to help the chalazion drain. Massaging the eyelid further promotes drainage.

/ Often this routine can be combined with antibiotic eye drops or ointment such as chloramphenicol (Chlorsig).

/ Oral antibiotics are not required, unless the whole eyelid is becoming red and sore (cellulitis).

If after several weeks the lump is still there, it is unlikely warm massage or antiobiotic (tablets, drops or ointment) will help things further.

/ In this situation a minor surgery to drain the remaining eyelid lump is very effective.

/ The alternative is to wait for the lump to heal slowly by itself. It is hard to estimate how long this will take, but it can often take many months.

/ As there is a good chance the chalazion will heal itself in the first two weeks, surgery is not recommended immediately.

Draining the lump can almost always be done as an in-rooms procedure, and is highly effective.

/ A local anaesthetic injection is used to numb the eyelid, and the incision is made on the inside of the eyelid. There are no sutures required.

/ After the procedure, an eye pad is placed over the eye for up to an hour and driving is prohibited.

/ It is advised to bring a driver to the appointment, or have alternative transport arrangements.

/ The eyelid may be bruised for a few days, but normal duties can be resumed immediately after the eye pad has been removed. One day of recovery from work may be required.

/ Some patients experience discharge from the eye in the first few days during healing.

Problems after chalazion surgery are uncommon.

/ Infection and prolonged bruising are both rare.

/ A repeat procedure is sometimes required for a persistent or recurrent chalazion but, as this is also uncommon, a review appointment after surgery is not routinely required. If after several weeks a lump remains, please contact the rooms directly to arrange a review appointment.

An untreated chalazion does not cause loss of vision, so if it is not uncomfortable or of cosmetic concern, leaving the lump alone is fine. In some cases, it can cause visual blurring due to interference with the normal tear film, or create an astigmatic effect of the cornea. These issues resolve with resolution or excision of the chalazion.

The development of a chalazion should not be considered a result of poor hygiene or a dirty/dusty environment. The exact trigger of a new lump remains frustratingly unknown, but in most people it is short lived and an uncommon event.

/ As eyelid margin inflammation (blepharitis) is probably the biggest risk factor, treatment with regular eyelid warm compresses and eyelid massage is probably the simplest way to reduce the development of further chalazia.

/ There is some evidence that a course of oral antibiotics (tetracylcines) may be beneficial for patients who are experiencing frequent and recurring problems. Antibiotics will not help the resolution of a chalazion that is already present, but may reduce the likelihood of further lesions forming.

Most ‘lumps and bumps’ appearing around the eyelid are benign growths that are not skin cancers. These include skin tags, age-related warts (seborrheic keratosis), styes (chalazion), skin cysts (hydrocystomas) and moles (naevi).

Skin cancers can appear like any skin lump or bump in the early stages. There tends to be slow growth, redness or a change in the shape of the eyelid with time. There is usually no pain but sometimes the eyelashes will fall out or the area will bleed by itself.

By far the most common skin cancer around the eyelids is a basal cell carcinoma (BCC). If left untreated a BCC will grow in size, eroding and damaging the skin and structures around it. A BCC does not metastasize to other parts of the body.

The longer the skin has been exposed to sunlight (i.e. ultraviolet radiation) the more likely it is that a skin cancer can occur. As Australia is a very sunny place, skin cancer more common among Australians with fair skin. Risk factors include:

/ a high level of sun exposure

/ getting older

/ fair skin, freckles

/ having had a previous skin cancer.

Most skin cancers around the eyelid are cured with surgery. This is the most reliable way to completely remove the skin cancer and has an excellent success rate. In some special circumstances, other non-surgical options (cryotherapy, radiotherapy, immunotherapy) may be considered, but usually only if surgery is not a possibility.

Losing vision, or even an eye, is very uncommon due to a skin cancer around the eye. This is, however, a possibility if a skin cancer is ignored.

The aim of surgery is to completely excise the skin cancer, protect the eye, and reconstruct the eyelid as close as possible to its normal appearance and function. The complexity of the surgery will depend on the size of the skin cancer and where it is located on the eyelids.

/ A biopsy may be required of the skin lesion to confirm the diagnosis before planning for surgery. This is usually done during the consultation in a treatment room

/ The surgery is done as a day case procedure with a twilight anaesthetic (intravenous sedation) and local anaesthetic, making the procedure painless. Occasionally a general anaesthetic may be used.

/ Most procedures take 60 to 90 minutes.

/ The skin cancer is excised for pathology and is often analysed on the day (frozen section pathology).

/ An eyepad may be needed for 1 to 7 days

/ Bruising of the eyelid can be very obvious for the first week.

/ Patients can resume driving 24 hours after the surgery (if they are no longer wearing an eyepad) and can return to their usual routine after several days.

/ It may be a week to 10 days before active exercise (swimming, lifting weights) is resumed, but light exercise (eg walking) is encouraged from the first day.

Some skin cancers are very hard to see, or may involve a large amount of the eyelid and pose special challenges. In these cases:

/ Removing the skin cancer may be done as a separate procedure by a specialist dermatologist Mohs surgeon. The reconstruction of the eyelid is done several days later.

OR

/ The reconstruction of the eyelid may involve two separate operations done two weeks apart. During this time the eyelid is closed and there is no driving allowed.

Most cases have excellent outcomes with a normal looking eyelid and complete removal of the skin cancer.

/ It may take some time (months) for the healing to be complete. The larger the skin cancer the greater the challenges posed. The eyelid can be red, swollen or have an altered shape for many weeks.

/ There are some cases in which the eyelid is altered in its final appearance or has healed in an unexpected manner. Further reconstructive surgery may need to be considered months after the original surgery.

/ Bleeding, chronic pain and infection of the eyelid is quite rare, but some patients will have watering and discomfort for the first two weeks after surgery.

/ There may be permanent loss of eyelashes in the area of the surgery.

/ Recurrence of the skin cancer is rare (if it has been completely removed).

/ Altered vision or damage to vision is rare.

/ Eye watering can be a problem if the tear duct system (lacrimal system) has been affected by the skin cancer or surgery. Further surgery may be an option to help this.

The aim is to reduce the amount of sunlight on the skin, especially if you have pale skin, freckles or red hair.

/ When outdoors, wear protective clothing such as long sleeve t-shirts, hat, and sunglasses.

/ Avoid long periods in direct sunlight (e.g. use shade umbrellas at the beach).

/ Always apply a high protective sunscreen (at least UPF 30) and do so every 2 hours whilst in the sun.

/ If you notice a suspicious skin change, see your GP or a dermatologist, and have regular check ups if you have had a skin cancer before.