Oculoplastic Surgery in Reading, Wyomissing, Pottsville, Pottstown, Lebanon.

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As we age the muscles around the eyes tend to weaken. Laxity of the eyelid tendons, combined with weakening of these muscles result in the eyelid turning in. Some patients have eyelid spasms, forceful blinking, squeezing, or other neurological conditions that cause the eyelid to roll inward. Entropion may also occur as a result of trauma, scarring, or previous surgery. When the lid turns inward, the lashes and the skin rub on the eye.

There may be a foreign body sensation in the eye, or excessive tearing, crusting of the eyelid, or discharge. Irritation of the cornea may develop from lashes rubbing on the eye. A chronically turned-in eyelid can result in acute sensitivity to light and wind, and may lead to eye infections, corneal abrasions, or corneal ulcers. If entropion exists, it is important to have a doctor repair the condition before permanent damage occurs to the eye. Entropion usually requires surgical treatment.

Prior to the surgery, the eye is protected by applying tape to the lower eyelid and using lubricating ointment. There are a number of surgical techniques for successful treatment and each surgeon will have a preferred method. The usual treatment for entropion involves tightening any laxity of the eyelid and its attachments to restore the lid to its normal position.

An excellent treatment for patients who are not able to have surgery is the Quickert procedure. This procedure requires two or three strategically placed sutures that will turn the eyelid in temporarily. The definitive surgery to repair entropion is most commonly performed as an outpatient procedure under local anesthesia with or without sedation.

Antibiotic ointment may be prescribed for about a week following the surgery. Most patients experience immediate resolution of the problem once surgery is completed with little, if any, postoperative discomfort. Patients with entropion from forceful eyelid blinking, spasms, or squeezing may benefit from a non-surgical treatment option.

Botulinum toxin injections into the overactive eyelid squeezing muscles can weaken them for several months, allowing the eyelid to roll back into its natural position. This may also be a good option for patients who cannot have surgery.

As with any medical procedure there may be other inherent risks including but not limited to anesthesia risks, swelling, scarring, or further surgery needed. Minor bruising or swelling may be expected and will likely go away in one to two weeks.

An ectropion is an outwardly turned, loose, or sagging eyelid. The lower lids are more commonly affected, but ectropion may occur in an upper lid as well. The sagging lower eyelid leaves the eye exposed and dry, and as a result, excessive tearing is common with ectropion. If it is not treated, the condition can lead to crusting of the eyelid, mucous discharge, and irritation of the eye.

Serious inflammation could result in damage to the eye. Ectropion can be diagnosed with a routine eye exam.

Ectropion may also be associated with conditions like obstructive sleep apnea. The wet, inner, conjunctival surface of the eyelid can flip outward, becoming exposed to the air. Normally, the upper and lower eyelids close tightly, protecting the eye from damage and preventing tear evaporation. If the edge of one eyelid turns outward, the two eyelids cannot meet properly, and tears are not spread over the eyeball.

This may lead to irritation, burning, a gritty, sandy feeling, excess tearing, visible outward turning of the eyelid, and redness of the lid and conjunctiva. Corneal dryness and irritation may lead to eye infections, corneal abrasions, or corneal ulcers. Rapidly increasing redness, pain, light sensitivity, or decreasing vision should be considered an emergency in a person with ectropion. The irritation can be temporarily relieved with artificial tears and ointments to lubricate the eye.

Surgical treatment for an ectropion often depends on the underlying cause. In the type of ectropion associated with aging, most surgeons elect to shorten and tighten the lower lid. This typically is completed with an incision of the skin at the outside corner of the eyelid and reattachment of the eyelid to underlying tissues and the upper eyelid.

Sometimes, there are scars from chronic sun exposure, following trauma, or the surgical removal of skin cancers. Your surgeon might need to use a skin graft taken from the upper eyelid or from behind the ear to repair the ectropion. Both the donor site for the graft and the surgical site will usually heal nicely within a few weeks following the surgery.

You may have a patch overnight and then you will likely use an antibiotic ointment for about a week. After your eyelids heal, your eye will feel comfortable again. Many patients experience immediate resolution of the problem once surgery is completed, with mild postoperative discomfort. After your eyelids heal, your eye will feel more comfortable and you will no longer have the risk of corneal scarring, infection, and loss of vision.

In addition to the removal of the sutures, minor bruising or swelling may be expected and will likely go away in one to two weeks. Thyroid eye disease is a disorder of the immune system. In thyroid eye disease the tissue around the eye is attacked by inflammatory cells and the result is inflammation, swelling, and bulging of the eye.

Thyroid disease and thyroid eye disease both come from the immune system attacking healthy tissue. We now know one disease does not directly cause the other. The immune system will attack both the thyroid and the tissue around the eye. The timing and severity of these two diseases is variable depending on the individual.

Common symptoms of thyroid eye disease include swelling around the eyes, bulging of the eyes, irritation, redness, and a pressure sensation associated with headache. If the inflammation involves the muscles, or if the swelling is severe enough, the pressure in the orbit eye socket can become extremely high.

This can cause compression of the optic nerve, resulting in progressive loss of vision, and possibly blindness if the condition is not treated promptly. There are two phases of thyroid eye disease. The first phase is the inflammatory phase, which typically lasts six months to two years.

The second phase is the stable phase when active inflammation is quiet. Many patients will be left with some degree of protrusion of the eye, eyelid retraction, or double vision that may require additional treatment. Chronic eye exposure from protrusion or lid retraction can lead to severe drying of the eye and corneal scarring.

Double vision can be severe and disabling. Depending on the severity of the thyroid eye disease, all patients should be followed closely by an expert. For many, the discomfort from thyroid eye disease can be treated with topical lubricants, wrap-around tinted glasses, sleeping with eye shields or by elevating the head of the bed at night.

When there is active inflammation, certain treatment modalities have been tried including steroids, anti-inflammatory medicines, and radiation. Promising new drugs and other treatments may improve the treatment of active thyroid eye disease in the near future. The function and appearance of the eyes can usually be improved by reconstructive eyelid or orbital surgery. The particular surgical technique used will depend on the type and severity of the eye problems, but typically progresses in three stages.

Not all patients with thyroid eye disease will require all of these treatments. Stage one of surgery is orbital decompression removing part of the bony orbit and fat behind the eye to relieve pressure in the eye socket. This can prevent damage to the optic nerve and allow the eye to move back into a more normal position in the eye socket. Stage two is eye muscle surgery to correct misalignment of the eyes and double vision.

This is achieved by repositioning the enlarged muscles that control eye movement. Stage three is eyelid surgery to adjust the position of retracted lids in order to improve eyelid closure and restore eyelid function.

Removal of excessive fat from the eyelids can also improve their appearance. While it may not be possible to completely eliminate all of the consequences of thyroid eye disease, surgery to correct these conditions is generally successful in satisfactorily restoring function, comfort, and cosmetic appearance. Bleeding, infection, anesthesia risks, and scarring, which are potential risks with any surgery, are very uncommon. The outer layer of skin is called the epidermis.

Epidermal cells include flat squamous cells, round basal cells, and pigment producing melanocytes. The dermis is the deeper layer of skin and contains the hair follicles, oil and sweat glands, and blood vessels.

Skin cancers can arise from any of these skin cells. A biopsy is usually required to confirm the diagnosis of skin cancer. What are the causes? Excessive exposure to sun is the single most important factor associated with skin cancers of the face, eyelids, and arms.

Fair-skinned people develop skin cancers far more frequently than darker-skinned people. Skin cancers may also be hereditary. The most common types of periocular eye area skin cancers are basal cell carcinoma and squamous cell carcinoma. The skin may be ulcerated, or there may be bleeding, crusting, or the normal eyelid structure may be deformed. The eyelashes may be distorted or missing. Melanomas arise from the pigment-producing melanocytes.

This is a less common but more serious form of skin cancer. A mole that bleeds or becomes tender, or one that changes is size, shape, or color, should be evaluated by a physician. Sebaceous gland carcinoma arises from the oil glands in the skin. This is also a more serious form of skin cancer. It may appear as a thickening of the eyelid, or as persistent eyelid inflammation.

Basal cell skin cancers enlarge locally and rarely spread metastasize to other parts of the body. Left untreated, they will continue to grow and invade surrounding structures. Squamous cell carcinomas, melanomas, and sebaceous gland carcinomas can metastasize to other parts of the body through the bloodstream or lymphatic system. Prompt, aggressive treatment is necessary because of the risk of early spread.

Surgical excision is the most effective treatment for periocular skin cancers. There are two very important principles in treating skin cancers — complete removal and reconstruction. Complete removal of the skin cancer is necessary to reduce the chance of recurrence.

Reconstruction of the resulting defect is tailored to preserve eyelid function, protect the eye, and provide a satisfactory cosmetic appearance. Your doctor may recommend Mohs surgery, which is a technique where the lesion is removed layer by layer with same-day microscopic confirmation.

A dermatologist specially trained in the technique performs Mohs surgery, and the oculofacial plastic surgeon repairs the area once the cancer is removed. Alternatively, your surgeon may elect to remove the cancer using frozen sections. In this instance, the surgeon removes the lesion with a small margin of normal tissue. The specimen is quickly frozen and the pathologist examines the tissue to determine if the entire tumor has been removed.

Once this is confirmed, the area is repaired. How the area where the skin cancer was removed is reconstructed depends on the size of the defect left behind. Smaller defects can be repaired by suturing the edges together. Larger areas may require local flaps or free skin grafts to close them. Radiation may be useful for patients who cannot tolerate surgery, or in addition to surgery in more aggressive types of skin cancers. Early and complete removal of eyelid skin cancers is vital to reduce the chance of a recurrence, and to reduce the risk of spread to other parts of the body.

Careful follow-up after surgery is necessary to look for recurrence and to look for new cancers so they can be treated promptly. Recurrence is rare but may occur even after complete excision of a skin cancer. Recurrence is much more common if the lesion is not completely excised.

If the skin cancer involves the tear drainage system, the eye may tear afterwards. These conditions can usually be treated with additional surgery. This usually results from anxiety and stress, fatigue, and caffeine. The contractions are often so small that they are not visible to others. Fortunately, this resolves on its own over several weeks. Benign essential blepharospasm BEB is uncontrolled contraction of muscles around the eyes.

The condition affects both sides and may result in a variety of problems including difficulty opening the eyes, rapid fluttering of the eyelids, or forced contraction of the lids and brows.

When the mouth and neck are involved with the spasms, the condition is called Meige syndrome. The initial symptoms may be excessive blinking with progression to more forceful and frequent muscle contraction. The spasms disappear during sleep and may be made worse with bright lights, fatigue or emotional stress. Aberrant facial nerve regeneration may occur after an episode of facial paralysis e. This rewiring can lead to eyelid twitching, drooping, and even tearing when other muscles of facial expression are activated e.

smiling, chewing. Hemifacial spasm HFS is uncontrolled contraction of the muscles on one side of the face, usually including the eyelids. The initial symptom may be twitching of the eyelids, with progression to involve the muscles on one entire side of the face.

The severity of symptoms may vary from mild fluttering to forceful contraction. Unlike blepharospasm, this condition occurs during sleep. The cause of BEB is unknown. The diagnosis may be made by your physician examining you and observing your facial movements. Blepharospasm is a benign condition that requires no further diagnostic testing. HFS is sometimes caused by irritation of the facial nerve at the base of the skull.

This irritation may be the result of an abnormal blood vessel pulsating against the facial nerve. When the facial nerve is irritated, it causes the facial muscles to contract and spasm.

Therefore, your physician may recommend magnetic resonance imaging MRI. Myokymia will stop on its own, particularly if the underlying cause is addressed. Oral medications are rarely effective in treating blepharospasm or HFS. The benefits are variable and short-lasting. The most common treatment of BEB, aberrent facial nerve regeneration, and HFS is with botulinum toxin injections.

Botulinum toxin is FDA approved for the treatment of these disorders. The toxin is injected into the muscles at several sites around the eyelids and brow to prevent unwanted contractions. The effects of botulinum toxin last an average of two to four months, and injections may be repeated as needed.

This treatment has been found to be safe and effective. Side effects are uncommon and last only for a short time, and may include droopy eyelids and double vision.

Surgery may be recommended for BEB if botulinum toxin therapy is not successful. Protractor myectomy surgery removes the eyelid muscle responsible for eyelid closure. This surgery is successful for some but not all patients. Many patients still require botulinum toxin injections after myectomy surgery.

Surgery for HFS may be contemplated if an aberrant blood vessel is found to be the cause. The surgery involves microvascular decompression of the vessel near the brainstem to relieve pressure on the facial nerve. Dark glasses are a mainstay of supportive therapy, and serve two purposes. They block the bright lights which worsen spasms , and they hide the eyes from other people. As stress makes these conditions worse, stress management intervention may be helpful.

The facial nerve is a branching nerve that travels from the brainstem to the face and controls movement involved in smiling, frowning, closing the eyes, and raising the eyebrows. When this occurs, patients may have trouble closing their eyes, raising their eyebrows or managing tears on that side of the face.

Symptoms may include an eye that waters, an eye that is dry and scratchy, a droopy brow or upper eyelid, or a saggy lower eyelid. Some patients will experience paralysis of the lower half of the face leading to drooling, change in speech quality, sagging of the corner of the mouth. Although function of the affected nerve may improve in some patients over time, that function does not always return to normal.

Symptoms of synkinesis include eyelid spasms, squinting when chewing foods, and drooping of the upper lid from over-action of the eyelid closing muscles. These changes are usually permanent. During this time, some patients will find lubrication of the eye with over-the-counter tears and ointment all that is necessary.

Some patients may require lid surgery to help protect or close the eye. This might involve placing a weight under the skin to help close the upper lid, tightening a saggy lower lid against the eye, or partially sewing the lids shut at the outside corner. Some of these procedures can be reversed if the function of the facial nerve improves. If facial nerve palsy is permanent, patients usually need to continue lubricating the eye indefinitely.

Surgery to lift the brow or lower face can be considered to help improve facial symmetry. There may be a role for rewiring the paralyzed muscles through facial reanimation surgery. Though most oculofacial plastic surgeons do not do reconstructive surgery for paralysis of the lower face, your surgeon can discuss the options that may be available to you.

Treatments for problems related to synkinesis are also available. Many patients benefit from physical therapy, which can help improve facial function and symmetry, especially during active movements. Eyelid spasms and drooping lids may be reduced with oral medications or even strategic use of botulinum toxin injections e. In some cases, surgery may be an option. It is important to discuss your concerns and goals with your physician in order to develop a treatment plan that works for you.

In the setting of paralysis, it is sometimes necessary to repeat surgery as the effects wear off over time. Bleeding and infection are potential risks of any surgery. The orbit, or eye socket, is a bony opening that contains the eyeball and the muscles, blood vessels, nerves and fat that help support it. The areas along the inside wall the wall between the eye and the nose and floor are the thinnest and fractures are more likely to occur here. A CT scan is usually obtained to confirm the presence and exact location of the broken bone s.

Soft tissue may sometimes be trapped in the fracture site. Symptoms of a blow out fracture may include pain, swelling, bruising, double vision, nausea, numbness of the cheek or upper teeth. After swelling subsides, the eye can appear sunken. It is important that the eyeball is carefully examined, as it can also be damaged as a result of the trauma. Not all broken orbit bones need to be fixed. Right after the injury, it is not always clear if a patient will need surgery.

Your surgeon will follow you closely and may prescribe cold compresses, antibiotics or a short course of anti-inflammatory pills. During this time you should avoid sneezing or blowing your nose and should not fly in an airplane or go deep-sea diving. These activities may allow air to enter the orbit, causing further discomfort and damage. Your surgeon will usually determine whether an operation is needed within two weeks after injury.

The most common reasons to consider surgery are bothersome double vision, nausea or severe pain with eye movement, or a visibly sunken eye. Your surgeon can describe the plans for your surgery based on your symptoms. Patients are put to sleep for the operation and depending on the situation, may go home after surgery or stay overnight in the hospital for observation.

Most patients are swollen and bruised for several days after the operation. Though the eye is not usually bandaged, vision may be blurry for several days. Cold compresses, antibiotic or anti-inflammatory pills may be prescribed. Some patients may have double vision or numbness across the cheek that usually improves over time. Most patients may return to work or school within a week, though many surgeons prefer to limit full strenuous activity, airplane travel and deep sea diving for several weeks after the operation.

In rare circumstances, surgery in the orbit can lead to loss of vision that may be permanent. Surgery for blow-out fractures may not always achieve the desired results and some patients may have persistent double vision, numbness or asymmetry in the appearance of the two eyes. A chalazion is a swollen lump on the eyelid. Chalazia arise from oil glands located near the eyelashes. If an eyelid gets inflamed, for any reason, these oil glands can get congested with very thick oil.

The thick oil not only flows and functions poorly, but can also lead to more inflammation. The most common symptom of a chalazion is a non-tender or mildly tender lump on the eyelid. The lump is usually visible, red, and noticeable to the touch. Chalazia may develop over days to weeks, sometimes at the site of a recent stye eyelid infection.

A chalazion might go away if its contents drain, either through the skin surface or onto the eyeball surface. The oil glands in a chalazion normally help keep the eye surface moist and comfortable.

When these glands malfunction, the eye can feel uncomfortable, dry, irritated, or itchy. Some patients complain of a foreign body sensation under the eyelids, and some have watery eyes.

The eyelashes can also develop flakes that look like dandruff. All these problems can lead to blurry vision. Applying warm moist compresses with gentle pressure to the affected eyelid several times daily may treat a chalazion. Baby shampoo is sometimes added to the compress for the same reason and to help wash away eyelid dandruff.

The heat also improves blood flow in the area, which can help clear away the inflamed chalazion tissue. The heat should not be so hot that it scalds the skin. Your physician may prescribe drops or ointment in addition to the warm compresses. Since chalazia are usually not infected, oral or topical antibiotics may not be totally effective. Your physician may recommend an injection of steroid medicine or even surgical drainage.

Although these procedures can be very effective, bleeding, bruising, infection, scar tissue formation, and recurrence are possible. As with any medical procedure, it is important to ask your surgeon about the risks and possible complications. Eyes that water or tear uncontrollably are one of THE most common complaints eye doctors hear from their patients. There are several reasons why eyes can water and the treatment depends on the underlying cause. In most cases, your oculofacial plastic surgeon will have an idea of why your eyes water based on your symptoms and physical exam.

It may be reassuring to know that in the vast majority of cases, tearing — while extremely bothersome to the patient — is not harmful to the eye. To understand why eyes can water, it is helpful to understand how and why tears are made and how they ultimately drain away from your eye. Mucous membranes by definition should be moist at all times.

In the mouth, that moisture is provided by saliva. This later stage Ramkumar, To the layperson, the burial jawbone shows a hairline fracture. The best way to describe it is to say it looks like a hair strand accidentally landed on the jawbone when the x-ray was taken.

Daniels, going back to page twelve, the Dayna Hester, And over time, with any activity whatsoever in each of us, that seemingly insignificant hairline fracture gets worse and worse and worse. The decay is often imperceptible to us, a slow erosion with each use. But the original crack will turn into a Tyler Wigg Stevenson, There is slight disruptionof the anterior longitudinal ligament, Matthew T. Walker, Alexander Nemeth, A fatigue hairline fracture may develop without apparent injury and in the absence of trauma.

hair transplantation, a form of dermatologic surgery and plastic surgery, performed to correct scalp hair deficiencies caused by hormonal changes, Mosby, Harold Earl Bennett, National Institute of Standards and Technology U. 用語 «HAIRLINE FRACTURE» を含むニュース項目. Kreider expects 'big things' from Rangers this season - NHL. It was the first time Zuccarello played in a game since sustaining a brain contusion and hairline fracture of his skull in Game 5 of the Eastern com, 7月 15».

However, Diarmuid O'Connor, who sustained a hairline fracture to his wrist during the Connacht semi-final victory over Galway four weeks ago, Royals Review Roundtable: The midway point - Royals Review.

but, again, Moore can't be trusted to replace the true weak link Alex Rios and instead might patch the hairline fracture with ducktape instead Too small for basketball: Former Dixie Heights player earns spot on …. At the end of her sophomore year, a hairline fracture on her kneecap put her on crutches for nearly eight weeks. But the 5-foot, pound The pressure's on Michael Clarke — and not just on his back …. That hairline fracture was aggravated by tensions as a place was held for him in the World Cup squad, against the better judgment of some.

Richmond midfielder Shane Edwards will miss at least 2 weeks after scans confirmed the 26 year old has a hairline fracture in his right fibula. INF Mike Olt hairline fracture in his right wrist was reinstated from the day DL and optioned to Triple-A Iowa.

GM Jed Hoyer says INF The Cubs reinstated Mike Olt , sidelined by a hairline fracture in his right wrist, from the day disabled list and optioned him to Triple-A Iowa. Also, Chicago reinstated Mike Olt, sidelined by a hairline fracture in his right wrist, from the day DL and optioned him to Triple-A Iowa and Olt had been out since April 15 with a hairline fracture of his right wrist.

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