Explaining oculoplastics: treating the skin in and around your eyes

Oculoplastic surgery is surgery that focuses on your eyes and surrounding structures, such as your eyelids, eye sockets, the skin around your eyes, and tear ducts. Although oculoplastic surgery can be used for cosmetic reasons, there are also many medical reasons that you may need it, including removing tumours and improving your eyesight.  

Here we’ll run through three reasons for oculoplastic surgery that I commonly see in patients. 

1. Midface and periocular lesions

A skin lesion refers to any change in the characteristics of your skin that is different from the surrounding skin eg a lump, fissure (crack), ulcer or area of unusual discolouration.

A midface lesion occurs in the middle third of your face, which includes your cheekbones, nose and upper jaw (maxilla). A periocular lesion occurs in the area surrounding your eyeball.

Fortunately, most midface and periocular lesions are not cancerous and can be treated with medication or surgery, without causing any scarring. If you have a lesion that doesn’t get better after three months, you will need to have a tissue sample (biopsy) of the lesion collected. The biopsy will be sent to a lab for analysis and depending on the results, appropriate treatment will be recommended.

2. Baggy and droopy eyelids

Baggy, droopy or loose eyelids are common conditions and are often not thought of as serious conditions. However, if they are affecting your eyesight, mental health or otherwise affecting your quality of life, then you should see your GP or an ophthalmologist (a doctor specialising in treating the eyes).

Droopy eyelids

Droopy eyelids affect the upper eyelids and are also known as eyelid malposition or ptosis. They can cause potentially serious problems with your eye health and are the third most common cause of corneal ulcers — an open sore on the front covering of your eyeball, your cornea.

Left untreated, corneal ulcers can cause vision loss and/or lazy eye (amblyopia), which can cause blurry vision and a reduced ability to perceive depth. Early detection of corneal ulcers through regular eye examinations makes treatment easier and can help prevent vision problems.

Baggy eyelids

Baggy eyelids can affect the upper and lower eyelids. They occur when the muscle that pulls your eyelid up becomes detached, causing the eyelid to drop down. In your upper eyelids, this can cause discomfort, reduce your eyesight and your field of vision, and in some cases, cause severe headaches.

At Spire Healthcare, treatment for baggy upper eyelids involves removing the excess eyelid skin and sculpting the upper eyelid for improved vision and aesthetics. For lower eyelids, surgery called an extended lower lid blepharoplasty is used, which involves removal of the excess eyelid skin and a midface lift.

3. Watery eyes

Watery eyes are most common in older adults and young children, and are usually caused by blocked tear ducts, which prevents tears from properly draining out of your eyes.

Around six in every 100 children are born without a fully developed tear drainage system or an abnormality in their tear ducts, which causes watery eyes. This can cause blurry vision, repeated eye infections and redness. However, treatment is effective and usually involves either a procedure called probing or tear duct bypass surgery.

In adults with blocked tear ducts, probing and tear duct bypass surgery are both effective too but there are other procedures that may also be considered, such as stenting and balloon catheter dilation. These approaches aim to either unblock the tear duct or create a new route through which tears can drain out of your eyes.

Oculoplastic surgery: what to expect

Before you decide to go ahead with oculoplastic surgery, your surgeon will talk you through the risks and benefits, so you can make an informed decision.

Oculoplastic surgeries are often performed as day cases, which means you can return home on the same day as your procedure. In most cases, you can return to all of your normal activities in around a week or so.

You will be invited to follow-up appointments to check on your recovery after surgery.

When to see an ophthalmologist

If you have any of the conditions discussed above, ongoing red sore eyelids, repeated conjunctivitis or a mucous discharge from your eyes that does not clear up in a few weeks, you should see an ophthalmologist.

Although in most cases, your condition will not be serious, it is important to get a diagnosis and, if needed, treatment, as soon as possible. This will reduce your chances of developing serious complications that could affect your vision.

How can oculoplastics help you?

If you’re experiencing problems with the skin in and around your eyes, an oculoplastics surgeon may be able to offer you relief from your symptoms. Oculoplastic surgery can offer long-lasting results by restoring the normal anatomy around your eyes. This can improve your vision and cosmetic appearance, as well as better protecting your eyes from a range of eye conditions.

Author biography

Mr Bijan Beigi is a Consultant Ophthalmologist at Spire Norwich Hospital and NHS Norfolk and Norwich University Hospital, specialising in oculoplastic surgery, squint surgery, eyelid and midface cosmetic surgery, and eyelid cyst surgery. Mr Beigi performs over 600 eyelid, mid-face, cosmetic and reconstructive operations every year and is a founding member of the British Oculoplastic Surgery Society (BOPSS). He is also actively involved in the research community, having produced over 60 publications and giving talks nationally and internationally on advances in the field.