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Информации за тековно работење во услови на Ковид - 19

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Interventions to restore normal eyelid function

Degenerative eyelid changes are not just an aesthetic problem, they can often cause very serious and permanent changes in the anterior segment of the eye. Our surgeons perform all types of eyelid procedures to restore normal eye function. The interventions are performed under local anesthesia, and the patients go home the same day.

During the aging process, the skin of the eyelid becomes thinner, less elastic, loses support, leading to loss of adipose tissue, fatigue of the tendons of the eyelid muscle leads to excessive relaxation of the eyelid, blepharohalase of the upper and lower eyelids (excess skin hanging over the eyes and eyelids), further ptosis (drooping eyelids), ectropion and entropion (excessive twisting of the eyelid towards the eye or the outside). Today, we have non-surgical methods and surgical methods available to correct the changes.

With daily action of the muscles of the face (frowning, wondering, laughing) wrinkles are created on the forehead, between the eyebrows, and on the outer corner of the eye.

Blepharohalase of the upper and lower lids and ptosis of various origins are treated with surgical methods. An incision is made in the natural grooves of the lid so that the scar is then unrecognizable and the excess skin is removed. In the event that the position of the lid needs to be corrected because it has lost muscle support, an intervention is performed to return the lid to its natural position.

Given all of the above, we have a lot of opportunities to look and feel young for a long time to come.

Blepharoplasty

The most common eyelid surgery, which restores freshness and youthful appearance, is called blepharoplasty. Aesthetic blepharoplasty is performed in case of excess skin on the eyelids (dermatochalasis), which usually loses its elasticity due to aging, so it hangs over the edges of the eyelid, and may be associated with prolapse of fatty tissue from the orbit that causes the formation of fat pads and eyelids. Functional blepharoplasty is performed in cases when, in addition to excess skin, the muscles can be weakened and the lid is lowered with the inability to be lifted (ptosis). Surgery under local anesthesia removes excess skin, fat and stretched muscle fibers on the eyelids.

An incision is made in the natural folds of the lid or under the lashes and closed with sutures that are removed in seven days, with a quick recovery and an almost invisible scar.

Ptosis correction (closed lid)

Ptosis is a medical term for a drooping lid. A patient with ptosis is unable to fully open the eye because the upper eyelid covers the pupil. Apart from being an aesthetic problem, it can also cause functional visual impairments and stunted vision development in children, while adults find it difficult to function in everyday life. It can be present at the birth of a child, so it is called congenital and occurs due to developmental errors while the child is still in the womb. If the child is born with ptosis that prevents normal vision, it is necessary to perform surgery as soon as possible, because the child’s eye will not develop and will remain weak for the rest of its life.

Acquired ptosis in adults occurs as a result of injury or degenerative aging of the muscles and tendons of the eyelids caused by aging. Ptosis is treated surgically, and there are several types of surgery. The choice of intervention depends on the type and degree of ptosis. If the levator palpebrae has a preserved part of the function, the operation is performed by shortening it. If by chance that muscle does not have sufficiently preserved function, the lid is connected with a special procedure to the muscles of the forehead that take over the function of the lid (so-called brow suspension). The ptosis correction intervention is performed under local anesthesia so that the patient goes home the same day and a very rapid recovery follows. Although the procedure is the same as in children, it needs to be done under general anesthesia.

Correction of impaired position of the lid (ectropion, entropion)

In older people, the edges of the lids sometimes twist due to changes in the structure of the edges of the lids, which are caused by changes in the muscles that hold the lids, their tendons and the skin around them. Often, such conditions occur after damage to the eyes due to scarring or stroke or similar conditions in the brain, which lead to injury to the nerves that innervate the muscles that move the eyelid. The surrounding muscles are no longer able to hold the lash cover in the correct position, but the edge of the lid is twisted. The edge of the lid can be twisted outwards (ectropion), so the eye can not be closed, tears drip over the edge and the cornea and the anterior segment of the eye dry out.

The edge of the lid can be twisted inward (entropy), so the lashes can constantly scratch the front of the eye, making sores on the cornea, and the patient with pain, of course, comes to the doctor’s office. The operation under local anesthesia strengthens the edge of the lid and adjusts it to the appropriate position, or new muscle attachments are formed so that the actual shape and function can be restored. The sutures are removed at the first check-up, one week after the operation, and that is how long it takes for the bruises to withdraw at the site of the operation.

Tear duct surgery

A well-distributed, high-quality tear film is essential for the eye to function properly. In the tear apparatus, the good function of all its parts is important: tear glands, lids and tear ducts. The eye and nose are connected to the nasal canal which serves to drain excess tears in the nose. In some cases, due to frequent inflammation, injuries or congenital narrowing, that canal becomes clogged. This condition is manifested by increased tearing (epiphora) and associated infections due to the congestion of tears in the tear sac located at the beginning of the duct.

In case the inflammation cannot be resolved with antibiotic therapy, nor can the canal be re-established, an operation called dacryocystorhinotomy (DCR) is performed. It is an operation that re-establishes the continuity of the canals and thus allows the excess tears to drain from the eye through the tear sac and the tear ducts to the nasal cavity. During the intervention, a silicone bag is implanted that stays in the eye for about six months. The intervention is performed under general anesthesia, and the first control is in seven days, after which the person can return to work.

In children, in some cases, there is a tendency for congenital narrowing of the tear ducts. If the tear duct does not open spontaneously with the help of massage and hygiene, during the second year of life, probing is performed under general anesthesia. If the channel does not open even then, the probe is repeated by inserting a silicone bag.

Removal of a tumor in the area around the eye

Tumors of the eyelids, as well as anywhere else on the body, must be taken seriously. The most common changes that occur are benign (cysts, warts, inflammatory changes) and can be cured with medication or simple surgery. Unfortunately, in some cases, the changes can be malicious. Apart from the fact that some types of tumors can spread to nearby and distant places, in case they are located in delicate and sensitive areas, such as the eyelids or the area around the eye, their removal needs to be done carefully and very gently through reconstruction of the surrounding skin and other structures in order to preserve the proper function of the lid and the aesthetic appearance of the patients.

Among the most common malignancies that require surgery are: basal cell carcinoma, squamous cell carcinoma, or, less commonly, melanoma. Tumor removal is performed under local anesthesia, and the first control is after seven days, when it is recommended to return to daily responsibilities.

Dystyroid (endocrine) orbitopathy

In some cases, patients with thyroid dysfunction have eye problems (redness, tenderness, pressure, bulging eyes, diplopia). These changes are due to the accumulation of antibodies in the structure of the eye, primarily in the muscle and adipose tissue in the back, leading to pushing the eye out. Changes in the muscles lead to impaired movement of the eye, which causes the creation of a duplicate image (duplicate, diplopia). In addition to the subjective disturbances caused by the disease, it subsequently causes changes in the eyes. The most typical change is “protruding” eyes, which in addition to affecting the aesthetic appearance of the patient, can also leave lasting effects on the surface of the eye itself, because the eye dries out due to the inability to normally blink and close.

The patient may also have a problem with a double image due to changes in the muscles that move one eye, so the eye is unable to follow the other when looking. With mandatory internal treatment of the thyroid gland, additional ophthalmic treatment is often required. When it is not possible to improve the condition with drugs and Botox, eyelid and eye muscle surgery is performed. Such interventions are performed under local anesthesia. During lid intervention, its structures are extended to correct the shortening and shrinkage of tissue caused by thyroid hormone disorders. During the intervention of the eye muscles, the strabismus is corrected and the mobility of the eye is improved, which are a consequence of the loss of the elasticity of the muscles. After muscle surgery, it is recommended to abstain from physical activity for three weeks, avoid smoky rooms and therapy with drops.

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