My Doctor Online The Permanente Medical Group
Are you having back pain with any of the following?
- Severe pain, weakness or tingling in your leg(s).
- Difficulty stopping urination or loss of control of bladder or bowels.
- Unexplained fever, nausea or vomiting.
- A history of cancer or unexplained weight loss.
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
James Claiborne, MD
Ophthalmology
Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.
My Offices
- San Rafael Downtown Medical Offices
- Appt/Advice: 415-444-2990
Quick Links
- Wellness Coaching
- Eye Videos
- Prepare for Your Procedure - Emmi
- Laser Vision Correction
- Dry Eye Handout
- Cataract Class
- Using the Amsler Grid
- Blepharoplasty
- Blepharoptosis
- Blowout Fracture
- Brow Ptosis
- Ectropion
- Entropion
- Nasolacrimal Duct Obstruction
- Strabismus and Amblyopia
- Subconjunctival Hemorrhage
- Thyroid Eye Disease
- American Academy of Ophthalmology
- Cataract Surgery
- National Eye Institute
- Vision Essentials
General References
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Blepharoplasty
Introduction
Dermatochalasis is the medical condition that indicates excess of skin in the upper or lower eyelid. This excess eyelid skin is usually attributed to aging and is more common in elderly patients although it occasionally may occur in younger adults as an inherited trait. Some medical conditions may predispose patients to develop excess eyelid skin. These conditions include thyroid eye disease, renal failure, trauma, cutis laxa, Ehlers-Danlos syndrome, amyloidosis, and hereditary angioneurotic edema.
Steatoblepharon describes the presence of excess fatty tissue underneath the thin eyelid skin. This fat arises from the migration of fat deep within the eye socket into pockets just beneath the eyelid skin. It is frequently associated with the development of excess eyelid skin. However, some patients may present with isolated fatty pockets within the eyelids. Most commonly, these fatty pockets are noted in the inner corner of the upper eyelid and through out the lower eyelids. When present they give the appearance of “bags” and are often mistaken by patients to contain fluid.
Symptoms
While excess eyelid skin is mostly a cosmetic concern for patients, occasionally significant excess eyelid skin and fatty pockets can serve to obstruct vision. Excess skin and fat can weight down the upper eyelids and result in a reduction in both the outer and the superior fields of vision. This obstruction in your vision may cause difficulty with activities such as driving or reading. In addition, patients may notice eye irritation if the upper eyelid skin covers the eyelashes and forces the eyelashes to be in contact with the sensitive surface of the eye. Rarely, patients may develop chronic dermatitis within the skin folds of the eyelid skin.
Diagnosis
Your surgeon will perform a complete eye examination to determine if you are a candidate for treatment. During the examination the degree of impaired vision will be estimated by a test of your field of vision. The presence of dry eye, occult skin cancer and associated age associated conditions such as brow ptosis, blepharoptosis and other eyelid mal-positions will also be assessed.
Treatment
Not all patients with excess eyelid skin require surgical treatment. Further patients with proper indication for therapy may not elect to undergo surgery. Non-surgical treatment options include doing nothing about the excess eyelid skin. In some instances when surgery is not possible for whatever reason a special appliance may be fitted on your glasses to hold the excess skin off of your eyelids thereby improving your field of vision. This device is known as a “ptosis crutch”. For milder cases some improvement of skin laxness, fatty deposits and skin wrinkles may be accomplished by non-surgical treatments.
The surgical procedure to treat dermatochalasis is known as blepharoplasty. Blepharoplasty can be either medically indicated or purely cosmetic in nature. When an advanced amount of upper eyelid skin is present so that this excess skin m hangs over the eyelashes and causes a loss of peripheral vision then surgery may be a covered medical benefit. In this circumstance, upper eyelid blepharoplasty is performed to improve peripheral vision. Patients with a less severe amount of excess skin may have a similar procedure performed for cosmetic reasons. Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid "bags" and reduce the wrinkling of skin.
Removal of excess eyelid tissue is performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids, or from the inside surface of the lower eyelid. Initial swelling and bruising take one to two weeks to resolve but at least several months are needed until the final result becomes stable. The anatomy of the eyelids, the patients' skin quality, age, and adjacent bone structure and soft tissue all affect the outcome of eyelid surgery.
Factors that are known to cause complications after surgery include pre-existing dry eyes, eyelid malpositions such as blepharoptosis or lower eyelid tendon laxity, droopy brows and droopy cheeks. In some instances other forms of eyelid surgery may be needed in addition to blepharoplasty including correction of brow ptosis, blepharoptosis or lower eyelid malpositions. In general, complications of blepharoplasty are rare and minor when performed by a surgeon trained in the surgical techniques. However, it is possible for the patient to experience incomplete eyelid closure, over or under correction, dry eye and other unintended outcomes.
Eyelid surgery is usually performed as an outpatient in your doctor's office or an ambulatory surgical center. After surgery, discomfort is usually minimal. Your surgeon may advise not taking aspirin products and blood thinners before and after surgery, as they may increase bruising. Your lids will feel a bit tight due to the swelling and bruising that normally accompanies surgery, and at least initially your eyes may tear and feel dry. Use cold packs after surgery to help reduce swelling and limit yourself to quiet activities for the first few days to help decrease bleeding or bruising. You can plan more vigorous activity about two weeks after your surgery. Most patients return to their work or social
schedule in one to two weeks and the majority of healing is complete at about six weeks.
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.