Reconstructive and aesthetic eyelid surgery

The consequence of a chalazion is inflammation caused by the blockage of the drainage duct of a Meibomian gland, located inside the upper and/or lower eyelid.

This then manifests as a small bump on the eyelid, which can grow in size and may become red, painful, with a sensation of heat over the course of several days.

Typically, a chalazion disappears after a few weeks, and in this case, there are no medical consequences. A chalazion is not contagious.

Stye and chalazion

Even though a stye is also a bump in the eyelid caused by the obstruction of a sebaceous gland, a chalazion is not a stye. A stye represents an acute infection of the gland. A chalazion is not an infection but rather an inflammation of the area. Inflammation is a process in which the body reacts to a condition and produces swelling, redness, pain, or heat. A stye is usually more painful than a chalazion and may appear infected.

A chalazion is caused by the oil from the Meibomian gland becoming too thick to flow out of the gland. The oil then accumulates within the gland, forming a bump in the eyelid. The gland's wall may rupture, releasing the oil into the tissue of the eyelid, which then causes inflammation of the tissues and sometimes even scarring.

Medical Treatment

The treatment for a chalazion may include the following:

Applying warm compresses for five to ten minutes, four times a day, to reduce swelling and encourage drainage of the gland.

A medical prescription for antibiotic drops or ointments if a bacterial infection is suspected.

Rarely, an injection of a steroid medication into the area of the bump (the chalazion) to help reduce inflammation.

If a chalazion causes significant symptoms or lasts for several weeks, it may be necessary to remove it surgically. If the appearance of the chalazion bothers the patient, surgical removal may also be performed.

In the case of multiple chalazia or recurrent chalazia, the possibility that the patient may have a generalized condition affecting the sebaceous glands should be considered. This is the case with rosacea: this condition can be treated long-term with oral medication to alter the consistency of the oils produced by the glands.

Dacryocystitis is an inflammation, usually of infectious origin, of a lacrimal sac. Dacryocystitis manifests itself by a typical continuous tearing, similar to that experienced during a cold. It occurs mainly at the extreme ages of life: in newborns and people over 70 years of age. In the elderly, dacryocystitis is linked to a narrowing of the lacrimal ducts. The reduced abundance of tears leads to an increased risk of infection.

In the early stages of the infection, treatment will consist of antibiotic therapy combined with local application of antiseptic eye drops.

When the infection is more advanced, an abscess of the lacrimal sac may occur, and a red and painful swelling may appear at the corner of the eyelid. In this case, the disease requires brief hospitalization.

After numerous recurrences and depending on the patient's discomfort, a dacryocysto-rhinostomy may be performed.

External dacryocysto-rhinostomy is the treatment of obstructions located in the nasolacrimal duct. The procedure is also performed via the endonasal route with similar results and complications, except for the absence of scarring with this technique.

It consists of bypassing the obstacle by creating a stoma between the lacrimal sac and the external wall of the nasal cavity.

An anastomosis will be performed between the lacrimal sac and the nasal mucosa. This is a preferable procedure to a dacryocystectomy in cases of dacryocystitis because it will not cause the patient to have permanent watering. The procedure has a success rate of approximately 90% and eliminates all symptoms. However, it is more difficult and time-consuming than a dacryocystectomy and requires specific equipment and expertise.

The procedure involves removing a piece of the bony wall between the lacrimal sac and the middle meatus of the nose, then suturing the mucosa of the sac to the nasal mucosa of the middle meatus.

Xanthélasma is a common condition that causes aesthetic discomfort and does not decrease with age. It is a xanthome plan palpébral (an infiltrate of histiocytic or macrophage cells filled with lipids – esterified cholesterol) that forms a yellowish plaque which gradually extends and darkens over the years on the upper or lower eyelid.

The best treatment is surgical, performed by an ophthalmologist, or if the lesions are small, they can be removed with a laser by a dermatologist.

However, recurrences are common, around 50%, which necessitates further treatments.

The major issue is the risk of ectropion due to skin retraction after multiple treatments.

Ectropion refers to the outward turning of the eyelid's free edge ("eversion" of the eyelid), causing a loss of contact between the eye and the eyelid.

The causes can be diverse:

Ectropion involutif: occurring due to tissue changes (progressive laxity) related to aging.

Ectropion paralytique: secondary to facial paralysis, related to certain myopathies, etc.

Cicatricial entropion: following burns or certain diseases (such as trachoma, etc.).

The treatment for ectropion is surgical and involves the correct repositioning of the eyelid tissues.

Entropion refers to the inward turning of the eyelid's free edge, causing contact between the eye and the eyelashes.

The causes can be diverse:

Spasmodic entropion (for example, following a surgical intervention)

Involutive entropion: occurring due to tissue changes (progressive laxity) related to aging.

Cicatricial entropion: following burns or certain diseases (such as trachoma, etc.).

Congenital entropion: present at birth.

The treatment for entropion is surgical and involves the correct repositioning of the eyelid tissues.

Pterygium is a benign tumor of conjunctival origin invading the cornea.
It is most often located in the "white" of the eye in the inner angle of the eyelids (the canthus), on the nasal side.
This conjunctivo-elastic tumor most often takes the shape of a triangle compared to a "wing" (Greek etymology of the term pterys).

Promoted by UV exposure and dry eyes.

Surgical treatment of pterygium has several objectives:

Maintain visual function threatened by progressive invasion of the corneal surface, restore the aesthetics of the eye, prevent recurrences, restore visual function in the event of invasion of the pupillary area.

Spontaneously, after a simple excision, recurrence occurs in a significant proportion of cases, varying according to the development of the lesion and the primary or secondary nature of the intervention. 

It is important to carefully determine the time of the surgical indication because the more operations are performed, the greater the risk of recurrence.

This poses therapeutic problems, due to the exhaustion of the conjunctival capital available for autografting.
It is therefore essential to implement the best possible preventive strategy from the first pterygium operation.

To avoid frequent recurrences, some methods are based on the destruction of conjunctival fibroblastic cells, application of mitomycin C or other antimetabolite agent (thiothepa), radiotherapy by beta irradiation with Strontium 90.

The majority of methods currently used include reconstruction of the excision area:

>par une autogreffe de conjonctive, excellente méthode et simple,

>par une autogreffe cornéenne,

>par un allogreffe cornéenne lamellaire.

Ptosis refers to a drooping of the upper eyelid. It can be unilateral or bilateral, depending on whether it affects one eye or both, and is caused by a deficiency of the "levator" muscle of the upper eyelid.

Several factors can be the cause of ptosis: 

In the case of aging, the eyelid muscle thins and may sag with age. 

A neuromuscular disorder, ptosis can then be the first sign of a muscle disease; trauma, such as a blow to the eyebrow arch; or a congenital predisposition.

The main treatment is based on a simple surgical procedure. It involves "re-attaching" the upper eyelid to the muscle. Health insurance will not cover this procedure if the purpose is solely aesthetic.

Treatment: Blepharoplasty

Very fine and delicate, blepharoplasty (correction of the lower and/or upper eyelids) provides great satisfaction by rejuvenating the eye contour. 

Most often performed under local anesthesia with or without sedation, but sometimes upon request, under general anesthesia. The procedure lasts about one hour, and you can leave after one to two hours of rest or stay overnight.

The excess skin and fat pockets are removed through an incision in the natural fold, at the crease of the upper eyelid. The fat pockets of the lower eyelid can be removed through an incision beneath the lash line if there is excess skin. Otherwise, this can also be done without a scar via conjunctival approach. A bandage is optional for a few hours to avoid hematomas and bruising.

You may have traces of the procedure for 8 to 10 days, but activity is still possible with sunglasses with tinted lenses.
It is a delicate and meticulous procedure, but it is light and has nothing to do with the ocular globe or vision.

Complications are exceptional.

An ectropion (outward turning of the lower eyelid) may occur if the technique is not properly performed.
The eye contour will be rejuvenated, but a few years later, there may be the possibility of another procedure.