Surgical treatments

Blepharoplasty is surgery performed to reduce excess skin around the eyes, particularly on the upper lid.  This surgery may be performed when the excess skin on or around the lid causes visual impairment.  We do not perform lower lid cosmetic blepharoplasty.

The amount of skin to be removed is measured carefully for symmetry. The incision is then placed in the natural skin crease of the lid to minimise any visible scarring. If the eyelid muscles are required to be tightened, this will also be performed during this surgery.

The procedure may take approximately an hour and you should be able to go home the same day. There will be some swelling, bruising and discomfort after the surgery which can be controlled with cold compresses. Pain medication may be prescribed and the swelling will usually subside within the first few days and bruising may take some weeks to disappear. The results of the procedure will be apparent several weeks after the surgery and the results are long lasting.

Cataracts are a common condition particularly with those over age 65. A cataract is a ‘clouding’ of the lens of the eye, where the transparency of the lens is lost due to various causes but commonly due to ageing. Injury to the eye and some medications can accelerate or cause cataracts as well.

Cataract surgery is a very common surgery, has a good success rate and provides a wide range of benefits. Most importantly it restores a quality of vision which usually provides significant benefit to most people and their lifestyle choices. People also may find they no longer require the use of glasses although this will vary with the individual.

Keyhole cataract surgery is performed with the aid of an operating microscope through the clear part of the eye where the “old” lens is replaced with a new one. The procedure is performed under local or topical anaesthesia, the person will be awake, usually able to see lights and movement but not the actual surgery itself. The whole procedure typically takes 30 min to perform. A pad is applied to the eye after the surgery, this is removed on the following morning when the postoperative drops are commenced. You will be asked to wear an eye shield for 1 week at night and be required to use the eye drops provided for approximately 3 weeks.

Persistent watery eye (medical name: epiphora) is due to an impairment of tear drainage from the eyes through the natural canal drainage system (nasolacrimal duct) located in the lids and the bone on the side of the nose. A blocked nasolacrimal duct will result in tears overflowing onto the cheeks, give a sensation of pooling in the corners of the eyes, eyelids may be sticky and the site of the blockage may also become infected.

The most common site of blockage of the nasolacrimal duct is in the lower portion of the system as it passes through the bone of the nose. To correct the blockage, the canal needs to be opened. To achieve this, there are 2 methods – either through an incision directly through the skin on the side of the nose or through the inside of the nose. Procedures done through the nose are done with the aid of a surgical telescope called an endoscope and because there is no incision of the skin, will leave no visible scarring.

DCR is a procedure which restores the function of the tear drainage system by bypassing the obstruction to tear flow and opens the system directly inside the nose. The surgery can be performed either under local or general anaesthetic. Most people experience little pain and are usually able to return to work within 5-7 days.

Ectropion surgery is performed to correct an outward rolling eyelid into its natural position against the eye surface. There are various types of ectropion and surgery is tailored to the needs of the individual. Although some forms of ectropions require skin grafts, most are corrected by tightening the lid against the eye. The surgery is performed under local anaesthetic. Although most eye dressings after the surgery are applied overnight only, some patients may require padding for five days or longer. There will be some swelling and bruising but most people recover within one to two weeks and can return to work.

Entropion surgery is performed to correct an in-rolling lid into its natural position against the eye surface. The most common form of entropion is due to age related changes in the lid. The lid is brought to its natural position through a skin incision below the lash line. The procedure is performed under a local anaesthetic and there will be some swelling and bruising after the procedure for up to 2 weeks. The eye is padded overnight and most people recover within two weeks and can return to work.

A pterygium is excess tissue which grows from the membrane on the white part of the eye (the conjunctiva) and can gradually move onto coloured part of the eye (the cornea). Pterygiums can affect anyone, in one or both eyes and is caused by constant exposure to bright sunlight, hot and dusty/sandy and windy environments.

Pterygium surgery involves the removal of the thickened tissue mass and repair of the membrane defect over the white of the eye with a graft taken from under the upper eyelid. The procedure is performed under local anaesthesia. After the surgery the eye will be covered overnight and for the next several days the eye will be red and uncomfortable. You will be prescribed eye drops and pain medication. The discomfort and redness, a feeling of dryness and grittiness may persist for a while. Infection is not common and the wound should heal in around 4 weeks time. Pterygiums can be a recurrent condition where the regrowth often grows more rapidly than the initial growth. To reduce the recurrence of regrowth, you will be asked to continue using the post-operative eye drops for 2 months.

Ptosis is the medical name for drooping upper lids present in one or both eyes. Drooping lids can interfere with part of the visual field or it may be a cosmetic concern. People experiencing ptosis may have difficulty in keeping their eyelids open, experience eyestrain or eyebrow ache from constantly having to raise their lids to see properly. It can also cause fatigue especially when reading.

Ptosis surgery is performed to elevate the lid muscle into its natural position. The position of the lid is adjusted during the surgery and is performed under local anaesthetic with an incision placed in the natural skin crease of the eyelid to minimise visible scarring. Afterward an eye pad will be placed on the eye overnight. This will be removed the next morning and you will commence post operative medications. There will be some discomfort, bruising and swelling and the eyelid may feel tight for a few days. Most people feel comfortable to return to work after about 2 weeks although some swelling and/or bruising may still be present.

It is important to understand that similar to many other lid procedures the lid is likely to be in higher position after surgery than desirable (overcorrection) as the lid will settle down a few weeks after the surgery.

Reconstructive surgery is commonly required following injury or removal of eyelid tumours and may be a complex procedure depending on the area to be repaired. It should be performed as soon as possible after the injury or surgery. The primary aim of reconstructive surgery is to restore function and symmetry. It is always the aim to achieve the best results possible given the situation. It is important to understand that many lid procedures require overcorrection as the eyelid will eventually settle to its final position within weeks or sometimes months following the surgery.

The type of reconstructive surgery required is determined by the size and location of the defect. At times, staged procedures may be required where the second part of the surgery may be performed days or weeks later. The outcome of the surgery is very much dependant on the extent of the initial defect.

Removal of eyelid tumours are always performed with 'tumour margin control' either through rapid paraffin or frozen sections to maximise the chances of total removal of the tumour. When appropriate we recommend 'Mohs surgery’ method for tumour excision and we can assist with arranging this surgery where required.

Non-surgical treatments

A number of eye conditions can be treated non-surgically in our rooms with the use of lasers. These conditions include some forms of glaucoma, "cataract recurrence", diabetic retinopathy and retinal tears.

The laser treatment itself will take around 15 minutes depending on the type of treatment required, however you should allow minimum 1 hour for the whole process. Local anaesthetic drops will be used to numb the eye. There is usually minimal pain experienced during the treatment however there may be some discomfort in the eye afterwards. You will not be able to drive afterwards and it is recommended you bring a carer with you for the journey home.

Certain eyelid tumours (periocular tumours) can be treated with creams designed to treat the affected skin. This treatment can only be used for certain types of malignant and premalignant skin conditions. A biopsy will be performed in our rooms to ascertain the suitability for the treatment. If applicable, you will be provided with a prescription for the medicated cream and instructed on its application. Treatments usually last for 6 weeks with periodical progress checks in between.

Disclaimer: The information provided on these pages is for general information only and should not replace individual medical advice. Please speak with Dr Kuzniarz directly regarding your specific situation.