I had Blepharoplasty 3 weeks ago, and I wrote here you about droopy eyes. I went to see my surgeon and he diagnosed chemosis, but an oculoplastic from the University of Miami told me she could not see it. They both ordered massage and eye drops. My surgeon also prescribed Tobradex, but the oculoplastic surgeon said that steroids don't help and can cause glaucoma. I am confused. Could you diagnose what I have? Is it ectropion or chemosis? And above all, can it be fixed?
Chemosis or Ectropion After Blepharoplasty?
Doctor Answers (11)
Ectropion, still may be reversible
Ectropion occurs when the lower lid is pulled down, in this case by scar tissue from your surgery. You lower lid should contact the very bottom of your iris (the colored part) when you are looking straight ahead in the mirror. Unfortunately, your lid is a good bit lower. When the cornea is exposed, it gets irritated, which may manifest as chemosis, and a dry eye, with tearing and a feeling like there is something in your eye.
Start with aggressive massage. Place your finger on your lower lid and push it upward. If you can get it to cover or even touch part of your iris, that is a good sign. When you first start this, it may not budge, from the new scar tissue. But even a good 10 minute massage after a warm washcloth soak can lift your lower lid immediately. Focus on getting those lower eyelashes and lid up, up, up. Taping, usually taping your upper lid to your lower lid at night, can be helpful, as it pulls up on your lid all night long.
Scar tissue will continue to form thickly for the next three weeks, so be aggressive and massage at least six time per day for 10 minutes each time. You will make great strides in three weeks when the collagen naturally softens and begins to give way. I personally would not suture the lids now or do any surgery now until you give conservative therapy a chance. Meanwhile, keep using moisturizing eye drops to protect your eyes when your cornea is in this more than normal exposed state.
And my answer is....
I see ectropion, not chemosis. I would add to the mix, taping with steristrips. You should keep the lower lids supported while they heal so that the tissues don't shrink and shorten permanently,
During this time, you need to protect the eys and keep it moist. Genteal drops and ointment are great. Patching at night should be done also.
Everyone has good points
I won't repeat all the great points below, but will move to the next stage, if conservative therapy (taping, sutures, drops and ointments) don't work.
Think of the lower eyelid as a sandwich. The outer bread is the skin, the inner bread is the conjunctive (the pink inside the eyelid), and the filler is the muscle.
The biggest no-no is cutting or injuring the muscle.
The most common no-no is removing too much skin.
The best way to determine which is your problem would be to have an examination. But if it turns out to be the removal of too much skin, then a simple skin graft can make this all better. If it's a muscle problem, then lifting and tightening of the muscle is the only choice and is not as good in creating a natural long-lasting outcome. Pulling up on the muscle will sag over time. Skin grafts replace the over- resected muscle.
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Your photo shows that you have an early post operative ectropion. At this early stage, the condition can be and usually is easily corrected. Correction involves taping the lid up, massaging the lids, and sometimes even a temporary stitch to bring the lids into closer approximation. Whichever method is chosen, you should have frequent contact and follow up with your surgeon to monitor the progress of the correction. Good luck!
Bascom Palmer has great eye plastic surgeons
You can be completely confident with the oculoplastic surgeons at the University of Miami. They are extremely experienced in dealing with these issues. Unless your original surgeon was an ophthalmologist or a fellowship trained eye plastic surgeon, you were not examined using a slit lamp microscope which is a very specialized piece of equipment that general plastic and facial plastic surgeons are not trained to used and don't possess in their offices. This instrument is very helpful to identify even trace amounts of chemosis, which is swelling of the conjunctiva, the white of the eye. In fairness to your original surgeon, you may have initially had chemosis but as the swelling resolves, the chemosis can also settle.
Regarding tobradex, the steroid in this medication can raise the eye pressure. The antibiotic is also irritating. There are specific indication for this medication but treating chemosis is not one of them. On balance, a bland ophthalmic ointment without the steroid or the antibiotic would serve the same purpose. This may be helpful at bed time to keep the eyes from drying out. An artificial tear drop every few hours during the day will also keep the eye more comfortable. So the doctor you saw at the University of Miami is correct in their assessment and management. This should not be surprising as a full time university base eye plastic surgeon will have much more experience in eyelid surgery than your community based plastic surgeon.
And yes this can be fixed. Take a look at my website: lidlift.com for examples of these repairs.
You have ectropion after Blepharoplasty
Chemosis is swelling and puffy fluid filled tissue on the white part of the eyes (sclera).
Chemosis is a sign of irritation that is caused by drying of the eye that is due to the ectropion. Inadequate coverage of the eye by the drooping of the lower eyelid causes dryness and irritation of the eye which causes the chemosis.
At three weeks, you need support of the lower eyelid. If taping with steri strips does not adequately support the lower eyelid, then I would place a stitch in the corner of the eyelids to pull the lower lid up to protect the eye. This is called a temporary tarsorraphy.
You need intervention now. If your doctor does not want to address this, then you need to see an eyelid specialist--either an experienced plastic surgeon or an occuloplastic surgeon.
You need intervention soon--in the next few days.
Meanwhile keep your eyes moist with a lubricant like lacrilube 3-4 times a day (you can buy over the counter at a drugstore) and tape an eye patch over each eye at night when you sleep to help keep the lids closed.
You will need to have a canthoplasty
From the picture you have ectropin and pulling of your lower eyelid. When you can see the white part of thr eye between the eye lid and cornia , you have ectropin. Message will help and you need to protect your eyes at night from getting too dry. Eye patch and moisturizing drops will help. You will need to have canthoplasty. Make sure your surgeon has done this befor.
Your pictures demonstrates an early ectropian. This has resulted in downward pull on your lower eyelid and exposure of the white portion of your eye.
In the early post-operative period, ectropians can be managed conservatively with massage and eyelid taping to support the lower eyelids. In most cases the lower eyelids will snap back and patients will have total resolution of their problem. When lower lid drooping persists after a suitable period of time has elapsed, surgical correction may be necessary.
This problem requires close monitoring by your surgeon. In some cases consultation with an expert in eyelid reconstruction may be necessary.
Unfortunately it looks like ectropion
Without personally examining you it is impossible to be sure, but based on your pictures it looks like you do have a developing ectropion. In this early period aggressive massage, blinking excercises, and management of any additional chemosis will help prevent any further progression. You may have to unfortunately have your procedure revised if this continues or does not resolve. I wish you the best of luck.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.