Chemosis or Ectropion After Blepharoplasty?

Dear Scared
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 appear to have minor ectropion from the photo. It is not clear if you also have chemosis. The eyelid specialist (oculoplastic surgeon) is probably correct in his/her diagnosis. A short course of steroids will not cause any problems, so you probably should use them as well as taping your lower eyelid upward. This is an easy problem to correct should it not resolve. 

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. 

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.

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.

Scared,
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!

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.

i agree with the above answers.  You appear to have ectropion.  I would tape and keep the lower lid supported.  Using Tobradex does help as well.

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.
sek

I'm sorry that you have some confusion about your diagnosis. To make it very simple:1. You have lower lid malposition following cosmetic eye surgery. This is not an uncommon situation. Most cases could be treated conservatively without further surgery. Some cases will require revision eye surgery,canthal support or more.2. As long your eye protective mechanism is intact, i would rather proceed with conservative management. Eye protective mechanism including bell's phenomen (eyes rolling back when you close you lids) and the ability to cover the cornea.3. Now, please do not confuse ectrpion with chemosis. Chemosis is swelling of the inner linning of the eye lids(conjunctivia). Ectropion is a lower lid malposition.4. You are still in the early stages of healing. As long as you do not have eye exposure, I would recommend massage and eye drops. Maxtrol or tobradex. A balanced antibiotic, light steroid should be fine when used conservatively. If you have any corneal ulcer it is a no no to use it. The effect on glaucoma is better left for your eye doctor to define based on his exam, history, etc.I hope that helps!