Reconstructive Surgery

The eyelids and surrounding areas are extremely delicate and complex structures that are vital to the preservation of sight and are important features of a normal facial appearance. Oculoplastic Surgeon, Dr. Kenneth Neufeld is uniquely qualified to perform this delicate surgery and to provide care to the eye itself. Dr. Neufeld offers reconstructive surgery procedures including:

• Ptosis Repair (drooping eyelids)
• Functional Upper Eyelid Blepharoplasty
• Ectropion/Entropion
• Tearing
• Thyroid Eye Disease
• Facial and Orbital Trauma
• Blepharospasm and Hemifacial Spasm
• Skin Cancer
• Orbital Tumors
• Loss of an Eye

Ptosis Repair – Correction of Drooping Eyelids

Drooping of the eyelids is usually due to a loosening of a muscle and tendon that normally holds the eyelid in position. This results in the eyelid margin (the area where the eyelashes grow) crossing the eyeball at a point that is too low. This often blocks part of the visual field and limits how much a person can see. This can be repaired by surgically reattaching the tendon to a more appropriate position, thereby elevating the eyelid to a more appropriate and natural position.

Pre Operative – Post Operative
Ptosis Repair

Functional Upper Eyelid Blepharoplasty

Excess upper eyelid skin can hang over the eyelid margin and obstruct peripheral vision. Upper eyelid blepharoplasty is removal of redundant upper eyelid skin to restore normal field of vision. If your upper eyelids inhibit your vision, you may be eligible for a functional upper eyelid blepharoplasty.

Ectropion/Entropion

Ectropion and entropion are rotation of the eyelid margin from its natural position. This can cause irritation, tearing, dryness, infection, and damage to the eye itself. Surgical correction is usually straightforward but can be more complex in certain instances.

Pre Operative – Post Operative
Entropion

Pre Operative – Post Operative
Ectropion

Tearing

The eye, being largely composed of liquid or moisture-bearing tissues, needs a constant supply of fluid or tears to retain health and function. There is a delicate balance between enough fluid, too little, or too much.

There are several reasons why excessive eye watering can occur. The most common is as a reflex to dryness of the cornea or surface of the eye. This type of tearing can be alleviated simply with artificial tears to stop the reflex from occurring or with punctal plugs to decrease the rate of drainage of the tears. There are newer medications that help the body produce more moisture to coat the eye and keep it comfortable and protected. This often can stop the reflex that produces too many tears in response to a dry eye.

Another common cause of eye-watering is an obstruction in the outflow of the tears from the eye. If tears cannot drain properly but more tears are being produced, the eye fills uncomfortably. Normally, tears flow from the eyelids into the back of the nose. When people cry, they often sniffle to keep the excess tears flowing into the nose from dripping out. An obstruction or blockage can occur anywhere along with this “plumbing system” and cause the tears to roll down the cheek. Sometimes, the existing drainage system needs to be corrected to keep the tear flow system open. Other times, the existing system needs to be bypassed entirely for the tears to have a way out of the eye.

This involves surgery to establish an open and unobstructed drainage pathway. Procedures to achieve this vary according to the specific problem area involved. The specific procedure is determined after an exam in the office where the tear drainage pathway is examined very closely. To learn more about eye-watering treatment or any of our other aesthetics and oculoplastic treatments, contact us to any of our Thomas Eye Group locations.

An obstruction or blockage can occur anywhere along with this “plumbing system” and cause the tears to roll down the cheek.

To learn more about eye-watering treatment or any of our other aesthetics and oculoplastic treatments, contact us to any of our Thomas Eye Group locations at (844)285-7363.

Thyroid Eye Disease

Thyroid Eye Disease is often a condition related to an auto-immune disorder that affects the thyroid gland in the neck. It generally occurs in conjunction with the thyroid disorder called Graves’ disease. The disease can affect nearly any of the tissues that surround the eye or the bony orbit that houses the eye. It causes these tissues to swell and thereby changes their ability to function properly and to change the position and appearance of the eyeball. Most patients who have Thyroid Eye Disease are hyperthyroid (too much thyroid hormone in the blood), but those who are hypothyroid (too little thyroid in the blood) or euthyroid (normal thyroid levels in the blood) can be affected as well, albeit less frequently.

Pre Operative – Post Operative
Thyroid

What Are the Symptoms of Thyroid Eye Disease?

• Bulging of the eyes
• Pain, especially with movement
• Dry, irritated eyes
• Double vision
• Blurred vision
• Light sensitivity
• Redness (bloodshot eyes)
• Swelling that affects the optic nerve which may lead to vision loss
• Color blindness

Thyroid Eye Disease usually runs its’ course over a period of one to three years before the eyes become stable. The appearance may be back to where it started or some of the appearance of the Thyroid Eye Disease may persist. There are many procedures that can be performed to counteract the changes that Thyroid Eye Disease causes, most are minor but occasionally more major surgery is needed. In some patients, the eyes return to normal, while others are left with permanent changes. Much can be done to improve these problems, but such improvements may require surgery.

How Is Thyroid Eye Disease Treated?

There are many different procedures that can deal with the manifestation of Thyroid Eye Disease. These can range from mild procedures, such as a TEPEZZA infusion, to major surgery. The specific cure will depend on the exact problem that is occurring. This will be discussed after a detailed consultation with Dr. Neufeld. Tepezza is a medication that is given by several IV infusions over a period of several months. This medication has the potential to improve thyroid eye disease findings without the need for surgery. If you have questions about Thyroid Eye Disease or our other aesthetic and oculoplastic offerings, feel free to contact us at (844)285-7363.

Facial and Orbital Trauma

The eye is housed in what is called the orbit. The orbit has a wall on either side, a roof, and a floor. The floor of the orbit, which lies under the eye, is the most common part of the orbit to become fractured or broken. This can occur when there is trauma to the eye area. Automobile accidents, falls, and fistfights are the most common causes of an orbital floor fracture.

When the orbital floor is fractured, the structures behind the eye and the eye itself can get caught in the fracture or the break in the bone. When this happens, patients can experience double vision, pain, or a sunken appearance of the eye.

A repair of the fracture must be performed in certain circumstances. The repair involves removing any orbital structure from the fracture area and repairing the break by means of a plate. The plate reforms the floor and provides support for the eye itself. This is usually done as an outpatient surgery which allows the patient to return home the same day. It usually takes approximately one hour to perform this surgery and there is minimal pain or discomfort following the surgery. Patients use eye drops for one week after surgery to prevent infection.

If you have any questions about orbital fractures or our other aesthetic and oculoplastic treatment options, call us at (844)285-7363.

Blepharospasm and Hemifacial Spasm

Benign Essential Blepharospasm and hemifacial spasm are neurological conditions that result in uncontrolled eyelid closure. Most patients have excellent results with Botox® treatment. For severe cases, a surgical myectomy (removal of the muscles that close the eyelids) is indicated.

Skin Cancer

Skin cancer can occur anywhere on the skin, but usually on sun-exposed areas. The face is a common area for sun exposure. Eyelid skin cancer occurs less frequently in the general population, however, since Dr. Neufeld is an eyelid specialist, he sees many patients who have eyelid cancer.

Too much exposure to sunlight is the single most common cause, and fair-skinned people develop skin cancers more frequently than dark-skinned people. Skin cancers could also be hereditary. Skin cancers usually appear as painless bumps or nodules, and occasionally eyelashes are distorted or missing. There may be ulcerations of the area, bleeding, crusting and distortion of the skin. Oftentimes, cancer can masquerade and appear very benign. This often leads to undue delays at diagnosis and treatment. As a result, it is prudent to have any suspicious areas evaluated to determine the presence of skin cancer.

How is Eyelid Cancer Treated?

Treatment of skin cancer on or near the eyelids involves the complete removal of cancer. Following the removal of cancer, the eyelid will need to be reconstructed. This is imperative not only for the area to look normal, but to function normally as well. The area surrounding the eyelids is an area with complicated structures that lie beneath the skin surface such as tear ducts, muscles, tendons, and support structures for the eyelids. The goal of surgical reconstruction is to preserve the function of the eyelid, to protect the eye and to obtain the best cosmetic appearance possible.

Pre Operative – Post Operative
MOHS

Sometimes cancer can extend under the skin surface, and its true borders can be much larger than they appear. It is very important to remove all the cancerous tissue to decrease the likelihood of a recurrence or spread of cancer. There is a surgical technique called Mohs surgery that is often used to eradicate skin cancers. Dr. Neufeld works very closely with the Mohs surgeon to ensure the cancer is completely removed and the area is reconstructed properly. Early detection of skin cancer is an important factor in its treatment. Be sure to discuss any eyelid lesions, no matter how “normal” they may seem with your doctor. If you would like to consult with Dr. Neufeld about eyelid cancer or any of our aesthetic oculoplastic treatments, please call us at any at (844)285-7363.

Orbital Tumors

An orbital tumor is a growth inside the bony socket that contains the eye, the muscles that move the eye, the optic nerve, and other important structures. Orbital tumors can be benign or malignant, and do not always require removal. An accurate diagnosis and customized treatment plan ensure the best outcome.

Orbital Tumors should be evaluated and treated by surgeons trained in the specific anatomy of the orbit. Extensive training in an Oculoplastic fellowship is required to become skilled at dealing with problems in this very unique anatomical area.

Loss of an Eye

Various chronic ocular diseases, trauma or prior surgery on the eye can result in an eye that is painful and no longer see. In certain instances, the removal of the eye is deemed the best option for these patients. Surgery to remove an eye is delicate and precise. Dr. Neufeld has been trained in various techniques of eye removal and can evaluate the individual patient and come up with the best option available. Surgery is done as an outpatient basis and patients are usually significantly more comfortable after the surgery than they were before.