Monday, January 30, 2012

Pain and Visual Loss from Ingrowing Eyelashes

Long and dense eyelashes enhance the beauty of the eyes. However, if they grow in the wrong way ie. instead of growing out they grow in, severe discomfort can occur. If untreated, the chronic rubbing of the eyelashes against cornea may give rise to scarrings and visual loss. This woman had ocular inflammation as a result of adverse reaction to medication (Steven-Johnson's syndrome), the right eye was painful and had poor vision as a result of ingrowing eyelashes of the upper eyelids (Figure 1).

Figure 1. Right red eyes and corneal scarring from
ingrowing eyelashes of the upper eyelid.

There are several ways of treating this condition. The easiest way is to pull out the eyelashes (epilation). However, the eyelashes will eventually grow back and epilation need to be repeated at regular interval. The alternative is with electrolysis, however, the process is laborious in this patients as the whole upper eyelashes were involved. Furthermore, electrolysis is not 100% successful. To achieve a more permanent result, surgery is a better option for this patient. There are several surgical methods described for this condition. The technique chosen here is called tarsal rotation (Figure 2) and has the advantages of faster recovery and without external eyelid incision scars.

Figure 2. Steps showing the tarsal rotation technique.
Three sutures were used to evert the upper eyelashes.

Figure 3. Post-operative picture taken at one-week
shows improved right eye appearance.

Sunday, January 29, 2012

Droopy lower eyelid from facial paralysis

This old man developed a left facial palsy about one year ago. Despite investigations including brain scan, no cause was found. Bell's palsy is the name given to facial palsy of unknown cause. In the majority of cases, the palsy resolves with time but this patient unfortunately failed to do so. The facial palsy caused problem with his eyelid closure and the left eye was always uncomfortable because of exposure (Figure 1). In severe cases, such exposure can cause problem with vision. To alleviate the discomfort, the lower eyelid needs to be repair to avoid better eyelid closure. In this case, the best procedure was to shorten the lower eyelid using lateral tarsal strip procedure (See Figure 2).

Figure 1. Left facial palsy causing droopy eyelid
and ocular exposure.

Figure 2. Lateral tarsal strip. In this procedure,
the lower eyelid was shortened and tightened to
treat the droopy eyelid.

After the procedure, the appearance of the lower eyelid improved and the exposure and discomfort were reduced (Figure 2).

Figure 3. Immediately after the operation.

Sunday, January 22, 2012

A Phoney Surgeon on the Loose

With the approaching Chinese New Year, many women like to look their best on the festive season. Unfortunately, it is also the best time for unscrupulous people to make a quick buck by posing as doctors. Many of these phoney doctors collude with beauty centres to get unsuspecting customers for various operations under unsterilized conditions. Worse yet, many of these operations were badly performed and when the victims try to have the complications rectified these phoney doctors have disappeared into thin air.

This month I came across two such cases performed by a phoney doctor. The victims had thread lift performed in the same beauty centre by the same person who claimed to be a doctor. However, he refused to give away any name card or his surgery address. I thought this should have raised the alarm bell but the patients were persuaded by the beauty owner to part with over 4000 ringgits each for the procedures.

In a thread lift (see figure below), barbed threads are used to lift sagging eyebrows and deep nasolabial folds (the furrows between the nose and the corners of the mouth) or aging neck tissues. Although thread lifts have decreased in popularity becuase their effects are not lasting, in proper hands they can still be a useful tool.

Case 1
This woman had double eyelids and thread lift performed to lift her right eyebrows. The doubel eyelids were badly formed and there was an abscess in the right upper eyelid. She had pain each time she open her right eyes. The phoney surgeon could not be contacted. On examination, there was a hard mass. Surgical exploration showed the thread lifts had been badly placed resulting in constant irritation to the eyelid with each opening and shutting of the eyes and hence the abscess formation. The thread lifts were removed in total. 

Poorly formed double eyelid and a right
upper eyelid abscess.

Poorly formed double eyelid and a right
upper eyelid abscess.

The thread lifts removed from under the abscess.

Case 2
A woman underwent thread lifts to lift her sagging jaws. The sites where the thread lifts were passed were poorly sutured and the thread lifts were protruding (see arrows in the pictures below). There was pus oozing from the wound as well as bleeding. Again she tried in vain to contact the phoney surgeon. However, the owner of the beauty saloon, seeing the serious nature of her complications asked her to see a proper doctor immediately. The wounds were cleaned and mutiple pieces of thread lifts and sutures were removed. Recontruction was needed to close the wounds after draining off the pus.

Severe inflammation with abscess formation after
poorly performed thread lifts. The left pictures
show the extent of the wounds after
removing the thread lifts and sutures.

Some of the sutures and thread lifts
removed from the wounds.

Friday, January 20, 2012

A Woman with a Left Droopy Eyelid and Foreign Body Sensation

This woman underwent a suture technique for double eyelid surgery a year ago in a beauty centre.  For the past three months, she has been experiencing pain in the left eye with foreign body sensation. Unfortunately, the person who did her operation could not be contacted as she had since left the country.On examination, her left eyelid was slightly droopy and the eye was red. Everting the eyelid revealed a raw area with poorly placed suture which had eroded through the inside of the eyelid. The suture was removed with a pair of forcep and the symptom disappeared. Most of the suture technique performed by qualified surgeon rarely erode through the skin. However, most of the beauty centres  bring in unqualified personnels from oversea to perform the procedures. Worst still, these personnels could not be contacted when complication arises. 

Left droopy eyelid and foreign body sensation.

Raw area under the eyelid with protruding
stitch (arrowed).

Stitch removed.

Friday, January 13, 2012

Doc, why do I get these yellowish lumps on my eyelids?

Yellowish lumps on the eyelids of this man are caused by cholesterol deposits (xanthelasma). Blood test is important to find out if the patient has high blood cholesterol level. Although lowering the blood cholesterol will not make the deposits fade away, it is important to reduce the risk of heart diseases. There are several ways to remove the deposits including laser and direct chemical application. However, in Asian patients neither method is advisable as it can lead to skin depigmentation and make the resulting appearance worse. The best treatment is excision as shown here.