The eyelids are one of the most delicate structures in our face. These organs are extremely complex in their anatomy and function. Their main purpose is to protect the eye from trauma and lubricate the surface of the cornea with each blink. To accomplish these tasks, the delicate skin of the eyelid must be intact, and its structural integrity must be preserved. Any condition or surgical trauma that affects this integrity will cause impairment of eyelid function and will result in damage to the eye. Eyelid scarring is a common cause of impairment of eyelid function. We will briefly address the causes and treatment of this condition.
Main causes of eyelid scarring
Eyelid scarring may affect the skin or inner surface of the eyelids. Eyelid scarring secondary to skin shortage is arguably the most common cause of this condition. Frequently seen after esthetic or reconstructive lower eyelid surgery, eyelid scarring occurs when too much skin is removed during an operation. This is more commonly seen after lower eyelid blepharoplasty, a surgery that is performed to address bags under the eyes and reduce eyelid wrinkles. If skin removal is too aggressive or the tissues are lax, the normal healing process will cause the eyelids to retract downwards. The scarring down, or retraction, of the eyelids will expose the surface of the eye and this, in turn, will produce severe dry eye symptoms.
Eyelid scarring may also appear after a surgery to remove skin cancer around the eye. If too much tissue needs to be removed, the scarring process of the site may cause the eyelid to retract. This situation will result in exposure of the eyeball to air and will also cause severe dry eye. The best way to prevent this is to reconstruct the eyelid with extreme care to preserve its functionality.
Eyelid scarring is more common in patients who tend to heal poorly, such as those who form keloid scars; it is also more common in those with thicker skin. Even if the result of an operation is satisfactory, the surgical incision site may be thicker and more inflamed than expected. This will sometimes cause eyelid retraction and loss of normal function.
Treatment of eyelid scarring
The appropriate treatment will depend on the cause of the scarring. Eyelid scarring after cosmetic lower eyelid surgery is a very difficult condition to treat. These cases will usually require a skin graft to replace skin that is lacking. Most of these patients will need more than one operation to recover normal eyelid function. A cheek lift may be used as an option to recruit skin from the mid-face to avoid a skin graft.
A small, raised incision scar after an aesthetic surgical procedure does not always require surgical revision to improve its appearance. A simple injection of steroid may be enough to soften the scar. If this does not work, surgical revision will be necessary to improve the appearance of the scar.
Treatment for eyelid scarring secondary to skin cancer removal and other reconstructive procedures may be considered only after a few months have passed since the first operation. The oculoplastic surgeon will usually wait 3 to 6 months to allow the tissues to heal. However, if the eye surface (cornea), is in danger, the surgeon will intervene earlier.
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