1. Eyelid, Tear Duct, and Orbital Surgery

2. Surgeries Upper and lower eyelid Brow surgery Tear duct
Blepharoplasty – Entropion Repair
Ptosis Repair – Ectropion Repair
Brow surgery
Brow ptosis repair
Tear duct
DCR (re-routing of the tear duct)
Lacrimal intubation
Orbital surgery
Fracture repairs
Tumor removal
Decompression resulting from Thyroid Disease

3. Injections/Fillers
Botox
Juvederm
Radiesse
Cosmetic Eyelid Surgery

4. Outpatient Surgery Centers
St. Francis Surgery Center
Methodist Germantown Surgery Center
Tri-State Surgery Center
LeBonheur East Surgery Center
Saint Francis Hospital
Methodist Germantown Hospital
Baptist East Hospital
Regional Hospital of Jackson

5. Eyelid Surgery

6. Upper Eyelid Blepharoplasty and Ptosis Repair Procedure
Skin to be removed is marked.
Incision is made along the skin markings on the upper eyelid.
Skin, muscle, and fatty tissue are removed.
For a ptosis repair, the muscle that raises the lid is also tightened.

7. Blepharoplasty/Ptosis Repair
Before
After

8. Ptosis Repair
Before
After

9. Entropion and Ectropion Repairs
Entropion Repair
Is a surgical procedure to fix an eyelid that is turning back towards the eye
Ectropion Repair
Is a surgical procedure to fix an eyelid that is turning outward.

10. Entropion and Ectropion Repairs
For an ectropion repair, the lower tendon at the outer corner of the eye is exposed and tightened using an internal suture.
For an entropion repair, additional sutures are placed in the lower eyelid to help rotate the lid out, away from the eye.

11. Entropion Repair
Before
After
After

12. Ectropion Repair
Before
After

13. Lower Eyelid Blepharoplasty
As we age, the fatty tissue under our eyelids tends to protrude, and the lids sag.
In order to repair this, an incision is made either inside the lid to remove the fatty tissue (transconjunctival blepharoplasty) or
The incision can also be made below the lashes and extended to the outer corner. This is called a transcutaneous blepharoplasty. With this approach, some excess skin can also be removed.

14. Surgical Fixes for Excessive Tearing
There are many scenarios which can cause a person to experience excessive tearing
Eye irritation
Dry eyes (ironically)
Lower eyelid laxity
Blocked tear ducts
The first two can be treated with drops
The last two may require surgery

15. The Tear Duct
The tear duct is like the drain in a sink, if it gets clogged, tears will run over the lid and down the face (epiphora).

16. The Tear Duct
There a few reasons a tear duct can fail to drain properly
The duct can narrow or close due to
Age (women, generally, have narrower tear ducts)
Chronic eye infections
Sinus/Allergy problems
Chronic use of eye drops and some chemotherapy
Previous trauma or placement of punctal plugs
The duct may have a “stone” blocking the passage. 17

17. Tear Duct Surgery
Minor tear duct surgery can be done in the office with local anesthesia.
These procedures usually involve removing a foreign body or enlarging the opening.
This may also involve irrigation of the lacrimal system.

18. Tear Duct Surgery
Major tear duct surgery which typically involves re-routing the tear duct is done in the operating room under general anesthesia.
This procedure is called a DCR.
To begin, a small, half inch, incision is made between the eye and the nose.
A new, internal opening is made between the tear sac and the inside of the nose, re-routing the path through which tears drain.

19. Tear Duct Surgery
Lastly, a small, flexible, silicone tube is placed, and acts as a stint to keep the new duct open.
This tube is generally kept in place for about 6 weeks and is removed easily through the nose, in the office. 19

20. Post Op - Eyelids For upper or lower lid surgery
Bruising generally lasts for 1 to 2 weeks
2 weeks if upper and lower eyelids are done simultaneously
Swelling can take a full month to go down, but a majority of it will decrease in the first week
For the first hours, you should keep ice on the lids and sleep with your head elevated.

21. Post Op - Eyelids
You will apply antibiotic ointment to the incisions twice a day, until your post-op appointment one week after surgery.
This type of surgery is typically not painful and pain medication is not usually needed after 1-2 days. 21

22. Post Op – Tear Duct Tear duct surgery
Is similar to the eyelid surgery course
Bruising and swelling is usually limited to one side
There is some additional risk of bleeding from the nose since part of the procedure requires work in the nose.

23. Blood Thinners
You would need to be off of any blood thinners 5 to 7 days before surgery, unless otherwise discussed.
You may need to get a letter from the physician who monitors this stating that it is fine to be off the blood thinner.

24. Blood Thinners Some examples of blood thinners include
Over the Counter Prescription
Aspirin Plavix
Vitamin E Coumadin (or Warfarin)
Ginko Pradaxa
Ginseng Aggrenox
Garlic supplement Ticlid
Fish Oil Efient 24

25. Risks
Although eyelid and tear duct surgery is typically safe and uneventful, it is still surgery. Usual risks include:
Bleeding, which could affect your eyesight
Scarring
Infection
Asymmetry
Need for additional surgery
Anesthesia – Anesthesia staff will discuss with you before surgery

26. Scheduling
If you did not schedule your procedure on your initial visit, we will get in touch with you over the next few days to set this up.
We are generally booked out about two weeks in advance.

27. Scheduling
If you have a commercial insurance (CIGNA, BCBS, Aetna, United, etc), certain types of eyelid surgery may require pre-authorization. This can take up to 4-6 weeks.
Medicare does not require pre-authorization. 28

28. James S. Linder, MD, PC
Thank you for giving us the opportunity to take care of you.
If you have any questions during this process, please call the office at (901) , and speak to one of our staff members.