Eyelid Surgeries – Lesions

Mohs Surgery Reconstruction

Mohs micrographic surgery is a procedure used to remove skin cancer with precision and success. While we remove and reconstruct many eyelid lesions, some are more amenable to being excised with an experienced MOHS surgeon. For these cases we will work with your MOHS surgeon and reconstruct the resultant eyelid defect after he or she has removed the lesion.

Despite its high level of efficiency, Mohs surgery often leaves behind large wounds or scars in prominent areas. These deformities can be emotionally upsetting as well as physically damaging to the eyelid and eye. Fortunately, plastic surgery can be performed to repair the wound and restore your skin to a more healthy and natural appearance.

While complete tumor resection is the main goal, your doctor also takes your appearance into consideration by leaving as much healthy tissue as possible. Reconstruction uses this remaining healthy tissue to carefully restore the area for both effective and aesthetic results. This may involve moving skin around within the surgical area, or taking skin from other areas (eyelids, behind ears) to graft in place.

Blepharospasm Treatment

Blepharospasm is a condition in which the eyelids spasm, closing involuntarily, forcing the patient to blink abnormally. Blepharospasm is a form of focal dystonia or abnormal contractions of the eye muscles. Patients with blepharospasm have normal vision, but the disturbance interferes with visual perception and may, in severe cases, result in functional blindness.

There is no current cure for blepharospasm but there are treatment possibilities. These include:

Oral Medications

Several medications have been found to be helpful in some cases of blepharospasm. Some of these medications may include: clonazepam, also known as Klonopin, lorazepam, also known as Ativan, haloperidol, also known as Haldol, diazepam, also known as Valium, and zolpidem, also known as Ambien. These are often prescribed and managed by a neurologist. Ritalin has also been used with success.


Injection the affected eye muscles with botulinum toxin (BOTOX®), incobotulinumtoxinA (XEOMIN®), or abobotulinumtoxinA (DYSPORT®) is currently the most successful treatment for blepharospasm. This may be repeated every 3 months as indicated.


If medications and injections prove ineffective in treating blepharospasm, surgery may be recommended. The surgical procedure for this condition is called a myectomy. It involves removing portions of the affected muscles to relieve symptoms. Other problems, such as an inability to open or close the eye, may be managed with ptosis surgery or canthoplasties. Injections of botulinum toxin may be required after the surgery.

Deep Brain Stimulation

While still experimental, this method of treatment has demonstrated important possibilities in the treatment of blepharospasm.

Alternative Treatments

Sometimes alternative treatments are used, either alone or combined with prescribed medications or injections, to combat the symptoms of blepharospasm. These treatments may include: acupuncture, chiropractic care, biofeedback and nutritional therapy.

Eyelid Crease Formation & Fixation

Eyelid creases may change with the aging process, inflammation, and injuries, since the skin around the lids is much thinner than other parts of the face. People of different backgrounds, races, and ethnicities also may have different types of creases from anatomic differences. Fixation and formation of eyelid creases is possible for both cosmetic and functional reasons.

Cosmetic blepharoplasty may be performed to remove fat and skin from, and to reshape, either the upper and/or lower eyelid. During this procedure the lid crease will be fixated and the incision created at the desired level. See blepharoplasty above.

Floppy Eyelid Syndrome Treatment

Floppy Eyelid Syndrome, or FES, is an uncommon ocular condition that occurs when the upper eyelids are loose and may be easily turned inside out. FES is often associated with sleep apnea and metabolic syndrome. While lubrication may be used to treat an affected eye, these treatments are usually not successful at treating the underlying problem, so surgery is usually required for the condition.

Surgery will usually involve removing a segment of the eyelid, tightening the eyelid and turning it correctly. Additionally, see your primary care physician if you suffer from FES for a sleep study to evaluate for sleep apnea and a full medical work-up of hypertension and associated cardiovascular risk factors.

Excision Of Lesions On Eyelids

Lesions on and around the eyelids are extremely common, and may be either malignant or benign in nature. If a lesion is suspected to be benign, patients usually prefer to eliminate the entire growth, a process known as an Excision, or Excisional Biopsy.

Topical anesthetics will be used in the excision process, and the lesion will be evaluated following the excision to determine if the lesion was in fact benign. If the lesion is malignant, the patient may need further surgery and reconstruction.

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