Procedures

Droopy Eyelids (Ptosis)

Ptosis is the drooping of one or both upper eyelids, which may result in vision obstruction and may cause the patient to appear sleepy or tired. This condition can affect children and adults. After assessing the severity of ptosis, we will tailor a treatment plan to meet your specific needs.

The top most photo is a patient who was post-op week one from ptosis repair, with minimal swelling.

This patient also underwent ptosis repair. The top photo was taken pre-operatively while the bottom photo was taken two weeks after surgery.

When your eyelids are down, Dr. Ford's in town!

This patient underwent combined droopy eyelid repair and upper eyelid blepharoplasty to address her excess skin. The bottom photo was taken two weeks postoperatively.

This patient underwent combined droopy eyelid repair and upper eyelid blepharoplasty to address his excess skin. The bottom photo was taken two weeks postoperatively.

This patient required frontalis slings to address his droopy eyelids and an eyelid blepharoplasty to address his excess eyelid skin. The bottom photo was taken two weeks postoperatively.

This patient had excess eyelid skin and xanthalesma (yellow cholesterol deposits underneath the eyelids). She underwent a combined procedure (xanthalesma removal and upper eyelid blepharoplasty); the bottom photo was taken two weeks postoperatively.

Eyelid Malposition (Ectropion/Entropion)

Entropion of the eyelid is a common condition in the eyelid turns inward, resulting in rubbing of the eyelashes onto the eye surface, which causes significant irritation, pain, redness, and watering of the eye. There are many reasons for why this could happen – most commonly from age-related loosening and weakening of the periocular tissues. This can be easily corrected by eyelid surgery to tighten and rotate the eyelid to its normal position.

Ectropion of the eyelid is a common eyelid malposition in which the eyelid is turned outwards, leading to watering, redness, and an unsightly appearance for the patient. The most common cause is senile ectropion, or age-related loosening of the periocular tissues. It can also be caused by scarring of the eyelids from previous trauma or surgery, also known as cicatricial ectropion, or in cases of facial nerve paralysis (paralytic ectropion). Depending on the cause, eyelid surgery is tailored to correct the underlying eyelid deformity.

Tearing/dacryocystorhinostomy

Our eyes have a small pipe that drains the tears from the eye into the back of the nose. Sometimes this drainage system can become blocked, resulting in teary eyes (epiphora) and sticky discharge. When the tear duct drainage system is blocked, the tears and secretions accumulate in the lacrimal sac next to the eye. The risk of this is a severe eye infection if the condition is left untreated, manifesting as swelling, pain, and watering due to infection of the tear sac (dacryocystitis).

A dacryocystorhinostomy (DCR) is a surgery performed to unblock the tear ducts by creating a new passage for the tears to flow freely into the nose. This surgery has about a 95% success rate.

Orbital Tumors

These types of tumors arise from the various tissues behind and around the eye, including muscles, blood vessels, fat, lymphoid tissue, lacrimal gland tissue, and the optic nerve. They can be either benign or malignant, and they can also be metastatic from other parts of the body.

Some symptoms you may have if you develop an orbital tumor include bulging of the eye (proptosis), double vision (diplopia), pain, and loss of vision. Through clinical evaluation along with orbital imaging studies such as CT or MRI, we can determine a probable diagnosis. A surgical biopsy (orbitotomy) gives the definitive diagnosis regarding the type and severity of the cancer.

Whenever possible, we try to completely remove the tumor if doing so does not damage other structures around the eye. Sometimes, if the tumor involves adjacent structures around the eye (i.e the sinuses, the brain, etc), we may need to form a multidisciplinary team involving ENT surgeons, Neurosurgeons, Radiation Oncologists, and Oncologists, in order to provide holistic care.

Eyelid Cancer

Thousands of new cases of skin and eyelid cancer are diagnosed each year. Some common early signs of skin cancer include scale-like or flaking skin, loss of eyelashes (madarosis), bleeding/infection of the eyelid, red splotches, dark spots, and/or bumps or raised skin.

Cancer of the eyelids is very dangerous and needs to be addressed urgently. We see and treat the following types of eyelid skin cancer, but this list does not include some of the exceptionally rare pathologies:

1. Basal cell carcinoma: This is the most common type of skin cancer and can present in many ways, but most commonly as a pearly nodule or raised area along the eyelids.
2. Squamous cell carcinoma: This is the second most common type of skin cancer, often presenting as a scaly lesion that may or may not bleed.
3. Sebaceous cell carcinoma: This is a much rarer type of eyelid skin cancer that be be very aggressive and metastasize early in the course of the disease.
4. Melanoma: This is a very deadly form of skin and eyelid cancer that can present as a growing, changing, irregularly colored splotch on the skin or the eye.

As is often the case, we first take a biopsy of the suspected eyelid lesion and send it to be examined under the microscope by a trained pathologist. If the biopsy confirms cancer, further treatment to the eyelid is necessary, the extent of which depends on the level of involvement of the lesion – some treatments may involve just a tad bit more removal of eyelid skin, while others may necessitate removal of the entire eyelid.

Thyroid Eye Disease

Thyroid eye disease (also known as Graves’ disease) is a condition in which the body’s immune system attacks the extraocular muscles of the eye and the surrounding orbital tissues. This can lead to a swollen and “bulging” appearance of the eyes, and if left unattended, can eventually cause blindness.

Treatment for this condition may be medical and/or surgical.

Teprotumumab (Tepezza®) was used to treat this patient's proptosis. The top photo depicts her appearance prior to Tepezza® administration and the bottom photo was taken just after her third infusion of the medication.

Tepezza is a life-changing medication.

When this patient presented to Dr. Ford, she was rapidly losing vision from her Graves' (thyroid eye) disease. She had significant exophthalmos (bulging eyes), resulting in markedly increased intraocular pressures, and evidence of compressive optic neuropathy as seen on her visual field exam (see below). She also had double vision and eye pain.

Dr. Ford admitted the patient to the hospital for high-dose intravenous steroids and prescribed Tepezza. Just one treatment of Tepezza has resulted in remarkable improvement.

Botox for Facial Cosmesis

Botox is a minimally invasive treatment used to reduce the appearance of fine lines and wrinkles, to give you a refreshed, youthful look. It works by relaxing the muscles that form wrinkles between the brows, the forehead, and around the eyes and face. By relaxing these muscles, the appearance of skin creases may be delayed. The effects of treatment may be noticed within 3-7 days and may last for 3-6 months. Of course, each patient is unique and may require more or less Botox to obtain a more refreshed look, but our goal also is to make you appear as natural and as real as we can.

You can receive Botox as often or as little as you want. If you would like to receive Botox injections every 3-6 months, that's totally fine, or if you want it just in time for a special occasion, that's fine too!

Dr. Joshua Ford

Procedures We Perform

Droopy Eyelids (Ptosis)

Upper and Lower Eyelid Blepharoplasty