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Also known as eye-bag surgery or an eyelift, blepharoplasty is the
removal or repositioning of eyelid skin, muscle, or fat. The procedure can be carried out in the upper or lower eyelid. People have this operation because of eyelid hooding or eye-bags. In the upper lid people are often trying to lift skin away so that they can see their eyelid again. In the lower lid people are often trying to reduce the tear trough and achieve a fresher less tired look.

What happens during blepharoplasty?

A blepharoplasty can be done under a local anaesthetic injected into the eyelids or under general anaesthetic. The operation take up to an hour and a half.

Your surgeon will make a cut in the natural skin crease of your upper eyelid or below your eyelashes in your lower lid. They will remove any excess skin and fat and close the wound using very fine stitches.


What happens during ptosis correction?

Ptosis correction performed on adults is usually performed under local anaesthetic. The procedure usually takes 45 – 90 minutes depending on whether one or both eyelids are being corrected.

Local anaesthetic drops will be placed in your eye. Local anaesthetic will also be applied to your eyelid. Your surgeon will usually make a cut in the natural crease of skin on your eyelid. They will identify the muscle that lifts the lid and shorten it. The wound will be closed using dissolvable stitches.  
In children with congenital problems the operation is done under general anaesthetic.


Eyelid ectropion is a rolling out of the eyelid.

It is usually caused by laxity of the lid. Most commonly this is due to aging but may also be caused by contracted skin of the lower lid. You may be aware of increased redness of the eyelid and it may be irritable. Your eye may be watery. The operation should put the eyelid back into the correct position. This should improve the redness, irritation and also the watering. There will also be a cosmetic improvement by making the eyelids more symmetrical.

What is ectropion surgery?

Ectropion surgery is an operation to correct rolling out of the eyelid. A small incision is made at the outer angle of the eyelids within a natural skin crease. The eyelid is tightened by shortening it (removing a small piece of it) and then reattaching it to the bone at the side of the eye. Further sutures are placed on the inside of the eyelid to roll it inwards. The operation should take 30 – 45 minutes to complete and is usually carried out as a day case. Most operations are carried out under local anaesthetic without sedation. After anaesthetic drops have been put in both eyes, an injection of local anaesthetic is given just beneath the skin of the upper eyelid. This is similar to dental anaesthesia and usually takes less than 30 seconds to give. Local anaesthetic with sedation involves an anaesthetist administering intravenous sedation via a drip so that you are very relaxed and may not remember having the operation. General anaesthetic means that you are completely asleep.

Lacrimal (Watery Eye)

What is a blocked tear duct?

Tears are produced by the lacrimal gland, which is located in the upper outer part of the orbit, next to the eyeball. Tears flow over the surface of the eye towards the nose through a tiny tube called the canaliculus. After tears have collected in the tear sac they flow down the tear duct into the nose. The flow of tears can be blocked at any point in this drainage system. The commonest site of blockage is the tear duct, the last part of the drain. When the tear drainage system is blocked, tears build up on the surface of the eye and overflow onto the cheek. In some people the tear sac may also fill up with mucous (mucocele) or become infected (acute dacryocystitis).

Tear duct bypass surgery aims to reduce the symptoms of watery eyes. If successful, tears should not run down the cheek, vision may improve a little and the lower eyelid may become less dry and scaly. Recurrent discharge and conjunctivitis may also improve.

What is Dacryocystorhinostomy – DCR?

Dacryocystorhinostomy (or ‘DCR’ for short) is an operation to bypass the tear duct.

External DCR

Via a small incision on the side of the nose, a small amount of bone is removed in the lateral wall of the nose next to the eye. A new passageway is created for tears to flow directly into the nose from the tear sac, bypassing the nasolacrimal duct. At the end of the operation very fine tubes are placed within the new passageway to prevent scar tissue from closing it. These remain in place for 1-2 months in most cases. They are removed painlessly in clinic.

Endonasal DCR

The operation is carried out without a skin incision. Using a tiny endoscopic camera, carefully placed inside the nostril, the operation is performed using instruments inside the nose. This includes the same hand held instruments as in external DCR, but also a drill to remove bone. The rest of the procedure is very similar to external DCR. This is a relatively straightforward procedure. It carries with it the rare risks of a septal perforation or altered contour of the nose. This operation is usually carried out under general anaesthesia.

Lester Jones Tube endonasal DCR

If the canaliculus is blocked the above operations will not work. In this situation the natural tear drainage system needs to be completely bypassed. This is done using a Lester Jones Tube. This operation is not an alternative to external / endonasal DCR, it is the only procedure that will work in these cases. This operation is carried out under general anaesthesia.

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