Reconstructive Surgery

When is Reconstructive Surgery Needed?

Tearing Disorders

Tears are made by glands located under the eyelids and are eliminated by evaporation and drainage. As you blink, the eyelid spreads the tears over the surface of the eye and pumps the fluid into a duct, which drains into your nose. Irritation of the eye (from misdirected eyelashes) or eyelids (due to blepharitis) can cause excess tear production. Poor eyelid position can lead to inadequate pumping of tears into the duct. Blockage of the duct will cause the tears to back up and spill over the eyelid. As a multitude of problems can cause wet, tearing eyes, a thorough evaluation is needed to determine the causative factors. Medical and surgical treatments are available to alleviate these symptoms.

Blepharospasm And Hemifacial Spasm

Blepharospasm and Hemifacial Spasm are both conditions causing uncontrolled spasm of the eyelid, brow, and cheek. Blepharospasm is a rare neurologic disorder affecting both eyes. Patients have frequently forced blinking and eye irritation which can be worsened with stimuli such as bright lights, fatigue, stress, wind, and air pollution. The average age of onset is 56 years. Blepharospasm is more common in women. The cause of blepharospasm is unknown.

Hemifacial spasm is characterized by contractions on one side of the face. Hemifacial spasm may follow an episode of Bells Palsy. It may be caused by pressure on or irritation of the facial nerve.

Treatment for both conditions is most commonly botulinum toxin injection. The medication is injected in small quantities to the muscles causing the abnormal contractions. The toxin weakens the muscles for approximately three months at which time the injections are repeated.

Eyelid Surgery Revisions

For most patients, eyelid surgeries are very successful procedures. However, complications following cosmetic eyelid surgery, as well as functional/reconstructive surgery, can occur. The eyelids can have a rounded appearance, the eyelids may be asymmetric, the eyes may be uncomfortable.

The eyelids are designed to protect the eye. If the eyelids do not close completely, are not in good contact with the surface of the eye, or if the lower lid is pulled down inferiorly, the health of the eye can become compromised. Patients can experience red eyes, irritation, dry eyes, discharge, and tearing.

Oculoplastic Surgeons are specifically trained to manage the intricacies of eyelid surgery complications. If you have experienced a complication from eyelid surgery, Dr. Onofrey is available for consultation.

Types of Reconstructive Surgery


Ptosis is the medical term for droopy eyelids. The edge of the eyelid falls and covers the pupil causing a falsely tired appearance. The vision may be blocked. Ptosis occurs in adults as the tendon that lifts the eyelid stretches or separates from its normal attachment. Children can be born with ptosis due to poor development of the eyelid’s elevating muscle. It can also occur after cataract or retinal surgery. Adult and congenital ptosis are treated surgically.


The eyelids are designed to protect the eye. If the eyelids are not in proper position, patients can experience redness, tearing, discomfort and blurry vision. Ectropion is a condition commonly seen where the lower eyelid is loose. The eyelid can dip down exposing the bottom of the cornea. In some patients, the lower lid flips forward exposing the pinkish/red tissue inside the eyelid. Ectropion is treated with a variety of surgical techniques.


Entropion is another common eyelid malposition. With this condition, the eyelid margin rolls inward causing the lashes to rub against the eye. The lid margin appears thickened. Patients complain of tearing, mucous discharge, foreign body sensation and redness of the eye. Entropion is corrected with an outpatient surgical procedure.

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