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Dr. James
Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2451
Experience:  Eye Physician and Surgeon
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If you had a small 1mm notch on your eyelid margin from a

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If you had a small 1mm notch on your eyelid margin from a previous surgery. What is a potential surgery to fix it ?

Greetings.
I will be happy to answer.
Do you think you can share the picture of that area without showing your identity.
What previous surgery was performed?

Customer: replied 1 year ago.
Sure , I have had various procedure lately . More recently a cornea transplant, however the notch on the picture was from a incision made to turn the eyelid during a upper lid Tarsotomy in 2007 To fill the notch in, what suggestions would you recommend to explore ?

hi, my name is ***** ***** an ophthalmologist.

thank you for your question and photo.

this can be fixed easily and successfully with minor surgery (either in the operating room or office). that they surgery would do is cut out notch and then reapproximate the two edges of the eyelid edges with sutures. if done meticulously, it will heal with very little scar. you should consult an ophthalmologist or oculoplastic eye surgeon.

Customer: replied 1 year ago.
How do you cut out the notch. Do you have to go so high padt the notch . Or just cut around the notch in like a u shape a stitch back together ?

hi, you cut up about 10mm in the shape of a pentagonal wedge and stitch it together (with internal absorbing sutures and skin sutures that are removed about 1 week later).

if you really want to see the details, I can direct you to videos on youtube. they can be graphic however.

Customer: replied 1 year ago.
Please direct
Customer: replied 1 year ago.
Would you have much swelling ?

hi, yes you would have a mild amount of swelling that would go away after 1-2 weeks.

Customer: replied 1 year ago.
Would you have to also make a horizontal incision right across top lid ?

no, you make two vetical incisions first, then two angled incisions like a triangle to form a pentagon.

Customer: replied 1 year ago.
you shouldn't have a horizontal incision like this ?

hi, for a wedge resection procedure to fix an eyelid notch, you should not need to make horizontal eyelid incision like that. that type incision is often done as well, but for other types of eyelid surgeries.

Customer: replied 1 year ago.
Can you see the eyelashes in the corner of my eye on the photoe ?
Customer: replied 1 year ago.
the snapped tarsal plate ?

are you referring to the first photo you posted? if so, it is hard to tell since the photo is zoomed in. a wider angle photo would be better.

Customer: replied 1 year ago.
The very first photograph.there is no eyelashes in the notch or after it . Then on the last 3 photo graft. Which you can only see clear on first two. There is eyelashes in the corner of eye. Where there was non. Can you see this ?

I see the notch in the first photo, a wider photo of the upper and lower eyelid would be helpful.

the last 3 photographs appear to be after surgery. they are a little blurry and has swelling, so hard to compared these last 3 with the first.

are you asking if the original procedure was done correctly? or are you asking what new procedures can be done to correct the notch you have now?

Customer: replied 1 year ago.
I am asking if original procedure was done correctly. I believe they have actually cut all my eyelid off from the tear duct to the notch .
Meaning the full height of eyelid.Then they have gone in where incision is. Set remainder eyelid back by altering it.
So I only had 5mm of eyelid.
Then then pulled and snapped the tarsal plate across and down in corner of eyelid where tear duct is and stitch it there.
While pulling the skin out from under eye ( the stretch) and stitching that to tarsal plate what they had pulled across.

i see.

i would be helpful to get more photos of the original of the notch to see all the landmarks of the eyelid. it is helpful to see a current photo as well absent all the swelling.

Customer: replied 1 year ago.
This is how my eyelid was. I could not close eye .
Customer: replied 1 year ago.
It collapsed my eye .

it appears you have a lot of scarring on the inner aspect of that upper eyelid.

what was the cause of the original injury?

Customer: replied 1 year ago.
I had a chemical injury 17 years ago. However that scarring only come after they altered my eyelid. They altered inside the eyelid so it was stretching tight on end of eyelid with every blink. The incision mark was moving as it was stretching my eyelid.

can you show me another photo from before the surgery?

Customer: replied 1 year ago.
They left me with 5mm of eyelid .
Customer: replied 1 year ago.
File attached (LVGMS34)
Customer: replied 1 year ago.
File attached (TG6Z4VS)

hi, it looks like the area of chemical injury was large. in this case, a standard wedge resection that i reference in the youtube vision may not work since it is good for small areas. in your case, that may have been the reason your doctor made a larger horizontal incision to allow the eyelid edges to come back together.

future surgery options may be needed to address the scar tissue and that may require a skin graft to allow the eyelid to close better.

Customer: replied 1 year ago.
My injury was 17 years ago. My eyelid was functioning and closing. All zi had was that tiny notch.In the medial co ey nar now. All I have is 5 ml of tarsal plate which is stitch to the skin. He removed all of the eyelid from the notch to the corner.He has gone into my muscle or levator and then set the remainder eyelid back..Then stretched the remainder tarsal plate and snapped it and stitched it down. Pulling the eyelid down as he had set the levator back.The eyelid was then super tight and scraping over the eye.
i see. sorry about your experience with the surgery. it’s tough when it does not heal as expected.
Customer: replied 1 year ago.
I didn't know he was going to cut out. If I did I thought a hard pallet graft which I have revised would of been better option for me. If I really even needed it. It was to potentially help dry eye. But a different ointment at night could of potentially be alls I needed .
Customer: replied 1 year ago.
Is it the levator aponeurosis what gives the eyelid its stretch ?

hi, yes, the levator is what allows the eyelid to move up and down. if the levator is shortened to much, it can cause the eyelid not to close completely. the skin overlying the levator also contributes. if you do not have enough skin redundancy, then that can cause the eyelid to not close all the way.

Customer: replied 1 year ago.
I have seen a video of the Levator getting cut shorter. Can it just get folded or is it always cut ?

most of the time the levator is too stretched and needs to be cut shorter.

in your case, i would not think the levator would not need to be cut.

Customer: replied 1 year ago.
If it has be e.g. n cut though to short . Can it be extended ? Thanks

if it had been cut short, then it can be extended, lengthen with sutures.

Customer: replied 1 year ago.
Are you in UK ?

no, I am an ophthalmologist in california, usa

Customer: replied 1 year ago.
Can the tarsal plate be extended ?

the tarsal plate cannot be extended. one procedure which can help is disinsert the eyelid from the outside corner of the eyelid which allows the eyelid to stretch better toward the inside corner.

Customer: replied 1 year ago.
I thought that was the as answe. He has cut a third of my tarsal plate off . Not happy.

sorry that you have gone through this.

there are options in terms of fixing it. I'd recommend you consult with an experienced oculoplastic surgeon to discuss your options.

Customer: replied 1 year ago.
Thank you for you help . Do you have experienced oculo plastic surgeons by you ?

there are many her in usa and california.

there should be many excellent surgeons in UK as well, but I do not have any personal knowledge of particular doctors.

Customer: replied 1 year ago.
Thanks. I think a trip to the USA may be needed for my issue though

you're welcome.

Customer: replied 1 year ago.
Hi again. If the doctor has cut a third of the levator off . Can you add to it ?

hi, you cannot add it it but you can release any scar tissue and reattach it higher up (essentially lengthening it).

Customer: replied 1 year ago.
Would re attaching it higher up be for if you had a ptosis

if reattached too high, it can cause ptosis. so you has to be customized to your situation.

Customer: replied 1 year ago.
When doing the procedure where you cut up. Would you say you have to tick the box on consent form what states then can retain tissue . Or is this not relevant for this procedure ? .
would not be relevant to this procedure
Customer: replied 1 year ago.
Thank you .
you are welcome.
Customer: replied 1 year ago.
Do you know anything about stem cell defiency ?

what would you like to know about stem cell deficiency?

when you have time, please rate my answers so I can get credit for assisting you.

Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2451
Experience: Eye Physician and Surgeon
Dr. James and other Eye Specialists are ready to help you
Customer: replied 1 year ago.
If you had a amniotic membrane and a imogen lens in. Could you see if the Anterios chamber was formed ?

can you clarify a little more about what type of surgery has occurred with the eye?

Customer: replied 1 year ago.
They done cataract surgery with suture removal plus AMT and Omigen lens .

the cornea is the part on the surface of the eye. stem cells continually repopulates the surface cells of the cornea and are found in the periphery. these stem cells can be damaged from trauma, chronic contact lenses, or chemical injury. if you have stem cell deficiency, the cornea has a hard time to rejuvenate itself and prone to injury and abrasions.

amt or amniotic membrane (brand name omigen) is placed on the surface of the and provides a scaffold for the remaining stem cells to heal the eye. if the other eye is healthy, you can take a graft of the stem cells from that eye and put it on the sick eye.

Customer: replied 1 year ago.
Would you be able to see the anterior chamber if you had s amniotic membrane graft under Bandage contact lense ?
Thanks
with the membrane and contact lens, the view if the anterior chamber is blurry but you should be able to see something
Customer: replied 1 year ago.
If you was going to use sutures in the orbicularis muscle would they suggest you have sltered it and would 5.0 vicryl sutures be ok to use on Orbicularis muscle ?

hi, very difficult to to answer. it depends on what tissues you are using together. if it is orbicularis muscle to orbicularis muscle, then vicryl is ok.

Customer: replied 1 year ago.
Thanks for replying again . Much appreciated . Can I ask if you had a cornea perforation glues . Could you use a pentacam with glue in situ to see if the perforation is going smaller ?

hi, cornea perforation can be repaired with glue. however, this is only a temporary fix. you can use ptencam to image the side of the corneal defect and see if it is getting smaller and healing.

Customer: replied 1 year ago.
Thanks. And can I just clarify I understand You can still get a image of the cornea while the glue is on from side view ?

pentacam image is taken from frontal view. it can still image the glue from side view but the image will have oblique sections of the glue.

Customer: replied 1 year ago.
Can pentacam still get a image on a inflammed eye ? Thanks

yes

Customer: replied 1 year ago.
Thank you . Are there any such scans what see inside the eyelid ?
Customer: replied 1 year ago.
Not a meibography. I mean the other layers and muscles

no, but some doctors have experimented with high resolution ultrasound for eyelid.

Customer: replied 1 year ago.
If a dr has done something inside your eyelid and placed sutures in the Orbicularis muscle but is refusing to tell you anything. The only way to find out what he has done is to potentially open the eyelid again ?

since there would be alot of scarring, it will be very difficult to know what layers were sutured together.

Customer: replied 1 year ago.
I was thinking this
I believe he has pushed my tarsus as far back as can go and sutured it . Would it be only him who really knows where them sutures are ?

correct, the original surgeon knows best.

Customer: replied 1 year ago.
Thanks

you are welcome.

Customer: replied 1 year ago.
Would you need much pain meds by getting a small notch off eyelid removed ..

hi, you would not need much pain medicine, maybe for 2 or 3 days only.

Customer: replied 1 year ago.
Can a b scan check your iris ?

yes

Customer: replied 1 year ago.
Can a b scan show no apparent pupil defect then electrodiagnostics like Ganzfeld electroretinograms show a disorganised pupil. Or would this be very unlikely. Many thanks for constantly answering. Really appreciated.
Customer: replied 1 year ago.
Thanks. Can you see that all 4 quadrants of the iris are damaged on this image . So Superonasal,Superptemporal,Inferonasal,Inferotemporal ?

hi, i am not familiar with ganzfield electroretinograms. I do see the pupil damage on the photo (almost 360).

Customer: replied 1 year ago.
Hi again. If you had a superchrodial haemoridge during surgery. And it resolvee . Woukd there still be a sign you had one on a scan . Or if it resolved can there be no trace what so ever you had one ? Thank in advance again