The quality of a treatment depends on the experience of the surgeon. ELZA’s eyelid surgeon is Dr. Dr. Dion Paridaens. He has more than 25 years of experience and has performed more than 20,000 eyelid surgeries. Dr. Paridaens is the co-founder of the Thyroid Center Rotterdam and, since 2021, ist he president elect of the ESOPRS (European Society of Ophthalmic Plastic and Reconstructive Surgery).
Dr. Paridaens heads the Department of Eyelid, Tear and Orbital Surgery at the Eye Clinic Rotterdam in Holland and has been operating complex cases in Switzerland since 2003. Since 2001, he has offered a fellowship in eyelid and tear surgery, and has already trained several generations of young surgeons in this sub-specialty.
Over the course of his career, Paridaens has published more than 160 scientific publications on eyelid, lacrimal and orbital surgery.
The main focuses of Dr. Paridaens are involved in cosmetic and reconstructive eyelid surgery, tear surgery, and ocular orbital surgery.
Need more info? The links on this page refer to ELZA pages (in English) with more detailed information on the topic.
Hooded eyelids (dermatochalasis) are a result of excess skin on the upper eyelid, thanks to skin losing elasticity over the course of the aging process. In rare cases, inflammation can cause this to occur in children, a process called “blepharochalasis”. It is treated in the same way in both cases.
Dr. Paridaens also has extensive experience in treating Asian eyelids, which differ from European eyelids in terms of anatomy.
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A typical consequence of the ageing process, eyebrow ptosis is the descent of the eyebrow when the brow and the brow fat pad behind it drops over time.
This is easy to recognize: in a normal brow position, the edge of the bony eye socket can be felt under the eyebrow. In brow ptosis, the eyebrow is often 1 to 2 cm below it.
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Entropion is an inwardly turned lower eyelid, and the main cause of it is a progressive age-related relaxation of the lower eyelids.
Entropion cannot heal spontaneously and will worsen over time. The eye becomes irritated because the eyelashes of the lower eyelid are in constant contact with the cornea. Typical symptoms include pain, redness of the eyes, tears, and photophobia. In some cases, the constant rubbing of the eyelashes can cause severe infections in the cornea.
Entropion can be corrected by horizontally and vertically tightening the lower eyelid. The horizontal relaxation is corrected by straining the lower eyelid at the outer edge.
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An ectropion is an outward-facing (everted) lower eyelid: the insides of the lower eyelids are constantly exposed to the air and dry out.
Most commonly, ectropion appears as a symptom of aging, whereby eyelid tissue relaxes horizontally. In rare cases it can also be caused by skin diseases, infections or scarring of the skin of the lower eyelid. Irrespective of the cause, the outcome is the same: the eye becomes permanently irritated because the eyelids no longer close properly and dry out the surface of the eye. Often there is a compensatory excess production of tears, resulting in a watery eye – but the tears can not flow properly because of the malpositioning of the lower eyelid.
Long-term ectropion predisposes patients to developing corneal infections, which can lead to serious changes, in extreme cases to a corneal ulcer.
Ectropion eyelid surgery, much like entropion surgery, can be corrected by horizontally and vertically tightening the lower eyelid. The operation lasts about 45 minutes, is usually performed under local anaesthesia, and the success rate is 70–80%.
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The word “ptosis” is the medical term for a drooping upper eyelid. Normally, the upper lid is opened by what’s called the levator muscle. The muscle runs from the upper edge of the eye socket into the upper eyelid. It fans out and enters the connective tissue, which gives the upper lid its strength.
The acquired ptosis usually occurs on both sides in adults and may have various causes. The point of attachment of the levator muscle on the upper eyelid slips upwards over time: the muscle works well, but it can no longer lift the upper eyelid to the correct height. In severe cases, the upper lid may partially or completely cover the pupil.
Ptosis can narrow the field of vision and also damage the even damage the region of the spine between the shoulders and the base of the skull, as patients try to balance the limited field of vision by constantly raising their chin.
The success of the operation also depends on how good the remaining power of the eyelid muscle is. Different approaches can be used, from Fasanella-Servat surgery (see below) to levator muscle resections and reinsertions
“Ptosis” is the medical term for a drooping upper eyelid. There are two reasons why an eyelid droops: there’s a either a problem with the “levator” muscles that lift the eyelids, or a problem with the nerve that controls them. There are a number of causes – trauma, infection, cancer, autoimmune or inflammatory disease, and sometimes ptosis can be hereditary.
It’s caused by a dysfunction in either the muscles that raise the eyelid, or the nerves that control those muscles. Ptosis can occur on its own, but it can also be associated with trauma, autoimmune or inflammatory disease, infection, cancer, and in some cases, hereditary disease.
Sometimes, the ptosis is mild, and the upper eyelid droops only slightly. But in moderate-to-severe cases, the upper lid may partially or completely cover the pupil. This is of particular concern in children, ptosis that covers the pupil can cause amblyopia: the part of the brain that deals with vision from that eye just doesn’t develop properly as it isn’t receiving as much information from this partially closed eye.
Instinctively, children try to compensate for this by the following behaviours:
But if you have a child with an eyelid that covers the pupil and they don’t use these compensating mechanisms, then it’s important that they get seen by a professional quickly: the ptosis can cause visual suppression, and can leave your child with permanent, lifelong amblyopia.
Congenital ptosis is usually based on a malformation of the muscle (levator muscle), which should raise the upper eyelid. This change can affect either one or both upper eyelids. Other, rarer causes of congenital ptosis may include: certain muscle diseases, tumors of the eyelids or neurological disorders.
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The seventh cranial nerve (facial nerve) supplies the circular muscle around the eye and other important facial muscles. There are a number of different causes Paralysis can have a variety of causes, including diabetes, multiple sclerosis, tick bite disease (Lyme disease), accident, tumor or infection. Paralysis may also persist since birth or may be temporary following vaccination. However, in more than 50% of cases, no cause can be found. Medicine then speaks of “idiopathic facial paralysis”.
The typical symptom of the eye is the incomplete eyelid closure (lagophthalmos): the lower eyelid is deeper than normal and the circular muscle does not receive enough orders from the nerves to completely close the eye.
If a facial paralysis has occurred only recently, then only the dry eye should be treated and it should be awaited whether the paralysis returns by itself. However, if the paralysis has been around for some time, the prospects for spontaneous recovery are small. Then the eyelid closure function should be improved for medical reasons, as there is a permanent eye irritation, which in extreme cases can lead to a corneal ulcer and complete vision loss.
Depending on the extent of facial nerve paralysis, one or two operations are needed:
The word “tumor” can be a frightening word for people to hear – many patients view “tumour” as being synonymous with “malignant cancer”. It’s important not to confuse the two terms.
The first distinction to be made is the difference between an inflammatory swelling in the eyelid area and “more tissue”. Eyelid tissue is delicate and a slight inflammation can lead to a massive swelling, and there can be many causes of this inflammation, including an inflamed lacrimal gland or an infection caused by a small injury.
If there is a real “extra tissue” (such as from a tumor), then it is often benign changes such as an encapsulated barley grain, a wart, or a so-called “molluscum contagiosum”, caused by a harmless, but contagious virus.
However, various malignant tumors (carcinomas) do occur on the eyelids. The most common malignant eyelid tumor is basal cell carcinoma (90%), followed by squamous cell carcinoma (~5%) and sebaceous carcinomas (~5%). In all cases, suspected malignant tumors should be treated quickly. If necessary, we will consult specialists of other disciplines such as internists, dermatologists or oncologists (cancer specialists).
Basal cell carcinoma (BCC): 90% of all malignant eyelid tumours. BCCs are the result of intensive, long-term sun exposure of the skin, preferably in fair-skinned people. BCCs grow locally and only rarely form new tumours (metastases) in other parts of the body.
Squamous cell carcinomas (SCC): make up about 5% of malignant lid tumours. Here, too, excessive sunlight plays a role. The lower eyelid, like in BCC, is more frequently affected because it receives more sunlight. Squamous cell carcinoma metastasizes in about 20% of cases, initially to the lymph nodes of the ear and jaw.
Sebaceous Carcinomas: Make up about 5% of malignant eyelid tumours. Arises on degeneration of a sebaceous gland. This tumour is aggressive and metastasizes early.
For small tumors, we first take a biopsy in a short outpatient procedure. The material is sent to a laboratory and examined under the microscope to confirm the diagnosis. In a second operation, the tumor is removed.
For large tumors, the tumor is excised, plus an additional region of what appears to be non-tumour tissue to ensure all of the tumor has been removed, and this often requires the patient to be under general anaesthesia. This is followed by what’s called “rapid-cut diagnosis” – the pathologist examines the material immediately under the microscope and informs us 1–2 hours after removal whether the cut edges are free of tumour. Subsequently, the reconstruction of the lid takes place on the same day in a second operation.
The next step is lid reconstruction. There are a variety of surgical options available to do this, and in general, eyelid reconstruction has made tremendous progress over the past two decades.
In the past, large skin transplants from the middle of the face were used to replace one or even both eyelids – and sometimes eyes were removed altogether. Fortunately, thanks to improved techniques, this “radical” surgery is no longer used in most cases today.
These days, defects of all sizes, including the complete lid can be covered by material derived from near the eyelids. Which method is used depends on how much of the eyelid needed to be removed (or in other words, how big the defect needing to be covered is). Modern surgical techniques range from a direct closure, to skin grafts, muscle or connective tissue slices, which are taken from the upper / lower lid of the same side or the lids of the other, healthy eye.
In rare cases where more skin is necessary, this is taken from behind the ear.
In addition, some of the modern procedures require two rounds of surgery, where the lid is reconstructed and the eye can not be opened for about 10 days. This is followed by another (short) intervention to complete the reconstruction.
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