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The eyelids protect the eye and they also spread the tears over the surface of the eye to maintain clear vision. Within the eyelids there are many small sebaceous glands called Meibomian glands. These produce an oily substance in the tears to slow the rate of tear evaporation.

What is Blepharitis?

Blepharitis (pronounced blef-a-right-is) is a common inflammation of the eyelids. It is not an infection, thought the natural bacteria on the eyelid skin can predispose patients to blepharitis. It occurs more frequently in older people, fair skinned, and light eyed individuals.

There are two main types of blepharitis:

  1. Anterior blepharitis: this affects the base of the eye lashes with a dandruff-like condition.
  2. Posterior blepharitis: this is due to an overreaction of the Meibomian (sebaceous) glands that can become blocked, inflamed and infected.

Signs and symptoms:

  • Eye and eyelid irritation
  • Redness of the eyelid or eye
  • Foreign body sensation (sandy/gritty sensation)
  • Ocular irritation (burning, stinging pain)
  • Blurry vision improving with forced blink
  • AM crusting and mattering the eyelashes
  • Dry eyes

Eyelid Hygiene:

There is no cure for blepharitis. It is a chronic condition. But with the regimented eyelid hygiene routine, the symptoms can be managed well. The mainstay of the treatment is regular lid hygiene to reduce the inflammation of the eyelids. This needs to be carried out regularly, between daily and weekly, over the long term to prevent the symptoms returning.

Other medications

  • Ointment: Sometimes your eye doctor may prescribe antibiotic/steroid ointment medications to help calm the inflammation in severe cases of blepharitis
  • Eye drops: Artificial tears can help soothe the symptoms of blepharitis. Use them regularly.
  • Oral supplements: Flax seed oil and Omega 3 Fatty Acids are thought to help this condition.

How do I perform Eyelid Hygiene?

  • Warm compresses: soak a washcloth in warm water and hold against closed eyelids for a FULL 5 minutes.
  • Cleaning the lids: this is performed to remove any debris that has accumulated on the lid margins. Use clean fingers or a Q-tip dipped in baby shampoo solution to clean along the base of the lashes in the upper and lower lids using a side-to-side wiping motion. Avoid rubbing the infer surface of lids.
  • Alternatively use an over the counter preparation such as Ocusoft or Almay oil free makeup cleaning eye pads.


This content is meant as a guideline for treatment in consultation with your doctor. Should your symptoms change or worsen or you have any additional questions please call our office and schedule an appointment at your earliest convenience.

Main office: 919-443-2557
Fax: 1-919-869-1869
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What is an endoscopic brow lift?

An endoscopic brow lift is a surgical procedure able to improve facial features, such as drooping eyebrows, frown lines, furrowed forehead lines, forehead creases and hooding over the eyes. This often provides a younger, more refreshed appeareance.

Who is the best candidate for an endoscopic brow lift?

The best candidate for an endoscopic brow lift is a physically healthy individual who has realistic expectations and is interested in improving the appearance of drooping or overhanging brows and furrowed lines above the nose.

Where is the endoscopic brow lift procedure performed?

An endoscopic brow lift may be performed in a surgeon’s office based facility, an outpatient surgical patient, or a hospital.

What type of anesthesia is used during an endoscopic brow lift?

Local anesthesia combined with sedation is typically used during an endoscopic brow lift procedure, however general anesthesia may be also used.

How is the actual endoscopic brow lift procedure performed?

After anesthesia is administered, tiny incisions are made in the hairline. The endoscope (a mini TV camera with a probe attached) is inserted through the incisions and guides the surgeon as he or she removes the muscles that produce frown lines and repositions the eyebrows to a higher level. The incisions are then closed.


The effects of aging are inevitable, and, often, the brow and forehead area show the first signs. The skin begins to lose its elasticity. Sun, wind, and the pull of gravity all affect the face, resulting in frown lines, wrinkling across the forehead, and an increasing heaviness of the eyebrows. Even people in their thirties may have faces that look older than their years. Others may mistake your appearance as tired, angry, or sad when this is not how you actually feel. As a result, many people have opted for a procedure known as the forehead lift. Based on variations in how men and women age and on new advances in medical technology, different methods are used to perform this procedure.


Your surgeon nay recommends a brow elevation to improve your function, quality of life, activities of your daily living, or cosmetic appearance. Options for elevating the brow include direct incision brow elevation, eyelid crease incision or endoscopic approach.

Eyelid Crease Incision: This technique is used when the brow is minimally droopy and requires stabilization with minimal elevation. It is performed at the same time eyelid surgery is performed.

Direct Brow or Mid-forehead: This involves the creation of an incision in the skin above the brow. The location of the incision is usually either just above the brow hairs or in the middle forehead area. Every attempt is made to camouflage the incision;however, it will always be visible.

Endoscopic Brow: To avoid a visible incision, your surgeon may recommend an endoscopic brow lift.

Location Incisions:

  • Coronal
  • Endoscopic
  • Pretrichial
  • Mid-Forehead
  • Direct Brow
  • Lid Crease Incision

Common Questions:

  1.  How Long does an endoscopic brow lift take to complete?
    The endoscopic brow lift typically takes two hours to perform
  2. In an Endoscopic brow lift a painful procedure?
    Patients typically experience minimal discomfort. Medication is usually prescribed to help control any discomfort that you may experience.
  3.  What is the recovery like after an endoscopic brow lift?
    Patients typically experience minimal discomfort. Some swelling is likely to occur and be minimized by keeping the head elevated for the first few days after surgery. Bruising and swelling will begin to fade within a week or so. Patients may also experience some temporary numbness.
  4.  How much time will I need to take off from work after an endoscopic brow lift?
    Most patients find that they can return to work within 7-10 days after an endoscopic brow lift.
  5.  When can I exercise after an endoscopic brow lift?
    Strenuous or vigorous exercise will need to be avoided for several weeks after an endoscopic brow lift.
  6.  When are the stitches removed after the procedure?
    Sometimes permanent stiches or staples are used to close the incisions. If so, they are typically removed within a week.
  7.  What are the risks or complications associated with an endoscopic brow lift?
    As with all types of surgery there are potential complications that can occur with an endoscopic brow lift and these may include the following: adverse anesthesia reaction, bleeding, hematoma, infection, nerve injury, problems with healing, and the need for addition surgery.
  8.  Does insurance ever cover the cost of an endoscopic brow lift?
    Insurance typically does not cover the cost of endoscopic brow lift.


This content is meant as a guideline for treatment. Should your symptoms change or worsen or you have additional questions please call our office and schedule an appointment at your earliest convenience:

Main office: 919-443-2557


Important numbers:
Main office: 919-443-2557
Greensboro Surgical Center:
Eastern Regional Surgical Center:
Rex Surgery Center or Cary:
Rex Surgery Center Raleigh


  •  At your pre-operative visit your doctor may order your post-operative prescriptions electronically. On the day of surgery, you may also be given a prescription for a pain medication to take as needed afterwards.
  • It will be important for you to have a ride to and from the surgery center on the day of the procedure.
  •  Do NOT eat or drink anything after midnight the day before surgery, or the morning of surgery (except for certain morning medications), or your surgery could be delayed or cancelled.
  • If you take blood thinners such as Aspirin, Warfarin, Coumadin, Plavix, Heparin, Ticlid or Lovenox, your primary care physician must be consulted before discontinuing.
  • STOP all Herbal Medications like Fish Oil, Vitamin E, Diet Pills, Multivitamins, and NSAIDS such as Ibuprofen, Motrin, Advil, Nuprin, Aleve, Naprosyn, or Naproxen 10 days prior to surgery
  •  Take heart and blood pressure medications with a sip of water on the morning of your surgery. Patients with a sip of water on the morning of your surgery. Patients with diabetes should not take insulin and diabetic pills, unless directed by your primary doctor. Please bring your insulin with you.
  • Wear loose comfortable clothing
  • Do not wear nail polish, make up, lotion, body powder or deodorant
  • You may bathe, shower, and brush your teeth before surgery. (Do not swallow water while brushing your teeth.)
  •  Leave all valuables at home including wedding bands and other jewelry. All body piercings should be removed.
    If you wear eyeglasses or contact lenses, please bring the case with you, as these items may not be worn in surgery.
  • You will have the opportunity to talk to your doctor before the procedure begins to review any questions or concerns.


Normal Expectations:

-Blood- tinged drainage from incisions or “bloody tears” for 24-48 hours
-Increased swelling and bruising two days after surgery- this may unequal comparing each side.
-Bruising may start in eyelids and move lower on your face- this may take 2+ weeks to fade.
-Schedule approximately one (1) week off from work (if possible) to allow for the resolution of swelling and bruising. Resolution times will vary.


– You may have a patch after surgery
– Apply ice compress as much as possible for the first 48 hours. You can use the ice more often on the day of surgery. Cold wet towels, ice masks, or a bag of frozen peas covered by soft cloth work well. Icing is not necessary while sleeping or if you have a patch over the eye.


– Apply a small amount of ointment to the operative sites as directed by your doctor. If your eyes feel dry, it may be helpful to squeeze a bit of ointment into your eyes as well- this will blur your vision.
– You may not need ointment if you have a patch in place
– Do not pull on your eyelids to place ointment.
– Take Tylenol tablets as instructed for the pain, while awake.
– Your doctor may prescribe a stronger pain medication than Tylenol. Do not take this medication with Tylenol.
– Restart blood thinning medications when instructed by your primary care doctor


– Do not rub your eyes around the surgical site
– Sleep with your head slightly elevated and avoid stooping or bending for 1 week. Avoid sleeping on operative side.
– Please avoid any strenuous activity, heavy lifting or bending for two (2) weeks after surgery.
– Do not drive while taking prescription pain medication
– Avoid sun exposure to the surgical site for one (1) month- this will improve the appearance.
– No swimming or hot tub use for 2 weeks after surgery
– If you had tear duct surgery, please avoid nose blowing for one (1) week.


– You may bathe normally after 24 hours. You may gently clean the operated area with mild soap and water starting the day after surgery. Please pat dry. DO NOT rub the eyes after surgery!
– Avoid the development of crusting over the incision by gently cleaning any blood or mucus with sterile Q-tips and saline.
– Do not use eye makeup until approved by your physician

Call Right Away If:

– Severe pain
– Rapid Swelling of eye or inability to move eye(s) in all directions.
– Dimming or loss of vision that does not improve with blinking and not caused by ointment.
– Continuous bleeding that is not controlled with cold compressed.

The Droopy Eyelid

Droopy Eyelids or Ptosis refers to eyelids that tend to descent to the point that they block the pupil and affect peripheral vision. There are many causes of droopy eyelids. The most common type of eyelid droop in adults is due to stretching of the tendon of the muscle that elevates the eyelids. This may occur as a result of ageing, eyelid surgery, trauma, or genetics. Another common cause is known as “pseudoptosis”. Pseudoptosis refers to the artificial appearance of droopy eyelids actually caused by excess of skin or fat in the upper eyelids.
There are other forms of ptosis that are due to abnormal functioning of the eyelid lifting the muscle itself. This is common in children who are born with droopy eyelid. Finally, there are instances where eyelid droop is related to an underlying medical condition.

Your physician will determine the exact nature of your droop eyelids as different surgical techniques are required for different types of eyelid droop.


Every year, many millions of patients elect to undergo eyelid surgery. The vast majority of these patients elect surgery because drooping eyelids or excess upper eyelid skin has begun to impact their vision, however, a number of individuals have recognized that droopy eyelids or excessive (and wrinkled) eyelid skin creases an aged or tired look, and therefore elect to undergo eyelid surgery to improve their appearance.

Before Ptosis correction: Upper eyelids can impair vision; The appearance of the upper eyelid is affected, the normal skin crease may disappear, and there is usually a hollowness in the upper part of the lid, and a lot of wrinkles, and sagging skin.

After ptosis correction: The upper eyelid is lifted so vision is no longer impaired. The eyelids look younger with tighter skin, more open appearance, better eyelash appearance, and fewer visual problems.


Most commonly, it is noted in the inner upper eyelid, but can also develop in the lower lids and is commonly referred to as “bags under the eyes”. It is frequently associated with excess of eyelid skin or ptosis lids, but in some patients, it may be present without any other findings.


Redundant and lax eyelid skin and muscle is known as dermatochalasis. Dermatochalasis is a common finding as adults get older. Gravity, loss of elastic tissue in the skin, and weakening of the connective tissues of the eyelid frequently contribute to this lax and redundant tissue. These findings are more common in the upper eyelids but can be seen in the lower as well.

Dermatochalasis can be a functional or cosmetic problems for the patients. When functional dermatochalasis frequently obstructs the superior visual field. In addition, patients may note eye irritation, turning in of the upper eyelid, turning out of the lower eyelid, blepharitis (eyelid margin irritation), and dermatitis (eyelid skin irritation). Patients may also note a fullness or heaviness of the upper eyelids, “bags” in the lower eyelids, and wrinkles in the lower eyelids and the outer corner (lateral canthus).

Frequently asked questions:

What are the risks of eyelid surgery?
Bleeding for several days after surgery, wound infection; persisting drooping of the eyelid, placing the lid too high, excessive overhanging skin; asymmetry in the eyelid height or the lid crease between the two sides, persistent swelling of the eyelid, prominent scarring…

Will my appearance be altered by eyelid surgery?
The goal of eyelid surgery to improve visual function and give the eyelids a refreshed appearance. Great care is taken to avoid changes to ethnic features so that you will maintain a natural appearance.

How do I know if my vision or health is affected by droopy eyelids?
Most patients appreciate clinically significant eyelid droop because of a decrease in peripheral vision, in combination with excessive headaches or brow-aches caused by overproduction of eyebrows that are attempting to counteract the effects of droopy eyelids.

What about laser eyelid surgery?
Although lasers may be utilized to create surgical incisions, they are often costly and provide no better results than conventional surgery. In fact, surgical incisions created by laser often heal more slowly and are prone to other surgical complications. Lasers are best utilized to reduce wrinkling within the delicate skin of the eyelids as well as to decrease hyperpigmentation and bagginess of the lower eyelids skin. If you would like to learn more, be sure to enquire about our cosmetic rejuvenation.

How long will the surgery take?
Surgery itself takes only about an hour. However, the pre-operative evaluation requires up to 30 minutes and patients that receive sedation may require up to 2 hours observation in the post-op holding area.

Can I have general anesthesia?

In most cases your doctor will not recommend general anesthesia. The eyelid lifting muscles are controlled by a single area in the brain. If one lid is elevated, the other often drops, much like a see-saw. It is therefore necessary to closely observe both eyelids for symmetry during eyelid surgery. your surgeon can minimize (but not eliminate) the risk of eyelid symmetry by having you open your eyes at the conclusion of the procedure.
By using heavy IV, it is possible for you to “sleep through” the entire procedure, yet at the same time, make it possible for you to be arousable enough to open and close your eyelids on command. Most patients report that they never even remember being asked to open their eyes during the procedure.

Will my surgery be covered by my insurance?
Eyelid surgery that improves visual function is covered by insurance. In cases where it is necessary to determine just how significant the eyelid droop affects vision, you may be asked to submit to a test of visual function. Such tests ensure that by elevating the drooping eyelids or removing excess eyelid skin, that vision will be improved. Typically, surgery is designed to remove eyelid wrinkles and surgery to remove bags from the lower eyelids is not covered by your insurance.

The tearing patient

The approach to the tearing patient can be complex. Tearing can result from any one of the three causes and a combination of three causes.

Our goal will be to determine whether your tearing is predominately due to overproduction under drainage.

We will inspect your eye, eyelids, and tear duct anatomy. By irrigating fluid through the inner corner of your eyelids, we can determine if there is a blockage in your tear duct system.

There is no medical cure for a blocked tear duct system. If a blockage is found in your tear duct system, surgical improvement can be achieved with tear duct bypass surgery,

Surgical options include “roto-rotoring” the tear duct system and placing temporary silicone stent tubes to hold open the “plumbing”. This lesser invasive technique works some of the time. The second, most definitive option is to create a tear duct bypass system.

Done through the nose with cameras, endoscopic dacrocystorhinostomy has over 85-90% success rate, has quick recovery time, and does not leave any visible scars!


Tearing happens for 3 main reasons:
1- Overproduction of tears
2- Under drainage of tears
3- The eyelids are in suboptimal position to help push the tear over to the drain


Occurs occasionally
Does not occur constantly
Usually outdoors, in windy conditions
Often have burning, stinging eye pain


Occurs constantly
Must constantly wipe eyes
Eyelid skin is irritated from constant tearing
Occurs indoors and outdoors
What is Endoscopic Dracryocystorhinostomy?

Well, it’s certainly a mouthful, to say the least!
Endoscopic dacryocystorhinostomy is the medical term for a “tear duct bypass surgery” performed with the assistance of cameras places in the nose.
Because there is no incision through the skin, there is no external scar!
Surgery takes approximately 1.5 hours per side and is done under general anesthesia. The recovery time is usually quick, and the main post-op instructions include taking it easy, with no heavy lifting for a couple of days. A thin, spaghetti like, silicone stent is placed at the time of surgery through the eyelid and into the nose to help keep the system open through the postoperative healing phase. The stent stays in place approximately 4-6 weeks. It is possible to continue tearing while the stent is in place.
This surgery has a very high surgical success rate in improving blocked tear ducts.
For more information about this procedure or to determine whether this surgery is an option for your tearing, discuss it with your surgeon.


This content is meant as a guideline for treatment. Should your symptoms change or worsen or you have additional questions please call our office and schedule an appointment at your earliest convenience:
Main office: 919-443-2557
Fax: 919-869-1869