From the desk.
Short, considered writing on the things that fill my working week: papers worth reading, lessons from the clinic, and the occasional update on research and teaching.
3 notes
When the tear duct is partly blocked: which operation, and does it last?
A syringing test that passes proves the pipe is not sealed shut. It does not prove it works. Why partial and functional tear duct obstruction is so often dismissed, what the two operations for it are, and why they look identical at three months and very different at eight years.
Upper eyelid surgery: there's more than meets the eye
Almost every patient asks for "just a bit of skin taken off". The operation is straightforward; deciding how much to remove, from where, and whether the eye can tolerate it is where the result is actually determined.
Measuring what matters in watery eye
Why a standardised, patient-reported way of measuring epiphora changes the conversation in clinic, and where the WEQOL questionnaire fits in.
7 notes
Rebuilding the eyelid after skin cancer surgery
One patient, three basal cell carcinomas, three entirely different repairs. What determines the reconstruction, why a large lower lid defect means a closed eye for a month, and what a graft looks like at three months compared with two years on the same face.
Skin cancer around the eye: how it is removed
Two patches at the inner corners of a lady's eyes had been treated as eczema for years. Both were basal cell carcinomas. What periocular skin cancer actually looks like, why it is so easily missed, and why the method of removal matters more than the operation itself.
Tarsal ectropion: when the lower eyelid turns inside out
One of the more dramatic eyelid problems I see, and one of the most often missed. Why it happens, why it is so common in men, and how a combined repair addresses all three parts of the problem.
Ingrowing eyelashes: why electrolysis often isn't the answer
Electrolysis is offered as a first-line treatment for ingrowing lashes more often than the evidence supports. Why the maths works against it, and what tends to work better.
Why do my eyelids look heavy?
Heavy upper eyelids are rarely caused by one thing. A Roman blind analogy for the three components that droop with age, and why treating only the obvious one disappoints.
Why does my eye keep watering?
A watery eye is rarely one problem with one fix. A simple sink analogy for the four things that cause it, and why assessing all of them is the first step towards real improvement.
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