Get treatment for all your mental healthcare needs.

Our services

Therapy

It all begins with an idea. Maybe you want to launch a business. Maybe you want to turn a hobby into something more. Or maybe you have a creative project to share with the world. Whatever it is, the way you tell your story online can make all the difference.

60 mins | $300

Psychiatry

45 mins | $250

Book a consultation

Eyelid Skin Cancers

Skin cancer is a common malignancy, particularly in sunny climates such as Florida. Eyelid skin cancers are most prevalent on the lower eyelid. They typically appear as painless elevations or nodules along the eyelid margin. The eyelashes may be distorted or missing. Ulcerations, bleeding or crusting may be present. Basal cell carcinomas and squamous cell carcinomas are most common. After the skin cancer is removed, the defect is reconstructed. The goals of treatment are complete tumor excision, and functional, aesthetically pleasing reconstruction.

The majority of eyelid growths – old and new – are benign. However, skin cancers can occur on the eyelid – in the lash line or in the skin.

Basal Cell Carcinoma

Basal cell carcinoma is the most common skin cancer found on the eyelids. It accounts for 90-95% of eyelid malignancies. They most commonly occur on the lower eyelid but can be found in the inner eyelid near the nose, the upper lid or outer eyelid.

Who Is At Risk To Develop Basal Cell Carcinoma?

People of older age, with fair skin, blue eyes, red or blond hair with Scottish, English, Irish or Scandinavian ancestry are most at risk to develop a basal cell carcinoma of the eyelid. Significant sun exposure and sunburns in the first 20 years of life, cigarette smoking, and a prior history of basal cell carcinoma also increase your risk.

While basal cell carcinomas come in several different forms, nodular basal cell carcinoma is the most common clinical lesion. The growths are described as a firm, raised, pearly nodule with central ulceration and associated increased vascularity (telangiectasia).

How Do You Treat Eyelid Basal Cell Carcinomas?

An eyelid basal cell carcinoma needs complete tumor excision, with pathologic proof of clear margins, and careful reconstruction. I prefer to utilize a team approach and schedule my patients with a Mohs dermatologist to excise cancer in their office under local anesthesia. Utilizing a Mohs micrographic technique, complete tumor removal is possible while creating a small tissue defect.

The physician numbs the skin, removes any suspicious tissue along with some normal tissue and examines the specimen under the microscope. If any tumor remains, they carefully excise more tissue in a very conservative manner, process the specimen and review the tissue under the microscope. The process is repeated until the entire cancer has been removed. The patient is then patched and is driven to the surgery center where I repair the defect under sedation. As an oculoplastic specialist, I have the training and experience to meticulously reconstruct the defect. The goal is to preserve proper lid position which will then protect the eyeball and the vision.

Suspicious Lesions

If an eyelid growth has associated redness, recurrent crusting, ulceration, bleeding, loss of eyelashes or irregular borders, skin cancer is suspected and must be ruled out.

How Do You Diagnose A Basal Cell Carcinoma?

A biopsy is performed in the office and the specimen sent for pathology review. Prior to biopsy, the lesion is photographed as the biopsy site can at times heal well enough that the original area is difficult to identify once it has healed.

Squamous Cell Carcinoma

Squamous cell carcinomas are much less common on the eyelid compared to basal cell carcinoma, but they are much more aggressive. They can appear as a new lesion or progress to cancer from an area of sun damage. Squamous cell carcinomas can have a varied appearance but in general are persistent, scaly/crusty, thick growths that occasionally bleed. Management is similar to basal cell carcinomas and involves Mohs micrographic surgery followed by reconstruction.

If neglected, these tumors can be lethal. Squamous cell carcinoma can spread along nerves, extend out directly or travel through the blood or lymphatic systems. Suspicious eyelid lesions need thorough evaluation and biopsy to obtain a definitive diagnosis and treatment plan.

Ptosis

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.

Ectropion

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

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.

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.

Benign Eyelid Growths, Chalazion/Styes

Chalazion & Styes

A chalazion is a very common eyelid condition and is seen in children as well as adults. It is a localized inflammation of the eyelid. Patients will notice a bump on the upper or lower eyelid that can become red, swollen and painful. Mucoid discharge can be noted especially in the mornings when waking which can blur the vision. If the chalazion becomes large, it can press on the eye and cause blurry vision by distorting the curve of the cornea.

A chalazion develops when an oil gland (meibomian gland) is obstructed. These glands are located in the back layer (tarsal plate) of the upper and lower eyelids. When the oils cannot drain into the tear film, they are released into the surrounding tarsal plate and soft tissues. This creates inflammation in the eyelid which the patient experiences as pain and redness of the skin. Chalazia are common in patients with rosacea and blepharitis.

Many people use the term stye and chalazion interchangeably. Technically, a stye is caused by an infected eyelash root at the eyelid’s edge or an infected oil gland on the back of the eyelid. A style (or hordeolum) is considered external if it begins as an infection in the hair follicle. The stye (or hordeolum) is termed internal if it is inside the eyelid and forms from an infected oil-producing gland.

Treatment for styes can involve plucking the infected eyelash. To treat both conditions, a warm wet compress should be placed over the affected eyelid for 10-15 minutes at a time, 3-5 times a day. This will help the oil gland open and drain. You may be asked to perform lid scrubs to wash up the lash line. If an infection is present, topical antibiotic ointments or drops can be prescribed. If the eyelid is extremely swollen and bacterial cellulitis (lid infection) is suspected, an antibiotic pill may be needed.

Most chalazia will resolve with conservative management in 4-6 weeks. If the inflammatory mass becomes chronic and cystlike, an office procedure can be performed to excise the back wall of the cyst and remove the inflammatory tissue. Steroids are also injected at that time to manage the inflammation and speed the resolution of the chalazion.

Xanthelasma

Xanthelasma are yellowish deposits seen just under the skin surface in the inner corners of the upper and lower eyelids. These cholesterol deposits are located in the superficial dermis and subdermal tissues. Occasionally, xanthelasma can become larger, modular and extend into the underlying orbicularis muscle. Xanthelasma has diagnosed most frequently in 40 – 50-year-olds. They usually occur in patients with normal serum cholesterol levels.

Treatment involves complete excision of the lesion and suture closure. Care must be taken to not remove too much skin which can result in the eyelids not closing well or the eyelids pulling away/rolling away from the eye.

Unfortunately, xanthelasma can recur. It is reported that 40% of patients with one excision/removal had a recurrence. If the xanthelasma return and repeat excision are required, a skin graft may be necessary if there is not sufficient tissue to close the wounds.

Eyelid Cysts

Eyelid cysts can be fluid filled or epithelial. Fluid-filled cysts are called apocrine hidrocystomas. They transilluminate meaning they glow as the internal fluid is highlighted with an external light source. These lesions can be translucent or bluish in color. Multiple cysts can be present. Treatment involves complete excision of the cyst to prevent a recurrence.

Solid cysts of the epidermis are called epidermal inclusion cysts. They form from either the base of a hair follicle or from a surface epithelial cell being trapped below the skin surface. The lesions are slow-growing, round, elevated and smooth. If a cyst ruptures, the surrounding tissues can become markedly inflamed and/or infected. Treatment involves complete excision of the lesion.

“I underestimated how hard it would be adjusting to working from home, but with Dr. Schell’s help, I was able to regain focus.”

— OLIVIA R., CLOVE CLIENT