Knock knees

Disease Description (Causes and Symptoms)

• Definition: An eyelid consisting of a single fold (a state without a double eyelid). In Korean, this is called “oe-kkeopul (single eyelid).”
• Main causes (summary): The low prevalence of double eyelids among East Asians is presumed to be related to anatomical characteristics such as the epicanthal fold (the skin and subcutaneous structures at the inner canthus). Some explanations propose the hypothesis that environmental and evolutionary factors, such as the last Ice Age, led to differences in the structures around the eyes, but this remains speculative.
• Pathophysiology summary: A single fold (monolid) forms when the connective structures of the dermis, muscle, skin, and fat that create the double-eyelid crease are weak or absent. Depending on the case, differences in eyelid skin and fat distribution and orbital supporting structures may also be present.
• Symptoms and related problems: Most people seek care for cosmetic reasons, but rarely, corneal irritation, inflammation, tearing, pain, and reduced vision may occur due to entropion (the eyelid margin turning inward and the eyelashes poking the eyeball), in which the eyelashes irritate the eye. Age-related skin sagging and protrusion of the fat under the eyes (giving a tired and aged appearance) are also common.

Treatment Methods (Standard Treatment · Precautions · Self-Management)

• Non-surgical management:
  • If there is no cosmetic concern, no special treatment is necessary. If there is eye irritation, symptomatic treatment such as artificial tears and hygiene and moisturization around the eyes may be used.
• Surgical treatment (related to blepharoplasty):
  • Double-eyelid surgery (double-eyelid blepharoplasty)
    • Non-incisional suture method: Suitable for young patients with thin skin and little fat. There is almost no scarring, but the sutures may loosen.
    • Incisional method: Partial removal and fixation of skin, muscle, and fat. Fat removal (or repositioning) is possible; the result is permanent, but a scar may remain along the incision (usually hidden when the eyes are closed).
  • Upper blepharoplasty (upper eyelid): Improves vision and cosmetic appearance by correcting sagging or multiple folds and removing excess skin and fat. Depending on the case, correction of ptosis (a problem with the eyelid-lifting muscle) may be performed at the same time.
  • Lower blepharoplasty (lower eyelid): Removal or repositioning of the fat pockets under the eyes, reinforcement of the orbital septum, and removal of skin and muscle or an approach through an incision inside the eye.
• Precautions and contraindications (before/after surgery):
  • Before surgery: Stopping smoking and medications that affect blood clotting, such as aspirin and clopidogrel, 2 weeks before surgery is recommended (coordinate this with your doctor). If systemic diseases are present, such as uncontrolled diabetes, bleeding disorders, active eye infection, or thyroid eye disease, surgery may need to be postponed or a specialist may need to make the decision.
  • Postoperative complications: Infection, bleeding, scarring, asymmetry, loosening of sutures, persistent swelling and bruising, tearing and light sensitivity, and, rarely, eyelid dysfunction (such as ptosis or ectropion) and corneal damage.
  • Self-management: Apply intensive cold compresses and keep the head elevated with a pillow for 2–3 days after surgery; limit strenuous reading, watching TV, and exercise for 1 week; makeup may be applied 1 day after suture removal (follow the doctor's instructions); complete recovery takes several weeks to several months. Follow instructions for ointments and medications and protect the eyes (wear sunglasses).

Outpatient Visit Checklist (Items to Bring · Information to Provide in Advance to the Medical Staff)

• Items to bring/submit:
  • A list of all medications currently being taken (including prescription drugs, over-the-counter medications, herbs, and supplements)
  • Past medical history (especially bleeding disorders, diabetes, thyroid disease, heart disease, etc.) and history of allergies
  • Results of previous ophthalmic or plastic surgery procedures or eye examinations (photos and records, if possible)
  • Photos of the problematic eye(s) (front and side views) and a record of when symptoms began and their severity
• Symptom records:
  • Whether eye irritation, pain, tearing, or vision changes are present and how frequently they occur
  • Who is affected (one eye/both eyes) and whether symptoms vary by season or time of day
• Examinations that may be expected: Eyelid and eye examination (slit lamp), evaluation of eyelid function (eyelid opening and closing strength and eyelid position), and, if necessary, blood tests/endocrine evaluation

Examples of General Questions to Ask the Doctor

• What are the expected effects and limitations of this surgery? How likely is recurrence (loosening of the sutures)?
• Which medications, including supplements, should I stop taking before and after surgery?
• What are the risks (complications) of the surgery, and how frequently do they occur? How would you respond if a problem occurred?
• What is the recovery period, and when can I return to daily activities (exercise, makeup, and work)?
• Which method is more suitable for my anatomical characteristics (skin thickness and amount of fat)?

Examples of Condition-Specific Questions

• I have entropion or symptoms of my eyelashes poking my eye. How completely can surgery resolve this? How can the risk of corneal damage be reduced?
• I have previously undergone double-eyelid surgery (or eyelid surgery). Is revision (corrective) surgery possible? What results can be expected from revision surgery, and what additional risks are involved?