Eye doctor talks about under-eye bags, swollen eyelids, thyroid eye disease and why learning to play piano when she was a kid helps her be a better eye surgeon
By Chris Motola
Q: When might someone need reconstructive eye surgery?
A: In cases where a patient has undergone skin cancer removal on the eyelid, subsequent lid reconstruction becomes necessary. Similarly, for individuals with eyelid lacerations resulting from trauma, it is crucial to perform the appropriate repairs. Addressing issues like drooping upper or lower lids, which are quite common, can be effectively corrected.
Q: What considerations need to be made when reconstructing an eyelid? How do you make it functional?
A: Properly functioning eyelids are essential for eye health and optimizing vision. Every eyelid reconstruction is tailored to ensure natural eyelid function, including proper opening, closing and blinking, all while aiming to minimize scarring.
Q: What does your patient base look like?
A: I provide care for patients of varying ages, tailoring my approach to their specific needs and concerns.
Q: Do you find the conditions you treat vary with age?
A: Yes. Age-related eye conditions encompass presbyopia, glaucoma, dry eyes, age-related macular degeneration and cataracts. Meanwhile, childhood eye issues include lazy eye, refractive errors, pink-eye infections and styes.
Q: What are common types of oculoplastic surgery?
A: The correction of drooping upper eyelids is a frequently sought-after procedure, typically involving the removal of excess skin or the tightening of a stretched muscle. Another common concern is under-eye “bags,” which can often be surgically reduced. In some cases, lower eyelids may turn inward or outward, leading to redness and discomfort, necessitating corrective surgery. Many individuals opt to have skin tags, cysts or styes removed from their eyelids for both aesthetic and comfort reasons.
Q: What causes under-eye bags? Are they preventable?
A: Under-eye bags can have various underlying causes, including loose skin, pockets of fat, changes in skin pigmentation, and natural shadowing. These factors can lead to the appearance of dark circles, fatigue, or “bags under your eyes.” While these traits can be hereditary and present from a young age, they often worsen with time. As we age, the tissues around the eyes gradually weaken and sag, allowing fat to protrude into the lower eyelids, creating puffiness and swelling. Additionally, fluid can accumulate in this area, contributing to the puffy appearance.
Q: How do you address these problems?
A: There are several home remedies you can try to reduce eye bag puffiness and shadowing:
1. Apply a cool compress to your eyes.
2. Ensure you get an adequate amount of sleep.
3. Sleep with your head slightly elevated.
4. Avoid consuming fluids right before bedtime and limit dietary salt intake.
5. Quit smoking, as it can exacerbate these issues.
6. Take steps to reduce allergy symptoms, which can worsen eye puffiness.
In certain cases, patients may consider a blepharoplasty, a type of eyelid surgery that can help reduce under-eye bags. During this outpatient procedure, a surgeon makes an incision either beneath the lashes or inside the lower lid. Excess fat is either removed or repositioned through the incision, and in some cases, extra skin is also addressed.
Q: What are some of the challenges of operating on and around the eye?
A: Performing eyelid surgery is a delicate combination of art and precision. My surgical approach focuses on achieving results that enhance the natural appearance, optimize eyelid function, and safeguard or improve overall eye health.
Q: Do you have any particular artistic inspirations that you draw on?
A: At the age of 7, my parents enrolled me in piano lessons, a decision that constantly reminds me of the intriguing parallels between surgery and playing the piano. The remarkable precision and focus demanded to beautifully play a musical composition bear a striking resemblance to the exacting nature of my surgical work. The dexterity honed in my fingers through countless hours of piano practice and the adeptness in using my non-dominant hand with ease have proven to be invaluable assets in refining my surgical skills.
Q: Do you perform elective surgeries as well?
A: Certainly, my practice encompasses a wide range of procedures, including medically necessary surgeries and cosmetic enhancements. I also offer non-surgical cosmetic treatments like Botox, dermal fillers, and skin tightening to provide a comprehensive array of options for my patients.
Q: What are some promising new developments in your field?
A: A groundbreaking medication named Tepezza received FDA approval a few years ago, revolutionizing the treatment of thyroid eye disease. Its success has offered new hope for managing this complex condition. Before the arrival of Tepezza, treatment options were exceedingly limited, yielding less than satisfactory results.
Q: What kinds of symptoms are typically associated with thyroid eye disease?
A: The main symptom of thyroid eye disease is bulging of the eyes. Additional symptoms include dry, gritty, red, or irritated eyes; swollen eyelids; eyelids that pull back more than usual or fail to close completely; double vision; light sensitivity; eye discomfort or pressure; and difficulty moving the eyes.
Typically, thyroid eye disease affects both eyes, although symptoms may initially appear in only one eye. These symptoms usually persist for one to two years. In rare instances, swelling around the eyes can exert pressure on the optic nerve, resulting in vision loss.
Q: What got you interested in eye surgery?
A: During my time in medical school, I had the opportunity to rotate through various medical specialties. Ophthalmology stood out to me due to its unique blend of medical and surgical approaches. What particularly appealed to me was the wide range of patients we serve, spanning from newborns to centenarians.
Q: A lot of patients see optometrists for their basic vision issues. Is there a good barometer for when a patient should take their eye concerns to an ophthalmologist instead?
A: A significant distinction between optometrists and ophthalmologists lies in their surgical capabilities. While many optometrists excel in managing most medical aspects of eye care, they do not perform surgical procedures. On the other hand, ophthalmologists are trained surgeons who can address your medical needs and perform surgical interventions. Both professionals are authorized to prescribe medications and treat eye diseases.
Another notable contrast pertains to their educational background. Optometrists undergo four years of optometry school, occasionally followed by an additional year of residency. Ophthalmologists complete four years of medical school, followed by four years of residency training. Some ophthalmologists pursue one- or two-year fellowships to specialize further, focusing on areas like glaucoma or retinal disorders. You can recognize an ophthalmologist by the presence of an MD [Doctor of Medicine] or a DO [Doctor of Osteopathic Medicine] after their name, while optometrists hold an OD [Doctor of Optometry] degree.
A good eye doctor will guide you in the right direction if you require the expertise of another specialist. Optometrists commonly refer patients to ophthalmologists for complex medical conditions such as uncontrollable eye infections, medically unmanageable glaucoma, cataract surgery, corneal transplants, or retinal issues.
Q: Do you remember much of your early childhood in Russia? What was it like?
A: One cherished memory that stands out is our apartment, where three generations coexisted under the same two-bedroom roof. I hold dear the recollection of my grandmother’s culinary talents as she lovingly prepared delicious meals for our family while also caring for my younger brother and me.
Q: Did some of those recipes come with you?
A: My brother and I have our grandmother’s handwritten recipe book. We have a plan to translate it into English and preserve it in digital form. One of my fondest recipes is for Ukrainian waffle cake. This delicious dessert features layers of wafers, sweet condensed milk, and crunchy walnuts. Whenever my parents come to visit, I eagerly anticipate this delightful treat they prepare.
Lifelines
Name: Anna Rothstein, M.D.
Position: Opthalmologist at The Eye Care Center in Canandaigua
Hometown: Pittsford
Personal: Immigrated to the United States at age 10
Education: Robert Wood Johnson Medical School (medical degree); Unity Health System, Rochester (internship in internal medicine); University of Rochester Eye Institute (residency in ophthalmology); fellowship in oculoplastic, reconstructive and cosmetic surgery at Ocusight Eye Care Center in conjunction with Paul N. Rosenberg, MD
Affiliations: FF Thompson Hospital, Geneva General Hospital, URMC
Organizations: American Academy of Opththalmology
Family: Husband (Ron), one daughter, one son
Hobbies: Foreign films, traveling, hiking with her dog