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Oculoplasty

WHAT IS OCULOPLASTY?

Oculoplasty is a branch of ophthalmology that focuses on plastic surgery procedures relating to the eyes, as well as the structures that surround it. This pertains to cosmetic or reconstructive surgery on areas around the eyes, such as the eyelids and orbit (eye socket).

WHY CHOOSE AN OCULOPLASTIC SURGEON?

Oculoplastic surgeons first train as ophthalmologists, learning in detail about the eye. After further higher training, they start to handle plastic surgery. They have the best knowledge about the eye and its surrounding structures, thus making them uniquely qualified to do delicate plastic surgery around the eye.

SERVICES AVAILABLE

Eyelid

Eyelid malpositions

Eyelids protect the eyes from any external objects while keeping them lubricated throughout. Any alteration in the shape, position or function of the eyelids can damage the eyeball and interfere with vision.Our eyelid is a complex structure consisting of three layers:

1. Anterior Layer contains the skin and orbicularis muscle

2. Middle Layer contains the orbital septum and eyelid retractors

3. Posterior Layer contains tarsus and conjunctiva.

Eyelid malpositions include any incorrect positioning of eyelids due to various factors that influence any of the three layers of the eyelids.It could be caused by ageing, trauma, scarring, birth defects or medical diseases involving any or all of the three layers.

Types of Eyelid Malpositions

Ptosis

Ptosis is drooping of the upper lid. It may be prescriptionent by birth, or appear later in life. Ptosis occurs when the muscles that raise the eyelid become weak due to nerve abnormalities, trauma, inflammation or lesions of the lid or orbit. It can affect one eye or both eyes and occurs more often in the elderly individuals.

Surgical procedures include:

1. Levator resection (Anterior/External approach)

2. Müller muscle resection 

3. Frontalis sling operation

Non-surgical options like the use of "crutch" glasses to support the eyelid might possibly also be used

Entropion

It is a medical term used to describe sagging and outward turning of the lower eyelid and eyelashes. This rubbing can lead to excessive tearing, crusting of the eyelid, mucous discharge and irritation of the eye

Ectropion

It is a medical term used to describe sagging and outward turning of the lower eyelid and eyelashes.

Common Symptoms of Eyelid Malposition

1. Dry eye and irritation

2. Painful eye

3. Disfigurement of the eyes

4. Excessive watering of eyes

5. Corneal ulcer

6. Photophobia

7. Decreased vision due to visual axis blockage by eyelids or corneal ulcer

Diagnosis and treatment of eyelid malposition needs to be disease-specific and hence requires consultation with an eye surgeon familiar with treating various eyelid malposition.

Eyelid tumours

Cancer of the eyelid can be quite a worrying thing. Treatments are variable and mostly depend on the type of cancer. Eyelid tumors can be of the following types

Benign cysts

These include epidermoid cysts, dermoid cysts, ductal cysts and epidermal inclusion cysts.Because of their benign nature they are easily treatable.

Inflammatory lesions

These lesions include hordeolum (stye), chalazion and parasitic infections.Stye often needs antibiotics and surgical drainage, chalazion benefits from simple observation and hot compresses if required, along with a gentle massage, while parasitic infections could need anti-parasitic medication.

Vascular lesions

Hemangiomas are vascular lesions that can mimic eye tumors. They could be a capillary hemangioma, cavernous hemangioma or a lymphangioma.They are often seen in children. Treatment includes steroids (administered as ointment or injection), laser photocoagulation and surgical excision.

Benign epithelial lesions

These include squamous papillomas, seborrhoeic keratosis, inverted follicular keratosis and keratoacanthoma. They can be removed surgically or in some cases interferon could be used. Some of these lesions might need a biopsy to confirm their benign nature.

Pre-malignant lesions

A number of different eyelid lesions could become cancerous. They include Actinic keratosis, leukoplakia, Xeroderma pigmentosum and radiation dermatosis.Diagnosis is aided by excision biopsy

Viral lesions

Common viral lesions include molluscum contagiosum, verruca vulgaris , herpes simplex and herpes zoster. Molluscum contagiosum is seen in individuals with low immunity, and can cause conjunctivitis. They are treated with cryotherapy or excision. Herpes simplex and zoster are treated with antiviral agents.

Malignant eyelid lesions

These are the cancerous lesions, and include basal cell carcinoma, squamous cell carcinoma, malignant melanoma and sebaceous gland carcinoma.

Basal cell carcinoma is the most common eyelid malignancy, and occurs as a small nodule at the inner aspect of the eye (medial canthus). They are locally invasive and require surgical excision.

Squamous cell carcinoma is not as common, and appears red and scaly with an ulcer in the centre. It is prone to distant spread so must be excised as soon as possible.

Sebaceous carcinoma is seen in elderly population, and can spread to lymph nodes and distant organs. Radical surgery is often needed. Melanomas are rare and could need excision.

Other Eyelid lesions

These include Xanthelasma, nevi and caruncular tumors. Most are benign in nature and require simple treatment. Xanthalesma is associated with high cholesterol levels in the blood.

When to Biopsy

1.skin growth increasing in size

2. mole or birthmark with irregular border and changes in size, thickness or texture

3.6mm large lesion which appears after age 20 and is pigmented

4. sore spot that fails to heal

Ocular trauma

Closed globe injury or Non-penetrating trauma: The eye globe is intact.

Penetrating trauma: Presence of a full-thickness entry wound ,may be associated with prolapse of the internal contents of the eye.

Perforating trauma: The globe integrity is disrupted in two places due to an entrance and exit wound (through and through injury).

Blowout fracture of the orbit

It  is caused by blunt trauma, classically described for fist or ball injury, leading to fracture of the floor or medial wall of the orbit due to sudden increased pressure on the orbital contents. A fracture in the bones around the eye can cause double vision, and a sunken small appearance of the eye. The fracture is repaired with an implant or plate. The best results are obtained in surgery within 2 weeks of injury, but surgery can also be done later.

Orbital tumours

They are the tumors that occurs within the orbit of the eye which is a bony housing in the skull about 2 inches deep that provides protection to the entire eyeball.It is lined by the orbital bones and contains the eyeball, its muscles, blood supply, nerve supply, and fat.

Tumors might possibly develop in any of the tissues surrounding the eyeball or might invade the orbit from neighbouring structures like the sinuses, brain, or nasal cavity, or it might possibly metastasize (spread) from other areas of the body.

What are the symptoms of an orbital tumor?

1. protrusion of the eyeball (proptosis)

2. pain

3 loss of vision

4. double vision

5 .redness

6. swelling of the eyelids

7. obvious mass.

How are tumors diagnosed?

Orbital tumors are most commonly diagnosed with either a CAT scan or MRI. If either of those tests looks suspicious, a biopsy might possibly be performed.

How are orbital tumors treated?

Treatment of orbital tumors varies depending on the size, location, and type. Some orbital tumors require no treatment, while others are best treated medically or with the use of radiation therapy.Some might possibly need to be totally removed by an orbital surgeon. After removal, additional radiation or chemotherapy might possibly be required.

Socket

Enucleation/ evisceration

A highly damaged eye may be replaced with an orbital implant; this restores the comfort and appearance.

Socket reconstruction

where the eye has been removed for a serious disease, the socket of the eye may get shrunken. The socket is reconstructed to improve comfort and appearance

Customized prosthesis

Ocularistry: When an eye has been removed due to disease, it may have a serious impact on the psychological and social well-being of the patient. Ocularistry is the art and science of manufacturing an artificial eye. For customised prosthesis (tailor-made artificial eye) measurements are taken from the patient’s own eye, and colour match is done. Thus the prosthesis fits well, is very comfortable, and looks similar to the patient’s own eye.

Lacrimal (eye watering)

Symptoms of blocked nasolacrimal duct are

1.tearing redness,

2.purulent discharge,

3.tender swollen lacrimal sac.

An infection within the "tear duct" causes a painful swelling in the inner corner of the eyelids.If the tearing causes severe symptoms, surgery can be performed to create a new tear duct. This operation is called "dacryocystorhinostomy

Aesthetic procedures

Your eyes including your eyelids, are perhaps one of the first things people notice in you. This makes your eyes and eyelids one of the most important components for an appealing facial expression and aesthetic appearance. Any visible change in the shape or size of the orbital or periorbital region can spoil the look of your face.

With age the eyelids may possibly become ‘droopy’ or ‘baggy’ due to the stretching of eyelid skin and gradually decreasing tone of eyelid muscles. This can make one look tired and sleepy. In extreme cases saggy upper eyelids can even obstruct vision,causing difficulty in reading or driving.

Blepharoplasty is a procedure by which the skin around the eyes can be tightened to give a more youthful and fresh look to the face

Upper eyelid blepharoplasty (for loose skin)

It assists in the reduction of excess skin and fat in the upper eyelids.

1. Incisions are made on the outside of the upper eyelids. They are barely visible and fade over time.

2. The excess fat is removed through incisions which are finally closed with fine sutures such that it forms an eyelid crease.

Lower eyelid blepharoplasty ( for eye bags)

Lower eyelid blepharoplasty is almost always done for cosmetic reasons - to improve puffy lower eyelid "bags" or to reduce wrinkling of skin. This is done either through a skin incision, called trans-cutaneous approach or through the inner aspect of the eyelid, called trans-conjunctival approach. Incisions made on the inside of the eyelids in the trans-conjunctival approach are not visible.

Special clinics

Thyroid eye disease

Thyroid diseases can also seriously affect the eyes. The eye develops a bulging look; the patient can have itching and burning, discomfort, corneal ulcers, double vision, and even loss of vision.In our thyroid eye disease clinic we monitor the eye health regularly, so that any danger to the eye is prevented. There are various treatment modalities also available to treat the damage caused to the eye.

Botox clinic 

Botox clinic for hemifacial spasm, essential blepharospasm, wrinkle treatment. Due to over-action of muscles around the eye, the eyes can go into spasm – where the face and eyes twitch; patient is not able to open the eyes comfortably. This can be treated safely and effectively by injection of botulinum toxin.