Orbit & Oculoplasty :

Oculoplasty is a special discipline in ophthalmology that deals with plastic and reconstructive surgery of the peri-orbital and facial tissues which include the eyelids, orbit and lacrimal system. Services available include management of abnormal eyelid position (entropion, ptosis ), removal of eyelid tumors, lid reconstruction, lacrimal surgery, medical management of orbital infections & inflammations, medical & surgical management of thyroid eye disease, orbitotomy, repair of orbital fractures as well as rehabilitation of anophthalmic socket with orbital implants, BOTOX treatment for various therapeutic purposes and cosmetic enhancement of age related changes in facial skin (orbital fat prolapse, brow ptosis, wrinkles) to a more youthful appearance by a wide variety of cosmetic and functional surgical intervention (Blepharoplasty, brow lift, botox injections).
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Facilities available in Orbit and Oculoplasty department
Surgical and therapeutic

Well-equipped ophthalmic plastic operating rooms.
Radio Frequency Surgical unit
Endoscopy for transnasal procedures
LASER dacryocystorhinostomy
Custom made ocular and facial prosthesis

Eyelid and Eyebrow

Ptosis correction
Entropion and Ectropion correction
Eyelid tumor removal and reconstruction
Blepharoplasty and Brow lift
Botox injections

Lacrimal system

Dacryocystorhinostomy, external, laser and endoscopic endonasal
Management of congenital dacryocystitis

Socket

Enucleation with orbital mplant
Cosmetic evisceration with orbital implant
Socket reconstruction
Custom made artificial eye and facial prosthesis

Orbit

Orbitotomy
Decompression

Trauma

Eyelid trauma repair
Repair of Lacrimal Canalicular Laceration
Orbital fracture repair

BOTOX injections & Cosmetic lid surgeries

What is Orbit?

Orbit is the bony socket in the skull which houses the eyeball and other structures. It is akin to the jewel box which keeps the jewels safe and protected. Apart from housing the eyeball there are a lot of structures in the orbit. The extra ocular muscles, blood vessels, nerves and fat pads and connective tissues make the major contributors to the orbital contents apart from the eyeball.

What is Oculoplasty?

Oculoplasty refers to a subspecialty of ophthalmology which deals with the plastic reconstruction around the orbital region of the face. Conditions which warrant an oculoplastic surgeon intervention is an abnormal rotation or position of the lids, a swelling of the lids, a tumour of the lids, tearing of the eyes and orbital conditions such as fractures and orbital tumours.

What is Ptosis?

Ptosis is the medical term for droopy eyelids. Droopy upper lids may be present in children since birth or present in the early years of life. This condition can obstruct the visual axis in children and cause amblyopia (“lazy eye”). Early intervention usually surgery is imperative in such a condition. Adults can develop ptosis as a consequence of trauma, prior surgery, chronic lid inflammation, long term contact lens use or aging. There are various methods of correcting ptosis depending on the type, degree and severity of ptosis. Recovery from ptosis surgery is usually quite rapid, and patients find themselves returning back to work within a few days.

Tearing from the eye

Tearing eyes is a very common symptom. The causes may vary from emotional tearing to a problem in the ocular surface or swellings causing blockage of the drainage system to a frank block of the lacrimal drainage system of the eye. It is important to consult an oculoplastic surgeon to assess the cause of the block and the tearing. Treatment is generally medical but in some cases surgical procedures may need to be done to correct the drainage system abnormalities and diseases.

What are the abnormal rotational problems of the lids? (Entropion and Ectropion)

The eyelids maintain a close apposition to the globe. The close apposition of the lid margin with the globe maintains a delicate film of the tears known as the tear film. Any malposition of the lids can cause irritation resulting in tearing, pain, discharge and reduction in vision due to corneal surface irregularity. Entropion is a condition in which the eyelid is “turned in” toward the eye. Ectropion is a condition where the lower eyelid is “turned out” away from the eye. Both these conditions need to be surgically corrected to bring the lid back to its normal natural position.
TREATMENT
FAQs

Orbital Surgery

Orbital tumors: The orbit can have all different varieties of tumors. Tumors may arise from the bone, periosteum, blood vessels, nerves, fat and the connective tissues of the orbit. Most tumors mandate surgical removal and histopathological examination to know the nature and characteristics of the tumor and also to know whether it is a benign or a malignant tumor. Aggressive tumors may require coordination with other surgical specialists and oncologists.
Thyroid Decompression: Thyroid Eye Disease or Thyroid Related Orbitopathy (also known as Graves’ disease) is an autoimmune inflammatory disorder that affects the tissues of the orbit (i.e. eyelids, eye muscles and other soft tissues around the eyes.) Thyroid Eye Disease can develop and affect patients with varying degrees of severity. Surgical and non-surgical treatments exist to manage the complications of this condition including eyelid malposition or retraction, ocular proptosis (bulging eyes), and double vision.
Evisceration & Enucleation (removing blind painful eyes): In spite of all ophthalmic endeavors to save the eye and vision there may be situations when the eye may have to be removed. Removal of the eye results in an unacceptable cosmetic deformity which is corrected by the placement of an orbital implant followed later by prosthesis. “Enucleation “is the surgery where the eyeball is removed in entirety and “Evisceration” refers to removal of the contents of the eyeball but leaving the outer coat of the eyeball intact.
Orbital Trauma & Fractures: Trauma to the orbit can result fractures of bones of the orbit. When these fractures cause symptoms such as double vision or when the fracture is large, surgical repair is normally recommended. The surgical repair is typically performed within a few weeks of the injury.

What is DCR Surgery?

DCR (Dacryocystorhinostomy) refers to a surgical procedure to correct tearing of the eyes due to a block in the drainage system of the eyes. There are various ways to do a DCR procedure. It may be done from the nose (Nasal endoscopic DCR)or from the skin or external approach. There are lasers to assist in the procedure as well. The oculoplastic surgeon will discuss and decide on the best option for the patient.

What is BOTOX?

Botox or Botulinum Toxin A is a toxin derived from the bacteria Clostridium botulinum manufactured by Allergan, USA. BOTOX is injected into muscles and used to treat certain types of eye muscle problems (strabismus) or abnormal spasm of the eyelids (Blepharospasm) and face ( hemifacial spasm)in people 12 years and older. Blepharospasm (BLEH-far-o-spaz-em) is a muscle disorder that causes involuntary spasms of the muscles around your eye. Botox is a US FDA approved drug for the treatment of Blepharospasm and millions of patients have benefitted from the drug worldwide. Botox injection is an outpatient procedure and the results will be discussed by the oculoplastic surgeon.

What is Artificial eye (Prosthesis)?

Following removal of an eye the orbital socket is “empty”, or devoid of the eye. The deficiency of volume is corrected by the placement of an orbital implant. This though corrects volume it does not provide adequate cosmesis. An artificial eye or prosthesis is the cosmetic answer to the problem.

Ocular prosthesis is made of a very fine medical grade plastic that is molded, colored and polished to create a realistic and comfortable artificial eye. The plastic is lightweight, yet tough enough to resist breakage if dropped. Each artificial eye is custom made and designed to specifically fit the individual eye socket. The ocular prosthetic is hand painted using the patient’s companion eye as a model and guide for matching. Our methods and technique allow us to create a custom prosthetic eye with the best possible cosmetic results.

What are the cosmetic lid surgeries?

Cosmetic surgeries can be performed around the lids, both upper and lower lids, for facial enhancement. Surgeries involved are upper and lower lid blepharoplasty and brow lifts. Surgery is done to correct “puffy” upper lids and lower lid “bags”. The “puffy lids” and lid “bags” occur due prolapse of orbital fat following a defect or thinning of the orbital septum. The incisions given for the procedures are either given subconjunctivally or masked along the existing lid folds to give an excellent cosmetic result. The excess or prolapsed fat is either removed or readjusted over the face to correct cosmetic blemishes. Recovery from the surgery generally takes about 7 to 14 days.

Brow ptosis is a droop of the brow giving rise to a “tired aged” look. Conversely brow ptosis may exist along with ptosis of the lids. There are many different ways to correct brow ptosis, your surgeon will discuss the options and pros and cons of each procedure before planning the surgery. When there is an additional ptosis of the lids along with brow ptosis, both the problems can be addressed together.

Some patients may have “crow’s feet” appearance at the outer aspect of the eye lids. Crows feet give rise to an aged appearance and are usually prominent when patients smile or laugh and are also known as dynamic wrinkles. These are corrected using a combination of BOTOX injections and filler injections. The cosmetic acceptance following these procedures is very high.

FAQs:

Why are eyelid swellings important to consult an oculoplastic surgeon?

There are many types of eyelid swellings, some can be observed safely while others should be biopsied or completely excised. Depending on the location and other general characteristics of the swelling a decision will be taken whether to biopsy the swelling or to completely remove the lesion. Some of the most common benign eyelid lesions are chalazion (stye), cysts, skin tags, and nevi (moles).

Facial weakness and the oculoplastic surgeon

Weakness of the facial nerve will lead to weakness on one side of the face. Depending on the severity of the weakness, the eyelids and eye itself can be affected. There can be weakness in blinking and closing the eyelids that can result in irritation, pain, and a potential risk for infection. Surgical and non-surgical techniques are available to protect the eye and provide symptomatic relief and functional improvement.

Article by
Sankara eye care