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OCULOPLASTY

What is Oculoplasty ?

Oculoplasty is a precise ophthalmological plastic surgery. This micro surgery is performed to correct/ aesthetically enhance/ reconstruct the areas around the eyelids, orbit and the tear drainage system. Surgical cuts are kept to a minimum and made along natural skin lines to hide scars.


Common Oculoplasty Conditions

Eyelid Defects

Loss or absence of eyelid tissue leads to eyelid defect. It can be seen in children at birth, caused by injury, burns and after surgical removal of eyelid cancer. The size and location of the defect determine the complexity of surgery. Skin from the surrounding area is often used for the same. Along with this, grafts maybe taken from the opposite eyelid, behind the ears, inside the mouth and various other areas. All these surgeries are done to preserve vision, maintain the function of the eyelid and improve the look of the patient.


PTOSIS | Drooping of the eyelid

Ptosis can range from a mild, barely noticeable droop to a severe droop that can cover the pupil and affect vision. Weakness in the muscle that lifts the eyelid leads to Ptosis in most cases. It can affect one or both eyes. It can be by birth (congenital) or acquired later in life.





In Child

Ptosis present in the child from birth (Congenital) can be associated with the eyelid changing its position when the child opens his mouth. To correct it, the weak levator muscle in the eyelid has to be strengthened by a surgery. In case of severe muscle weakness, an artificial sling material or material taken from own thigh is used to strengthen the same.


In Adult

Ptosis in adults is usually due to age related weakness or detachment of the eyelid-lifting muscle from its natural place. If severe, it can interfere in sight. It can be corrected by reattaching the muscle, surgically, before which the ophthalmologist needs to rule out the possibility of neurological causes.


Eyelid Retraction



Sometimes asymmetry of eyelid position can be due to eyelid retraction ( widening of aperture) . This can be corrected surgically to achieve symmetry in the level of the two eyelids.


Watering and Tearing Eyes

Watering eyes is a common problem especially amongst old aged people. Tearing eyes (Epiphora) is excessive watering from the eyes that result in overflow of tears.





Causes & Treatment

In Child

• Blocked or incompletely opened tear duct.
• Congenital glaucoma, watering along with sensitivity to light and big prominent eyes.
• Allergies.

In Adult

• Blocked tear duct
• Laxing of the muscles that hold the inner part of the eyelid against the eyeball.
• Eyelid abnormalities like eyelid turned outward or inwards or ingrown eyelash.
• Any eye infection or eyelid inflammation.

Treatment depends on the cause. Eye allergies and infections can usually be treated with drops. Eyelashes irritating the eye can be removed. Outward or inward turning eyelid can be treated with a minor surgery of the eyelid. Watering of eyes not amenable to surgery can be significantly reduced by giving a Botox injection in the tear gland. Treatment of tear duct obstruction Babies with tear duct obstruction usually grow out of it with conservative treatment. Massage over the lacrimal sac area as taught by the eye specialist along with eye drops helps in opening the blockage. If, even after this, eyes continue to tear beyond 9 months of age, a duct opening procedure is performed. In Adults a blocked tear duct can be treated with an operation where a new channel is created so that the tears can bypass the blockage in the tear duct.


Eyelid Masses & Tumours

Lid Tumour

Benign tumours such as cysts, nevus etc can be removed and the defect is closed by meticulous suturing to give the desired result. Cancerous (malignant) tumours require complete removal of the tumour and upto a certain extent surrounding normal tissue. This leads to a larger visible defect, which can be closed by using a combination of oculoplastic reconstruction techniques.





Orbital Tumour


Orbital tumours can develop in the tissues surrounding the eyes at any age. They look like a swelling around the eye and sometimes cause forward protrusion and displacement of the eye. A meticulous and complete tumour removal is required without causing any damage to the critical structures around the eyes. Surgery method needs to be selected so as to minimize the scar and hide it along the natural creases.

In the example here, Cancer tumour in the inner corner of the left eyelid has been removed and the defect has been reconstructed with oculoplasty.




Eye Removal & Restoration

Removal of eyeball or its contents may be required in cases of an eye tumor or a blind disfigured painful eye. Loss of the eye affects the person’s life significantly. In such a case, restoring the appearance of the face becomes critical for one’s self-image and self-confidence.




The restoration after removal of eye requires two components:

• An orbital implant to replace the volume of the eye which is placed to replace the eyeball at the time of surgery. • An artificial eye (or prosthesis) is placed in the eye socket tissue after few weeks by an ocularist. As eye contact is an essential part of human interaction, this surgery has to ensure that the patient will be able to maintain natural-appearing eye contact even with the artificial eye. Even after successful surgery upper eyelid hollowness, lower eyelid looseness, upper eyelid ptosis can develop. These can be corrected with small procedures and regular follow up is important.

Peri-ocular Trauma Peri-ocular Trauma is trauma to the eyelids or the orbital space around the eyes. Prevalent in road accidents, it is associated with facial trauma in some cases. Eyelid trauma can be a simple tear or it can be associated with damage to other important structures like the tear drain system, muscle that lifts up the lid and sometimes even the eyeball. A meticulous repair of the eyelids and the damaged structures within immediate few hours of the mis-hap, help the patient regain the affected functionality and aesthetics through Oculoplasty.

 

Orbital Fracture

When one or more bones around the eye are broken due to trauma, the condition is called an orbital fracture. This may involve the roof, floor, lateral or medial walls of the orbit. Such a fracture could result in swelling of the eyelids, pain in the eye, double vision, bruising around the eye, sunken eye, numbness of upper teeth and decreased movement of the affected eye. Based on clinical examination, usually a CT scan is done to confirm the diagnosis as well as to know the extent and location of the fracture. It is possible that one of the muscles which move the eye may be entrapped in the fracture, which would need a surgical repair at the earliest.


  Oculo-facial Aesthetics 

Eyes are the centre of an individual‘s expressiveness and attractiveness. Cosmetic eyelid and facial plastic surgery embraces a number of procedures to correct the hooded or baggy eyelids and improve the aesthetic appearance of the eyelids and surrounding area of the face, including the eyebrows, forehead and mid-face. Blepharoplasty is a surgical procedure to remodel excess tissue – skin, muscle and sometimes fat, from the upper and/or lower eyelids.



Brow lift is a surgical procedure to raise the level of the drooping eyebrows and forehead, often done in association with upper eyelid blepharoplasty. The aim is to correct eyebrow drooping. These surgical procedures are often combined with the use of botox injections to smoothen the deep activity lines and filler injections to correct the hollow lines of the face.