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What is Oculoplastic Surgery? Oculoplastic surgery is performed by surgeons who are trained in plastic and reconstructive surgery as it relates to the eye and surrounding structures. The surgeons have also completed full training as eye surgeons (ophthalmologists). There are several conditions for which you might be referred to an oculoplastic surgeon. Aging and the Eyelids Many people develop droopy eyelids, or "ptosis", as they age. As the eyelid droops, vision may be impaired due to the eyelid covering the front of the eye. In addition to droopy lids, many people also develop excess skin and fat in their upper eyelids as they age. Your doctor will determine whether you have ptosis, excess skin or fat of the eyelids, or a combination of these, and will suggest treatment for your particular situation. Surgery is performed using a local anesthetic. The incision is usually placed in a naturally occurring crease in the upper eyelid skin, which will serve to hide the incision. Surgery typically takes 1-2 hours and you are able to go home the same day. Usually, you will be seen one week after surgery to remove your stitches. Some bruising around the eyelids occurs in all patients and typically resolves over a 1-2 week period. Insurance often covers these procedures, but certain criteria must be met. Your surgeon will take photographs of your eyelids and perform vision testing as part of the evaluation process. Tear Drainage Problems There are many reasons for people to have watery eyes. In some cases, surgery may be able to reduce the amount of watering. The tears normally drain from the surface of the eye through the eyelids and into the nose. If the drainage system is blocked, the tears cannot leave the surface of the eye and may spill onto the cheek. Your surgeon will determine whether the drainage system is working properly or if a blockage is present. If a blockage is present where the drain starts in the eyelid ("punctum"), your surgeon may suggest a procedure to widen the drain opening ("punctoplasty"). This usually takes 20-30 minutes and is performed with local anesthesia. If the blockage occurs further in the drainage system pathway ("nasolacrimal duct"), you may require surgery to bypass the blockage and create a new pathway for tears to drain into the nose. The surgery, called DCR ("dacryocsytorhinostomy") takes approximately 1 hour and is typically performed while you are under general anesthesia. The procedure has a very high success rate (>90%), but some patients may require additional surgery to improve their tearing. Eyelid Malposition The eyelids are designed to protect the eyes. As we age, the lids may stretch and pull away from the surface of the eye, and may also turn in ("entropion") or turn out ("ectropion"). This may cause the surface of the eye to become irritated and may cause the eye to water. Surgery can often restore the normal position of the eyelid. The procedure is performed under local anesthesia and typically takes under an hour. Most patients notice improvement of their symptoms in the first few weeks after surgery. Skin Cancers of the Eyelid We are all at risk for developing skin cancer. Fair skin and increased exposure to sunlight increases this risk. The eyelids and face are common locations for skin cancers to develop. The most common types of skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma. You should inform your doctor about any growths on the eyelid or face that you are concerned about, whether they be new or old, especially if they have increased in size. Each lesion will be evaluated and your doctor will discuss with you if they should be biopsied and/or removed. In most cases, the diagnosis cannot be made until a biopsy is performed. The biopsy usually takes 15 minutes and is performed using local anesthesia. If the biopsy shows skin cancer, additional surgery may be necessary. The amount of additional surgery depends on the type and extent of skin cancer present, with the goals of removing the entire tumor and to reconstruct the eyelids to protect the eye. With these goals in mind, surgery will be planned to offer the best cosmetic outcome possible. The Orbit ("Eye Socket") The eye socket contains the muscles that move the eye and the bones and fat that protect it. Occasionally, the socket may be affected by injury, inflammation, tumors, or by certain medical disorders. If you are referred for evaluation of an orbital problem, your doctor will likely order a CT scan or MRI to assist in determining the location and cause of the problem. One of the most common medical conditions to affect the orbit is Graves' disease. In Graves' disease, the thyroid gland is overactive. Many patients with this disorder have manifestations in their eyelids and orbits, including bulging of the eyes ("proptosis"), restriction of eye movements and double vision, abnormal eyelid position, irritation of the eye surface, and occasionally vision loss. Some patients with eye manifestations of Graves' disease will be required to have additional surgery in order to decrease the risk of vision loss, reduce the bulging of the eyes, straighten the eyes and reduce double vision, and/or reposition the eyelids to a more normal location. Manifestations of Graves' disease vary widely and your doctor will discuss your specific findings and treatment plan with you. Anophthalmia (Loss of an Eye) The loss of an eye, understandably, is very difficult for the patient. The oculoplastic surgeon is one member of a team to assist with this transition and assist in ensuring the best possible outcome. After the eye has been removed, an implant is placed in the eye socket and the muscles that moved the eye are usually attached to the implant. After the socket has healed, the patient is seen by an "ocularist" who fits them with a prosthesis. This is referred to as a "glass eye", although they are not glass and have excellent cosmetic appearances. Patients typically continue to see the oculoplastic surgeon periodically after surgery in order to ensure the health of the socket. Your doctor will make sure that you have a comprehensive eye care professional involved in your care to assist in maintaining the health of the remaining eye. |
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