Oculoplasty is surgery with relation to the eye and surrounding structures. Oculoplasty surgery may be performed in order to improve function, comfort and appearance.
For the Eyelids
As people age, they develop droopy eyelids which can impair vision due to the eyelid covering the front of the eye. Excess skin and fat in the upper eyelids is another cause for droopy eyelids. The treatment will be suggested based on examination for your particular situation. Surgery is performed using a local anesthetic.The incision usually placed in a naturally occurring crease in the upper eyelid skin serves to hide the incision. Typically duration for surgery is 1-2 hours and the patient is discharged the same day. Sutures will be removed after a week and other bruising around the eyelids typically resolves over a 1-2 week period.
Tear Drainage Problems
The reasons for watery eyes vary across people. In certain cases, surgery helps 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 spill onto the cheek. If a blockage is present where the drain starts, then, a procedure to widen the drain opening ("punctoplasty") is done. 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. Sometimes, the socket can be affected by injury, inflammation, tumors or any medical disorder. Your doctor would generally suggest a CT or MRI scan in order to evaluate an orbital problem. This is done to determine the location and cause of the problem. The thyroid gland is overactive in people suffering from Graves' disease. Many patients with this problem 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 from case to case and your doctor will discuss your specific findings and treatment plan with you.s 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 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.
