Oculoplastics includes a wide variety of surgical procedures that deal with the orbit (eye socket), eyelids, tear ducts, and the face. It also deals with the reconstruction of the eye and associated structures.
Types of Oculoplastics
Excessive upper lid skin can drape down over the edge of the upper lid and affect vision and aesthetic appearance. This can be treated with a surgical procedure called an upper lid blepharoplasty in which excessive upper lid skin, muscle and sometimes underlying fat are removed. Prior to surgery, patients are carefully assessed by Dr. Glatt for anticipated effects on vision, aesthetic appearance and the health of the surface of the eye. The potential benefits also are considered in the context of the general health of the patient.
Downward drooping of the upper lid is called ptosis. Ptosis is most commonly caused by stretching out of the muscle that raises the upper lid, called the levator muscle. This is corrected with an operation called a levator advancement that isolates the levator muscle and repositions it relative to other structures of the eyelid. Occasionally, more severe forms of ptosis caused by neurologic or muscular diseases, or present at birth, require a different surgical procedure. In such cases, the forehead muscle is used to raise the lid. In this procedure, called a frontalis sling, the forehead muscle is connected to internal structures of the eyelid by a slender silicone rod carefully placed beneath the surface. With any ptosis procedure, great attention is paid to the health of the surface of the eye prior to surgery.
Skin cancers occurring on the eyelids must be removed to avoid damage to the eye. Treatment is surgical. The surgery consists of removal of the cancer, microscopic examination of the excised tissue under a microscope to ensure that the tumor has been completely removed and reconstruction of the eyelid by Dr. Glatt. Reconstruction of the eyelid often requires unique techniques specific to the eyelid.
Benign Eyelid Lesions
Benign eyelid lesions can become irritated, block vision or affect appearance. Removal generally can be performed as a brief procedure in which the lesion is excised and the defect directly closed with sutures. Attention is paid to preserve normal lid function, avoid eyelash loss when possible and maximize cosmetic appearance. More complex reconstructive techniques occasionally are necessary.
Excessive tearing can be caused by a variety of diseases of the eyes, eyelids and tear ducts. Dr. Glatt carefully assesses patients for possible causes of tearing and recommends the most appropriate treatment. Blocked tear ducts are an important cause of tearing and also can cause serious infections near the eye, a condition called dacryocystitis. Treatment for blocked tear ducts usually is surgical. Surgical treatment for blocked tear ducts can range from a brief procedure called a punctoplasty that is performed under local anesthesia to a more involved procedure called a dacryocystorhinostomy that is performed under general anesthesia and involves removing bone to allow connection of the tear sac to the nasal cavity.
The eyelid can roll inward, a condition called entropion. This results in eyelashes striking the eye and causing pain, irritation and scratches. The most common type of entropion occurs in the lower lid and is caused by stretching out of the lid with age. Treatment is surgical and consists of placing sutures to roll the lid outward and tightening the lid with a tarsal strip procedure.
The lower eyelid can roll outward, a condition called ectropion. This can cause tearing, pain, irritation and scratches. The most common type of ectropion occurs in the lower lid and is caused by the combination of stretching out of the lid with age and downward traction caused by scarring of the skin and/or sagging of the face. Treatment is surgical. Successful treatment most commonly requires release of the downward traction, tightening the lid with a tarsal strip procedure and placement of a skin graft.
There are three common types of eyelid spasms: Simple eyelid spasms, benign essential blepharospasm and hemifacial spasm. Simple eyelid spasms tend to affect a single eyelid and resolve on their own with time. Benign essential blepharospasm affects all four eyelids and is treated with Botox injections. Hemifacial spasm affects one half of the face, involves both the eyelids and the lower face and is treated with Botox injections. Botox injections are a brief procedure done in the office. Botox injections generally last for 3 to 6 months, at which point repeat treatment is necessary.
Facial Nerve Palsy
Facial nerve palsies can cause ocular pain and scratches by affecting the ability of the eye to close and causing the lower lid to drop downwards and roll outwards. In milder cases, artificial tears, ointments and nighttime moisture chambers can keep patients comfortable. In more severe cases, surgery can be very helpful. If the lower lid has retraction (displaced downwards) and/or ectropion (rolled outward), patients often get significant relief by an operation in which the downward traction is relieved, the lower lid is tightened with a tarsal strip procedure and a skin graft is placed. Placement of a gold weight in the upper lid can be helpful for some patients. Creation of an adhesion between the upper and lower lids, called a tarsorrhaphy, may be appropriate in some situations.
Removal of the Eye
In rare circumstances, an eye can become severely diseased, blind, disfigured and painful. In these tragic situations, removal of the eye will almost always markedly improve a patient’s quality of life by eliminating their pain and improving their appearance with a glass eye fitted after the surgery. Eyes also rarely require removal due to large cancers or severe trauma.