Oculoplasty & You

Ophthalmic plastic surgery or 'Oculoplasty' is the branch of ophthalmology that deals not only with the diseases of the eye, but also important structures around the eyes like eyelids, eyebrows, orbit and the tear system which are vital to the normal appearance and function of our eyes - viz Cosmetic Eye Surgery.
Common Conditions needing Oculoplastic Surgeries
  • Eyelid Lift (Blepharoplasty)
  • Entropion
  • Ectropion
  • Eyelid Drooping (Ptosis)
  • Eyelid and Skin Cancer Reconstruction
  • Facial Spasms (Eyelid Spasm) and Botulinum toxin injection
  • Surgery for a Watering Eye (DCR Surgery)
  • Thyroid Eye Disease
  • Orbital Surgery
  • Trauma and Maxillofacial Surgery
  • Evisceration / Enucleation with customized Prosthesis
Major procedures available for lid diseases
  • Blocked Tear Duct (Dacryocystitis)
  • Lid turning outwards (Ectropion) or inwards (Entropion)
  • Drooping of Eyelids
  • Prosthetic / Artificial Eye

Blocked tear ducts

Watery eyes are a sign of blocked tear ducts. A blocked tear duct prevents tears from draining out of your eyes. As a result, your eyes become watery from the tears that accumulate. Newborns, young children, and older people (above 60 years of age) are most likely to suffer from this condition.
Causes of the block in the tear duct

Ageing – as we get older, the tear duct openings may get narrower

Inflammation

Eye injury

Tumors

In some cases, newborn babies may be born with unopened tear ducts

Treatment of blocked tear ducts

Blocked tear ducts can affect your quality of life. You must get them treated, especially if you have other eye conditions. Luckily, the condition is treatable. The exact treatment will depend on what caused the blocked tear duct.

It could include:

  • Medication to treat an infection
  • Special tear duct massage (mainly for babies)
  • Probing – using a thin rod to open the tear ducts in children
  • Tubes to drain the tears through the nose

Dacryocystorhinostomy (DCR) is a very common procedure. Medications and massage may be able to treat the underlying causes, but not fix the block. That is why surgery is the only way to treat the tear duct block completely. Reopening the tear duct is possible with this surgery. The surgery will be carried out under anesthetic so you will not feel anything.

Drooping of Eyelids

Eyelid drooping (Ptosis) is when the upper eyelid droops over the eye. Symptoms include an abnormally low eyelid that doesn't impair vision. Drooping can be so severe that it covers the eye and blocks vision in severe cases.

The most common type of eyelid droop is congenital. Normally, it appears at birth. Babies can be born with ptosis if their eyelid muscles are too weak to hold their eyelids open.

Drooping of the upper eyelids is most commonly caused by aging. With time, the muscles of the eyelid can weaken, causing the lids to droop.

Symptoms and Causes of Droopy Eyelids

Both congenital and acquired eyelid droop are commonly caused by weak eyelid muscles.
Risk factors include:

Old age (for acquired eyelid droop)

Injury

Surgery

Muscular disease

Neurological disease

If your child has congenital eyelid droop, get their eyes checked by an eye doctor for other disorders. In some cases, ptosis may be linked to other eye conditions.

Treatment Eyelid Drooping

Surgery is strongly recommended for severe eyelid droop. It is a safe, effective way to improve your quality of life. In all cases, surgery makes the eyelids look normal. This boosts confidence and makes it easier to lead a normal life. If your eyelid covers your eyes, surgery will also raise the eyelid so it no longer blocks your vision!
Entropion & ectropion

As we age, the tissues holding the lower eyelids in place begin to loosen. This can be caused by trauma, surgery, medication side effects, and certain medical conditions including sleep apnea, skin cancer and Bells palsy. It can worsen with rubbing, smoking and side or face sleeping. This can lead to an eyelid that droops, turns outward (called Ectropion), or turns inward (called Entropion) toward the eye. A poorly positioned lower eyelid can lead to irritation, tearing and even damage of the ocular surface and may need repair.

Ectropion

Ectropion occurs when the lower eyelid turns outward and no longer hugs the surface eye. The conjunctiva can become exposed, red and irritated. The cornea can become irritated, scratched or even scarred, affecting the quality of your vision. Finally, the tear duct can turn away from the tear lake as the lid loosens, leading to tearing. Ectropion can affect one or both of the lower eyelids.

Causes of Ectropion

Relaxation of eyelid tissues due to aging

Chronic rubbing during the day or while sleeping

Skin damage from sun and/or smoking

Eyelid or facial surgery for cosmetic or functional concerns

Skin cancer

Trauma

Facial nerve palsy

Symptoms of Ectropion

Excessive tearing

Mucus discharge

Impaired vision

Redness

Ocular surface irritation and itching

Sagging skin around the eye

Sensitivity to light and wind

Treatment and management of ectropion

Artificial tears and lubricating ointments can be used to moisten the ocular surface to provide some relief. However, when symptoms do not respond to simple measures or if corneal scarring becomes a concern, surgery will be recommended to address ectropion.

Entropion

Entropion occurs when the lower eyelid and eyelashes turn inward towards the eye causing the eyelid and lashes to rub against the cornea and conjunctiva. This can lead to severe ocular surface irritation and early corneal scarring. As corneal scarring can lead to vision loss, surgical correction of entropion is generally recommended.

Causes of Entropion

Relaxation of eyelid tissues due to aging

Chronic rubbing during the day or while sleeping

Scarring on the inner surface of the eyelid

Trauma

Eyelid or facial surgery for cosmetic or functional concerns

Symptoms of Entropion

Excessive tearing

Mucus discharge

Ocular surface irritation and itching

Impaired vision

Redness

Sensitivity to light and wind

Treatment and management of entropion

As with ectropion, artificial tears and lubricating ointments can be used to moisten the ocular surface to provide some temporary relief. Alternatively, tape or sutures can be used to reposition the eyelid and protect the eye temporarily. If entropion does not resolve quickly, you might be prescribed a surgical plan to repair the eyelid position and protect your ocular surface. If you believe you are experiencing eyelid malposition, it is best to see your eye care physician immediately for a diagnosis and treatment plan.

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