Orbit & Oculoplasty
Includes eyelid surgery, socket surgery and removal of orbital tumors.
ORBIT AND OCULOPLASTY
The Orbit & Oculoplasty subspecialty at Saraswati Nethralaya is a distinct subspecialty in ophthalmology, which deals with the various diseases of the eyelids and orbits (sockets) including orbital cancer & orbital tumors. These include a vast spectrum of disorders and are managed by Oculoplastic surgeons who are highly trained in the field.
Orbital diseases involve the tissues lying in the bony socket. Generally the eyeball protrudes from its socket, producing a widening of the eyelids. Sometimes the patient does not blink frequently, developing a staring gaze. This may be the result of an endocrine disorder (thyroid disease), inflammation in the orbit or a tumor. Generally these lesions require investigations including CT scan and MRI. Treatment varies from case to case and may involve medical treatment, surgery, radiotherapy, chemotherapy or a combination of these.
A suspicious lid mass needs excision, examination under microscope and reconstruction of the resultant lid defect. Histopathological examination determines whether the lesion is cancerous or not, and the chances of its recurrence. Reconstruction in the form of suturing, tissue flaps from neighboring areas & other lid, and grafts preserve the lid function.
Apart from being cosmetically unacceptable, any irregularity of the lid margin is functionally detrimental to the eye, as lid defects may fail to cover the cornea fully and provide adequate lubrication. An oculoplastic surgeon repairs the injury in a way to make the lid as close to normal as possible.
Lacrimal passage diseases
Normally tears from the eye drain to the nose through the lacrimal passage. In case of any blockade in this passage, watering results. The causes can be incomplete development, seen in young children, or infection, which occurs in adult life. Treatment varies from performing a relatively simple procedure like probing the pathway to open it, to more complex surgery of fashioning an alternative pathway to drain the tears to nasal cavity. This procedure is known as dacryocystorhinostomy (DCR).
Lid margin abnormalities - Ectropion
In this condition the lower lid usually turns away from the eyeball. Ectropion may be due to laxity of the tissue in elderly people or to paralysis of the seventh cranial nerve (the nerve which controls the facial expressions), which causes the weakness of the muscles of the lid. It may also follow cuts, infections, or burns of the lids and face that heal poorly; the resultant scar tissue forms adhesions that cause the lids to turn out. Besides being cosmetically unpleasant, ectropion is accompanied by troublesome tearing and infection. Treatment is surgical rotation of the lid margin and its alignment with the eyeball.
Lid margin abnormalities - Entropion
In a condition known as entropion there is inward turning of the eyelids, causing the eyelashes to scratch the cornea and produce irritation. Tearing and secondary infection as well as an unpleasant looking eye cause the patient to seek medical care. Entropion may be the result of spasm or secondary contracture or strictures from burns, injury or trachoma infection. It may involve the upper or lower lids. An adhesive tape applied to the skin of the lid temporarily may straighten the lid and relive the annoying symptoms. Corrective surgery is usually required for a permanent cure.
Lid margin abnormalities - Trichiasis
Trichiasis is a condition in which there is misdirection of eyelashes. If the eyelashes turn in toward the eyeball and scratch the cornea, they produce a sensation like a foreign body. This condition may result from trachoma (an eye infection), burns or injuries to the lids. Removal of the offending lashes or corrective plastic surgery on the lid relieves the symptoms.
Drooping of the eyelid can be present from birth or develop later in old age. It is a cosmetic blemish but if severe, it restricts vision as well. The treatment in majority of cases consists of surgical correction. Surgery involves either strengthening the muscle, which elevates the lid, called LPS resection, or lifting up the lid with the help of a graft. This graft can be taken from the patientR17;s thigh area or can be an artificial sling material. This procedure is known as Frontalis Sling.When ptosis occurs in adults, it may be the result of a systemic disease, such as myasthenia gravis, which can be treated medically. It can also follow muscle or nerve damage in other parts of the body, or tumors of the lid. When ptosis occurs suddenly in one eye, disease of the brain itself must be considered, and the patient should be seen at once by a neurologist.