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Oculoplasty clinic Oculoplastic Service
The eyelids and structures
around the eye are critical for vision. Injuries, congenital defects, aging
changes and tumors affecting the eyelids as well as the tissues and bones
surrounding the eyes can cause pain, eye damage, vision loss and disfigurement.
In addition, changes in the eye's appearance can decrease one's ability to
interact in social settings and in the workplace. And, the tragic loss of an eye
because of injury or disease can decrease one's confidence and impair
self-image.
Left eye is prosthetic
Eye Specialty Hospital surgeons
can perform implants, reconstruct eyelids and eye sockets, correct
eyelid-position abnormalities, remove growths and rebuild critical ocular
structures. If an eye has been removed, state-of-the-art prosthetic implants are
used to restore the natural look and motion of the eye. Eye Specialty Hospital
oculoplastic surgeons can rebuild the lids and structures around the eye not
only to improve function but also to allow patients to look and feel natural
again.
Typical conditions treated at this service include
Oculoplastic surgery Orbital fractures and trauma Orbital tumors and cancer Eyelid and eye socket reconstruction Evaseration of the eyeball contents and re construction -
Enucleation (removal of the eye) and reconstruction after removal of the eye.
Oculoplastic Surgery
Our eyes say so much about us.
They reveal what we think and they express what we feel. But sometimes, because
of heredity or the aging process, our eyes do not convey the full range of human
thoughts and emotions.
"Tired" eyelids or droopy
eyebrows can make a person look constantly sad and worn out. An injury to the
eyelid or orbit or certain health conditions, such as Graves' disease may cause
an abnormal appearance as well as damage to the function of the eye. In addition
to aesthetic concerns, heavy eyelids and eyebrows can obstruct vision, creating
an unnecessary limitation.
Any number of eye conditions
can be corrected through cosmetic plastic surgery in which the appearance of the
eye can be improved to produce a younger, brighter, less tired look. Cosmetic
eye surgery at Wills Eye consists of plastic surgery of the upper eyelids, lower
eyelids and eyebrows. This service also offers chemical peels, laser resurfacing
and cosmetic skin treatment advice.
During your initial
consultation, surgeon at Eye Speciality Hospital will advise you as to whether
or not you are a candidate for cosmetic eye surgery. Complications are rare but
your physician will discuss these with you in detail, as well as your
expectations. Cosmetic eye surgery is performed in an outpatient operating room.
Before the procedure begins, you will receive local anesthesia administered by a
physician so that you are comfortable and do not feel any pain during surgery.
Following surgery, you will be prescribed medication to reduce any pain. A
regular follow-up examination will be scheduled. Following surgery, most
patients are able to return to work within one week.
Baggy Eyebrows
Baggy Eyelids
Blepharoplasty
Brow Lifts
Bulging Eyes
Droopy Eyelids
Dry Eyes
Excessive Tearing
Eye Tumors
Wrinkles
Baggy Eyebrows
Excessive skin below the eyebrow (between the brow and the eyelid). Also
referred to as "heavy" or "droopy" eyebrows. Brow lift surgery is performed to
remove excess skin in order to improve one's appearance and visual function.
Baggy Eyelids (Dermatochalasis)
Excessive skin on the upper or lower eyelid. Baggy eyelids are sometimes
referred to as "puffy" or "heavy" eyelids. While some people are born with heavy
or "dreamy" eyelids (congenital ptosis), others may develop bags as a result of
the aging process or injury. Blepharoplasty is the name of the surgery that is
performed to remove baggy eyelids to improve appearance.
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Blepharoplasty
Upper eyelid blepharoplasty is the surgery performed to reduce excess skin and
fat in the upper eyelids. During surgery, the surgeon makes small cuts
(incisions) in the natural contours and creases of the upper eyelids. Excess
skin and fat is removed and reshaped. The incisions are then closed with tiny
sutures (stitches). Because the incisions are made within the eyes' natural
contours, they are barely visible and the scars fade over time.
Lower eyelid blepharoplasty reduces excess fat or skin in the lower eyelids. The
surgeon makes incisions in the inside or outside of the lower eyelids and gently
removes excess fat. The incisions are then closed with tiny sutures. Incisions
made on the inside of the eyelids are not visible. Incisions made on the outside
of the lower eyelids are barely visible and the scars fade over time.
Sagging eyelids and puffy bags can make one appear older and more tired than you
feel. Eyelid surgery, or Blepharoplasty, is a procedure that strives to minimize
those effects and restore a more youthful appearance.
See photo
Upper eyelid blepharoplasty: Used to remove excess skin that hides the natural
creases, loose skin that hangs from the upper eyelids or puffiness in the upper
eyelids.
Lower eyelid blepharoplasty: Used to remove " puffy bags," dark circles, and
excess skin from the lower eyelids.
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Ectropion
When the lower eyelid turns outward, this condition is called ectropion. When
the lid turns inward, this is called "entropion."
When someone experiences ectropion, the eyelid skin may rub against the eye,
leading to excessive tearing, mucous discharge as well as crusting of the eyelid
and a general uncomfortable feeling that something is in the eye. This condition
can also affect vision.
Ectropion occurs when the skin of the eyelid become weakened as a result of
aging. However, it can result from chemical or thermal burns, conditions such as
cicatricial pemphigoid, or allergies. Though rare, some children are born with
ectropion.
To prevent damage to the eye, surgery is recommended to repair entropion. This
is achieved when your surgeon tightens the eyelid and it's adjacent muscles. This
is usually performed on an outpatient basis under local anesthesia. After
surgery, you will have to wear a patch over the treated eye for a short period.
You will also need to use a topical medication for about a week.
Cicatricial Ectropion
When scarring causes the lower eyelid to roll outward, away from the eye, this
is called "cicatricial ectropion." The scarring may also involve the skin, the
tissue just below the skin as well as the muscle or nostril. As a result,
cicatricial ectropion can cause a drying of the cornea.
When the lid turns outward and is caused by a process that does not involve
scarring, this is called "ectropion." When the lid rolls inward, this is called
"entropion." There are other variations of these conditions, paralytic
entropion, which are described elsewhere. Click on these terms for more
information on them.
When someone experiences cicatricial ectropion, the eyelid skin may rub against
the eye, leading to excessive tearing, mucous discharge as well as crusting of
the eyelid and a general uncomfortable feeling that something is in the eye.
This condition can also affect vision.
Cicatricial ectropion can develop from aging skin changes, sun damage, chronic
dermatitis, or injuries caused by chemical, heat or radiation burns. It can also
develop after surgery or as a result of an infection such as herpes zoster
("shingles"). Congenital ectropion is caused by a shortage of eyelid skin and
may be related to other conditions such as blepharophimosis syndrome,
euryblepharon and congenital ichthyosis.
To prevent damage to the eye, surgery is recommended to repair cicatricial
ectropion. This is achieved when your surgeon tightens the eyelid and it's
adjacent muscles. This is usually performed on an outpatient basis under local
anesthesia. After surgery, you will have to wear a patch over the treated eye
for a short period. You will also need to use a topical medication for about a
week.
blepharospasm
Involuntary Eyelid Blinking
Blepharospasm (pronounced "bla-for-o-spaz-m") is the name for a condition in
which the eye blinks excessively and involuntarily. It usually occurs in persons
in their 50's or 60's, and to women more commonly than men.
While it's cause is not yet known, it is believed that blepharospasm is caused
when there is a miscommunication among the signals between the brain and the eye
muscle. The patient may also experience spasms of the face and neck muscles as
well. Some people may have an episode of blepharospasm while for others, it
becomes a chronic condition.
Blepharospasm is also known as dystonia (impaired or disordered muscle tone) or
dyskinesia (a defect in voluntary movement).
It is important to have blepharospasm evaluated by a trained eye health
professional because it may be a symptom and not a condition unto itself.
Sometimes, blepharospasm may be the result of dry eye, eye infection, corneal
disease, acute glaucoma or several other types of ocular conditions.
Stress, fatigue, bright lights, and situations where one may need to stare ahead
(watching television or driving) may exacerbate blepharospasm. However, a
variety of relaxation techniques may decrease symptoms temporarily.
Treatment for blepharospasm include medications, local injection of botulinum
toxin (also known as "botox" injections which are used for cosmetic purposes)
and surgery. As with treatment for any kind of condition, it is important to
discuss with your physician the treatment that works best for you.
Use of Botox injections
Botox®
Every smile, laugh and frown leaves a permanent record on the face. Examples of
these are the deep wrinkles seen on the forehead, the frown wrinkles seen
between the eyes when angry, and the lines that extend from the nose to the
mouth. Over time, wrinkles and lines are likely to become deeper.
Dynamic lines (caused by the contractions of the underlying facial muscles, such
as furrows and frown lines) can be dramatically softened through a series of
injections with Botulinum Toxin Type A, better known as BOTOX®Cosmetic. BOTOX®
blocks the nerve impulses to the facial muscles that control expression lines
and relaxes them so they do not contract. The result is that the overlying skin
remains smoother and unwrinkled.
BOTOX® is a registered trademark of Allergen, Inc
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Brow Lifts
Coronal Brow Lift
This procedure raises the eyebrows and reduces creases and wrinkles on the
forehead as well as excess skin at the bridge of the nose. The surgeon makes an
incision across the top of the head, a few inches above the hairline. The brow
and forehead are lifted upward and excess skin is removed. The incision is
closed with sutures.
Direct Eyebrow Lift
This procedure elevates drooping eyebrows by removing excess skin above the
eyebrows. The surgeon makes incisions directly above the eyebrow and removes
excess skin. The incisions are closed with fine sutures. They fade over time and
can be covered by makeup. In men, thick eyebrows hide the scars very well.
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Bulging Eyes (Exophthalmos)
When an abnormal amount of the eye "white" is exposed, it may be because the
eyeball is pushed forward. When this happens, the cause is often a swelling or
growth that occurs behind the eye. The eye may feel dry and the patient may have
difficulty seeing and may have double vision or blurriness. The eyelid may not
close properly.
The most common cause of bulging eyes is Graves' disease, a type of
hyperthyroidism (which is an overactive thyroid gland). Other causes may be eye
tumors or an eye infection.
If one or both of your eyes bulge, it is important to see an ophthalmologist
immediately.
Graves' Disease
In Graves' disease, the thyroid gland goes into overdrive and produces more
hormones than the body requires. As a result, people with Graves' disease become
very "hyper," and exhibit a variety of symptoms: weight loss despite increased
appetite, irritability, heat intolerance, irregular heartbeats, and in women,
changes in menstrual cycles.
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In addition to these symptoms, some people with Graves' disease develop skin
problems that cause the lower legs to become red, shiny and swollen. Until the
patient receives treatment for Graves' disease (see below), creams and lotions
can temporarily relieve some of these symptoms.
Another condition that may develop with Graves' disease is bulging of the eyes.
This is caused when fluid builds up behind the eyeball, causing it to protrude
out of the orbit. In addition to the cosmetic changes this causes to the eye,
thyroid eye disease includes additional symptoms such as dry eye, redness and
swelling, excess tearing, sensitivity to light, blurring and double vision.
Currently, there are three treatments for Graves' disease. Together with your
physician, you can discuss which one is best for you.
Anti-thyroid medications which block the affects of the excess thyroid hormones.
One-time treatment with radioactive iodine, which essentially destroys the
thyroid gland. Afterward, the patient will need to take thyroid hormone
replacement drugs.
Surgery to remove most of the thyroid gland. As with radioactive iodine
treatment, the patient will need to take supplemental thyroid medication after
surgery.
The Thyroid Gland
Located on either side of the windpipe, the thyroid gland is responsible for the
production of hormones that communicate with many of our biological systems,
including metabolism, body temperature, energy and fertility.
Under normal circumstances, the thyroid is controlled by the pituitary gland,
which works in tandem with the thyroid to deliver the correct amount of hormones
when needed by the body.
In Graves' disease, the thyroid gland goes into overdrive and produces more
hormones than the body requires. As a result, people with Graves' disease become
very "hyper," and exhibit a variety of symptoms: weight loss despite increased
appetite, irritability, heat intolerance, irregular heartbeats, and in women,
changes in menstrual cycles.
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Droopy Eyelids
Individuals who have "droopy" eyelids have a condition called "ptosis"
(pronounced "toe-sis"). This occurs when the tiny muscle and tendon that lifts
the eyelid becomes weak or slack, causing the upper eyelid to hang too low over
the eye. This often impairs vision. In order to see better, people with ptosis
sometimes lean their head back, raise their eyebrows or physically lift the lid
with their finger.
Ptosis can be congenital, meaning that a person was born with the condition.
Children with droopy eyelids tend to have additional eye problems, such as
amblyopia or "lazy eye," strabismus (eyes that may cross or be unaligned),
astigmatism, refractive errors or blurred vision. Ptosis can also be acquired,
as a result of aging. Acquired ptosis can occur as a result of cataract or other
eye surgery, when the tendon may become weakened.
Blepharoplasty is the name of the surgery that is performed to repair droopy
eyelids.
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Dry Eyes
Tear Ducts (Lacrimal Drainage)
The lacrimal gland is an important part of the eye. It is responsible for making
tears and keeping the eye moist. A delicate balance is maintained by the
lacrimal glands, which manufacture the tears, and the tear ducts, which are
responsible for draining the tears from the eyes. Damage to the tear ducts can
result in "dry eyes" or "wet eyes."
Dry eye occurs when the lacrimal gland fails to properly moisten the eye. This
must be corrected surgically or with artificial lubricants to control the
drying.
When the lacrimal system does not produce enough tears to properly wet the eye,
the surface of the eye dries out. If this happens, your eye will feel gritty and
it may burn or sting.
Over-the-counter or prescription eye drops may temporarily resolve the
situation, but it is important to see your ophthalmologist if you continue to
have dry eyes. You may have a problem that requires more than a superficial
solution. Chronic dry eyes can lead to an eye or tear duct infection.
If medication fails to correct dry eyes, a procedure may be performed that
involves the insertion of silicone or collagen plugs to keep the tear drainage
ducts open allowing tears to remain in the eye. This procedure is called
"dacryocystorhinostomy."
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Excessive Tearing
Eyes that continually water may have damage in the lacrimal system, the part of
the eye that is responsible for producing tears. Normally, our eyes tear when we
cry or when we are exposed to certain smells (like onions) or irritations (like
allergies). However, the ducts that make up the lacrimal system can sometimes
become blocked. This may be caused by an injury or an infection. Tearing may
also be due to loose lower lids (lacrimal pump dysfunction) or even dry eye
syndrome.
Also, children can be born with a blockage of the tear duct. With no place to
go, tears become stagnant within the duct, leading to infection. You may notice
crusting or pus to collect around the eyelids. Sometimes these obstructions
resolve on their own. At other times, children may need to see an ophthalmic
surgeon to correct the problem.
If your eyes tear excessively, be sure to see an ophthalmologist as soon as
possible.
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The lacrimal (tear) system is a miniature drainage network which prevents tears
from continuously rolling down the cheeks.
From the surface of the eye, the tears flow along the edge of the lids toward
the nose. Just before reaching the corner of the eye, the tears slide into two
tiny drain tubes, and then into a larger tube which carries the tears into the
nose. This explains why crying often causes one to blow one's nose.
Many problems may cause the tear system to drain poorly. For instance, an
accident may cut one of the two tiny drainage tubes, a long-standing infection
may scar these tubes, or tumors may invade parts of the tear system.
All of these may lead to poor drainage causing the tears to well up in the eye
and roll down the cheek.
Fortunately, surgery or other kinds of procedures can usually relieve this
uncomfortable situation and restore a functional system.
Many infants, about 20 percent, are born with tear ducts or drain tubes that
have not opened. This usually leads to a chronic and low-grade infection in the
tear drainage system. That causes a mixture of mucus and pus to accumulate in
the inner corner of the eyes, between the lids. Parents should wipe that away
with anything clean, such as a tissue. The volume of this accumulation can be
reduced by applying antibiotic dropper ointment to the affected eye. Nearly all
of the time, the blockage of this drainage system will open by one year of age.
If the duct has not opened by the child's first birthday, an ophthalmologist may
open the blocked naso-lacrimal duct by a simple procedure called probing of the
naso-lacrimal system. This brief procedure requires a brief period of general
anesthesia and a short outpatient stay in the hospital. Some ophthalmologists
probe in the office, without general anesthesia, but usually before the child is
one year old.
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Eye Tumors
Any type of abnormal tissue growth is considered a tumor. Tumors may be benign
(non-cancerous) or malignant (cancerous). Both of these types of tumors can
occur in the eye, eyelid, or orbit.
Treatment is available for eye and orbit tumors, but it is important to see an
ophthalmologist as soon as possible if you are suspected of having an eye tumor.
If eye tumors run in your family, you should have regular eye examinations.
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Wrinkles
As skin ages, it becomes drier and less elastic. Though wrinkling is considered
a natural part of aging, certain health conditions, such as dry skin, or habits
(smoking, excessive alcohol use or sun exposure) contribute to premature
wrinkling of the skin.
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