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Oculoplastic and orbital surgery is a branch of ophthalmology which deals with eyelids, lachrymal ducts and orbital diseases. From removal of eye bags to prosthetic eyes, and intraocular tumor surgeries to Botox, all kinds of treatment and plastic surgery applications are performed through oculoplastic and orbital surgery.
Eyelids are much more sensitive than other body tissues. They comprise the muscles that open and close the eyelids, fatty tissue, lacrimal gland, skin and supportive tissue. In oculoplastic and orbital surgery, care should be exercised to protect overall eye health. It is essential in all surgical interventions to avoid damaging the intact tissues and work only where necessary. It is of great importance that the operation is performed by ophthalmologists who are knowledgeable about eyelid anatomy and principles of plastic surgery, are trained in oculoplastic surgery and have extensive case experience.
Eyelid surgery (blepharoplasty) involves removing the excess fat, muscle and skin tissue in the upper and lower eyelids, stretching the periocular regions that support these tissues. This surgical intervention allows correcting saggy, turned-in or turned-out upper and lower eyelids, eye bags forming due to trapped excess fat and wrinkles around the eyes, and giving the patient a more youthful and energetic look by getting rid of their former old and tired appearance.
Preparation for Surgery
Preoperative planning for surgery is important. Your doctor should inform you about the surgical technique and tell you what to do and what not to do concerning your operation. The effects of drug use, smoking, alcohol consumption and some vitamins on the surgery should be explained to you. Also, if required at the preoperative examination of eye functions, an examination by an ophthalmologist specialized in ocular diseases is requested.
Surgical procedures may be performed under general or local anesthesia depending on the circumstances.
Both eyelids and the area around the eyelids are swollen during the first two days after surgery. An ice pack is applied on the eyes on the first day following operation to reduce such swelling. In addition, antibiotics, swelling reducers and painkillers are given. Eye drops are also used to prevent dryness and antibiotic eye ointments are given to protect the inside of the eye. Home rest is recommended after the patient is discharged, particularly for the first two days. The patient is asked to return for controls at certain intervals, depending on the nature of the surgery.
It is an eye infection. The disease develops in 1-2 days. It manifests itself with stinging in the eye and tensioning of the eyelid.Formation of the sty can be prevented with eye drops, antibiotics and ointments in case of early diagnosis, but the disease resolves at a later stage since diagnosis often takes more than 1-2 days. Advanced forms of the disease include chalazion and blepharitis.
Drooping of the upper eyelid is called ptosis. Drooping eyelids can be seen in newborns, adults and elderly people. Ptosis is treated by surgery. The distance between upper and lower eyelids varies between people. The common method of treatment is surgery. Surgical method is determined with an examination of the eyelid.
Age-Related Eyelid Changes
Eyebrows and eyelids droop with aging, the lower eyelid becomes turned in or turned out; bags, hollowness and wrinkles form around the eyes. Such changes not only occur with aging but also may be seen in younger people as a result of heredity. The changes around the eyelids give the person an unhappy, tired and sleepy look. The method of treatment is determined according to the type of problem.
Eyelash Abnormalities (Trichiasis, Distichiasis)
Eyelash abnormalities can be congenital (distichiasis) or acquired after certain diseases of the eyelids, with the turning in of the eyelid’s edge (entropion) or ingrowing of the eyelashes (trichiasis). The treatment is surgery.
The majority of the tumors in and around the eyelids are benign. If persistent wounds develop in the eyelids, an ophthalmologist should be consulted to find out if they are related to a malignant tumor. The treatment is surgery.
Eyelids may suffer physical (traffic accidents, injuries etc.) or chemical (bleach, spirit of salt, detergents, lime etc.) injuries. Serious disorders in vision and shape may develop unless appropriate treatment is administered at an early stage.
Congenital Disorders of the Eyelid
Drooping eyelids (ptosis) are the most common type of congenital disorders of the eyelid. Other eyelid disorders include adhesion of the eyelids to each other (ankyloblepharon), turning in (entropion) or turning out of the eyelid (ectropion), full-thickness defect of the eyelid (coloboma) and extra row of eyelashes (distichiasis).
Involuntary Spasm of the Eyelid (Blepharospasm)
These are periocular spasms of unknown origin. It is seen at middle and advanced ages. Some patients cannot use their eyes because of the spasms and this affects their daily life greatly. Medication or surgical treatment can be used depending on the case.
Turned-In Eyelids (Entropion)
Usually affecting the lower eyelid, entropion occurs when the eyelid folds inward. Entropion can be congenital or acquired. Surgical treatment is applied.
Turned-Out Eyelids (Ectropion)
Turned-out eyelids often develop with aging. It may also develop as a result of palsy of the nerve that closes the eyelid (facial palsy) or after injuries. Surgical treatment is applied.
Facial palsy occurs when the nerve that moves the eyebrows, eyelids and the face cannot function for whatever reason. Medical treatment is given to protect the eyes in case of temporary paralysis. Different surgical treatments are applied in case of permanent paralysis.
Under Eye Bags
Genetics, i.e. heredity, is the most important factor causing under eye bags. Under eye bags make the person look older and more tired than they actually are. Treatment consists of removing or replacing fat tissues.
Operations can be performed under local anesthesia and effects are long-lasting. Interventions in the lower eyelid are mostly possible without skin incisions, from inside the eyelid. This eliminates the risk of scars or deformities in the eyelid after the operation.
Patients may have drooping eyebrows in addition to drooping eyelids. The outer sides of the eyebrows may fall downward with gravity as a result of aging or genetic factors. This creates a load and excess skin on the eyelid, spoiling the esthetic appearance.
In direct browpexy, a parallel suture is made immediately above the eyebrows and the brow is lifted. The incision can be made by a scalpel or carbon dioxide laser. The incision scar can be noticed to a degree for 3-6 months.
In internal browpexy, an incision is made at the brow line as in the technique called blepharoplasty. It is particularly effective in case of drooping of the 1/3 outer brow. This method leaves no scars on the brow.
Tear ducts start with two small canals inside the lower and upper eyelids, form the tear sac and open via a thin canal into the nasal cavity, where they terminate. The main purpose of tears is to protect the eyes against foreign bodies and ensure the continuous lubrication and clearness required for eye health. The front side of the eye is continuously washed by tears. This washing fluid and the harmful substances on the surface of the eye are transferred through the tear canal into the nose and then into the throat. Obstructions in this path cause watering and eye discharge. Tear duct surgery is the branch of surgery which deals with diseases of this area.
Symptoms of eye dryness change depending on the severity of tear deficiency. They can vary from small complaints like occasional mild burning, watering and redness to serious conditions which may severely damage the quality of vision and life. In mild cases, treatment consists of artificial teardrops which are intended to replace the deficiency. Severe eye dryness requires different, more serious treatments.
Acquired Lacrimal Duct Occlusions
The causes of tear duct occlusions which are not congenital are usually unknown. The occlusion is located at the intersection of the tear sac and the canal. It is more common in women. Surgical treatment is applied.
Congenital Lacrimal Duct Occlusions
Tear ducts continue to develop after birth. In some infants, symptoms like watering and eye drainage may occur when duct development is not completed after birth. Different treatments are required depending on the patient’s condition.
Treatments for Lacrimal Duct Occlusion
Lacrimal duct occlusion causes watering and inflammation. If the duct has not been cleared by the time the child turns 1.5 years old, a method called probing is used. It is performed under general anesthesia and lasts about 5-10 minutes. Entry is made with a probe into the upper end of the tear duct and the blockage in the lower end is cleared. There is a 90% chance of success. Success is less likely after 2 years of age.
Surgical Intervention (DCR)
In adults, instead of clearing a blocked duct, a new path is opened between the tear sac and the nose. The surgery can be performed through the skin or the nose. When performed through the skin, surgery is more likely to be successful (nearly 95% chance of success) and leaves no unpleasant scars on the skin.
Multidiode Laser (Treatment of Lacrimal Duct Occlusion with Laser)
Many new techniques are employed to clear lacrimal duct occlusions today. Having been used for the last few years in the US and several European countries, the new generation Multidiode Laser offers a fast solution for tear duct surgeries with topical anesthesia, without bleeding or scars.
Lacrimal System Tumors
Lacrimal gland tumors are more common than tumors of the tear drainage system. Prevalence is higher in adults. Treatment changes according to the type of tumor.
Watery eyes result either from too much tear production or from drainage slowing down or stopping. Increased tear production has several causes. Watery eyes are resolved when the causal factor is eliminated.
Tear Duct Injuries
They are often accompanied by eyelid injuries. If appropriate treatment is not applied at an early stage, permanent obstruction of tear ducts may lead to constant watering and eye discharge. The condition should be seen by an ophthalmologist and the disorder caused by trauma in the tear ducts should be corrected.
Indicated for people whose eyes have been removed, ocular prostheses can be custom-made in different colors and sizes.
Ocular prostheses are an esthetic solution which is preferred for irreversible loss of vision and serious esthetic damage occurring as a result of serious traumatic injuries, usually due to traffic accidents or foreign bodies entering the eyes. Ocular prostheses can be used at any age. They can be implanted with the doctor’s decision 3-4 weeks after the patient’s eye is removed.
Prostheses are completely customized for the patient and are designed to look and feel comfortable, esthetic and natural while causing no stinging, burning, redness in the eye or pain in the eyelid.
Ocular prostheses are made of acrylic, a very light material of high quality. This material is both compatible with the human body and unbreakable. With these aspects, it offers many advantages to the patient. Using orbital implants after enucleation or evisceration surgery enhances the movement of the prosthesis.
Wearing ocular prostheses, a person can;
• Engage in sports activities
• Take a bath/shower
Pterygium is a common eye disorder which is commonly known as “angel’s wing”. It is quite common in the climate zone of Turkey. Usually forming on the side of the conjunctiva closest to the nose and extending to the corneal tissue that covers the eye’s colored part, it is a wedge-shaped, pink, non-cancerous lesion which gradually grows. Also termed as “surfer’s eye”, pterygium more often occurs in people who spend long hours outdoors, are exposed to too much sunlight and dry air current and work especially long hours or do sports under the sun without protection, that is without wearing sunglasses or a hat. Its symptoms include burning, itching, discomfort, the sensation that there is a foreign body in the eye and blurred vision.
Ocular oncology deals with tumors developing in the eyes and periocular tissues.
Nearly ¾ of the tumors developing in the eyelids and surrounding area are benign tumors. If persistent wounds develop in the eyelids, an ophthalmologist should be consulted to determine if they are related to a malignant tumor. Surgical treatment should be performed.
Lacrimal System Tumors
Lacrimal gland tumors are more common than tumors of the tear drainage system. Prevalence is higher in adults. While treatment changes according to the type of tumor, treatment methods include surgery, chemotherapy and radiotherapy.
Intraocular Tumors (Melanoma)
Melanoma of the uvea is the most common intraocular tumor seen in adults. It is not life-threatening as long as it remains inside the eye. For large tumors, surgical treatment and removal of the eye (enucleation) is necessary. For smaller tumors, radiation therapy (radiotherapy), plaque radiotherapy (brachytherapy) and transpupillary thermotherapy (TTT) can be performed.
Intraocular Tumors (Retinoblastoma)
Retinoblastoma is the most common intraocular tumor seen in childhood. Surgery, radiation therapy (radiotherapy) and laser are the techniques used today.
Capillary hemangiomas are benign lesions consisting of overgrowth of capillaries. Developing around the eyes, particularly in the eyelids, and behind the eyes, they are congenital or occur within the first months following birth. Lesions affecting vision require treatment.
This is the most common benign orbital tumor seen in adults. Hemangiomas should be removed surgically.
Although this is a benign vascular lesion, complete recovery is difficult since it spreads between intraorbital tissues and continues to grow. Treatment varies by case.
This is one of the common tumors of the orbita and its incidence is increasing. Radiation therapy (radiotherapy) and chemotherapy are given according to the case.
This is one of the benign neurogenic tumors of the orbita. Treatment varies by case.
This is a tumor of the optic nerve and optic tracts. Radiotherapy or surgical treatment can be preferred depending on the condition of the eye.
This is the most common malignant orbital tumor seen in children. Surgical treatment, radiation therapy (radiotherapy) and drug therapy (chemotherapy) are applied at the same time.
Thyroid-Related Eye Diseases (Graves’ Disease)
Certain eye disorders and deformities occur in some diseases of the thyroid gland, which plays a significant role in the regulation of metabolism. This is more common in cases of over-functioning of the thyroid gland (hyperthyroidism). Findings include protrusion of the eyeballs (exophthalmia, proptosis), an eyelid distance that is too wide, strabismus, double vision and reduced vision. Called “thyroid-associated orbitopathy” or “Graves’ orbitopathy”, this disease can be very mild or severe enough to result in loss of vision. Treatment is determined based on the stage and severity of disease and whether it is active or not.
There are microbial infections and non-microbial orbital inflammation which are related to the body’s immune system. Microbial inflammation often develops in children following sinus infections but can also occur at any age due to various factors, particularly after trauma. Unless treated appropriately at an early stage, it can threaten vision and life. Depending on the case, medication or surgical treatment can be used. Radiotherapy may be necessary when there is no response to cortisone therapy.
Benign or malignant tumors make up approximately 20% of all orbital diseases. Tumors can be life-threatening when they spread to periocular tissues and other organs, particularly the brain. Therefore, early diagnosis and treatment of diseases is important.
Orbital injuries can be life-threatening because of the proximity to vital organs. Hence, the patient is first assessed for brain functions and the respiratory tract. The eyes are very likely to be affected by orbital injuries as well. So the condition of the eyes should be evaluated as a priority. Surgical treatment is applied.
Congenitally Small or Absent Eye
Since it is the size and presence of the eye which develops epiocular tissues, the eyelids, soft tissues around the eyes and the bone frame cannot grow sufficiently when the eyes are not developed. Conformers (devices which are gradually increased in size) are used for mild and moderate cases; more severe cases require surgery.
What is an eye stye?
A stye (also called a sty or hordeolum) is one of the infections of the eyelid glands. The disease usually occurs within 1 or 2 days.
What are symptoms of eye stye?
Stye formation begins with eye pain, swelling, redness, burning and stinging in the eyelid.
What is the treatment of stye?
It should be treated with hot water dressing and antibiotic eye lotion within the first week. Otherwise, it may turn into a chalazion, or eyelid cyst.
What is chalazion?
Chalazion is an eyelid cyst. If the stye turns into a chalazion, surgery should be performed within 1 month without waiting. Otherwise, it can spread to other eyelids.
What are symptoms of chalazion?
Chalazion causes pain, swelling and redness in the eye. As a result of the spread, it often starts to relapse and may lower the eyelid a little by disrupting the structure of the eyelid.
What is the treatment of chalazion?
Chalazion should be operated. The surgery should be performed by an oculoplasty specialist and the further spread of the disease to the eyelid should be prevented.