Oculoplasty is the art and science of plastic surgery around the eye. The Orbit &Oculoplasty subspecialty at The Himalayan Eye Institute deals with the various diseases of the eyelids, lacrimal system and orbits (sockets). Our Oculoplastic surgeon routinely performs procedures like DCT, DCR, Ectropion, Entropion, Lid surgery & Botox to treat vast spectrum of eye disorders.
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.
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
Ectropion is the opposite condition, and 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 infections 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.
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.
Any painful blind eye needs removal. The deep ‘socket’ left behind is not ideal for artificial eye fitting. Therefore, at the time of eye removal, an implant is placed in the orbit, which occupies the space taken by the normal eyeball. This reduces the hollowness of the socket seen with the artificial eyes placed without an implant. In some people, the artificial eye fit changes with passage of time. Socket surgery aims at giving the best possible ‘bed’ for artificial eye fitting, with or without an orbital implant. Do not hesitate to contact your eye specialist for further information.
Botox & Fillers
Smiling, frowning, squinting and even chewing – basically any facial movement can eventually lead to one of the most common signs of aging: wrinkles. They can make you appear tired or even angry when you are not. One of the quickest and safest remedies to remove wrinkles is an injection of botox.
Botulinum toxin can be used as a wrinkle treatment to smoothen:
– Frown lines
– Crows feet
– Forehead furrows
– Skin bands on the neck
Botulinum toxin can be combined with other cosmetic skin procedures such as chemical peels, dermal fillers or microdermabrasion to further improve your results. This combination of therapies can even help to prevent the formation of new lines and wrinkles.
Procedure of BOTOX
A very thin needle is used to inject small amounts of Botox into specific muscles. By carefully choosing specific muscles, the Oculoplasty surgeons at The Himalayan Eye Institute would weaken only the wrinkle-producing muscles, preserving your natural facial expressions.
Botox treatment injections usually take less than 15 minutes. The number of injections you need will depend on multiple factors, including your facial features and the extent of your wrinkles. Crow’s feet, for example, usually demand two to three injections. Furrows above your brow could take five or more.
No anesthesia is required. There is no down time or recovery time. You may notice results within a few days, but it can take up to a week to see the full effect. This improvement typically lasts about eighteen months to two years
The Ocular Prosthesis service is available at The Himalayan Eye Institute, for the management of patients with eviscerated, enucleated socket and physical eye. These problems are managed cosmetically by prosthesis.
Prosthesis is an artificial part supplied to remedy a deficiency. e.g. leg, teeth, eye etc. The institute offers both Customized Prosthesis, i.e., preparing eye shells for the patients according to their socket dimensions; and also there are Stock Eyes of readymade eye shells.