OCULOPLASTY

OCULOPLASTY

OCULOPLASTY




OCULOPLASTY

The Oculoplastic service deals with diseases of the eyelids, orbit and lacrimal system. Common disorders treated include congenital eyelid deformities, thyroid eye disease, orbital tumors in children and adults, eyelid reconstruction after skin cancer removal, tear drainage problems and cosmetic eyelid surgery. Because of the multitude of different surgical options each patient’s treatment plan is designed specifically for them to obtain the best functional and aesthetic outcome. Your eyelids help protect your eyes. When you blink, your eyelids spread moisture over your eyes. Blinking also helps move dirt or other particles off the surface of the eye. You close your eyelids when you see something coming towards your eyes. This can help protect against injuries.Like most other parts of your body, your eyelids can get infected, inflamed, or even develop cancer. There are also specific eyelid problems, including



* Eyelids that turn in or out

* Eyelids that droop

* Abnormal blinking or twitching

Treatment of eyelid problems depends on the cause.

PTOSIS (Eyelid drooping)

Eyelid drooping is excessive sagging of the upper eyelid. A drooping eyelid can stay constant; worsen over time (progressive), or come and go (intermittent). It can be one-sided or on both sides. When drooping is one-sided (unilateral), it is easy to detect by comparing the two eyelids. Drooping is more difficult to detect when it occurs on both sides, or if there is only a slight problem.A furrowed forehead or a chin-up head position may indicate that someone is trying to see under his or her drooping lids. Eyelid drooping can make someone appear sleepy or tired.Drooping lids are either present at birth (congenital) or develop later in life. A drooping eyelid is usually not a serious problem, but your health care provider will need to examine your eyes and lids.

Causes

Drooping eyelids may be due to a variety of conditions include aging, diabetes, stroke, Horner syndrome, myasthenia gravis, or a brain tumor or other cancer that affects nerve or muscle reactions. Below are some common causes.Both eyelids drooping:

* Medical problem, such as myasthenia gravis

* Migraine headaches

* Normal aging process

* Normal variation of the eyelids

One eyelid drooping:

* Growth in the eyelid, such as a stye

* Medical problem

* Nerve injury

* Normal aging process

* Normal variation

Home Care

Below is a list of recommendations based on the various causes of eye drooping:

* Caused by aging — no treatment is necessary, unless it affects your vision.

* Caused by an allergic reaction — consult your health care provider about antihistamine or steroid treatment.

* Caused by nerve injury — consult your health care provider about surgical correction.

For all other causes — follow your health care provider’s recommendations.

When to Contact your eye doctor

Contact your health care provider if:

* Eyelid drooping is affecting your appearance or vision

* One eyelid suddenly droops or closes

* It is associated with other symptoms, such as double vision

What to Expect at Your Office Visit

Your health care provider will get a medical history and perform a physical examination. Medical history questions may include:

* Are both eyelids affected or just one?

* How long has this been present?

* Is it getting worse or staying the same?

* Is it present all of the time or only sometimes?

* What other symptoms do you have?

The physical examination may include a detailed assessment of nerve functioning. Diagnostic tests that may be performed include:

* Slit-lamp examination

* Tensilon test

Interventions:

Surgery may be necessary to correct problems with the muscles that open the eyelid (levator muscle dysfunction). You may get special spectacle frames that suspend the eyelid by traction with a wire. Usually these frames help patients with temporary, partial paralysis, or those who are not good candidates for surgery.

DACRYCYOSTITIS

Dacryocystitis is infection of the tear (lacrimal) sac. The tear sac is a small chamber into which tears drain. The usual cause of dacryocystitis is a blockage of the nasolacrimal duct, which leads from the tear sac into the nose. Dacryocystitis may occur suddenly (acute) or be longstanding (chronic). In acute infection, the area around the tear sac is painful, red, and swollen. The area around the eye may become red and watery and may ooze pus. Slight pressure applied to the tear sac may push thick material through the punctum (the opening at the inner corner of the eyelid near the nose).

Symptoms

Often the infection is mild. Sometimes, the infection is severe and can cause fever. Sometimes a collection of pus (abscess) may form, which can rupture through the skin, creating a passage for drainage.

Diagnosis

* Symptoms and a doctor’s examination

A doctor bases the diagnosis on the symptoms and examination findings.

Treatment

* For acute dacryocystitis, antibiotics

* For chronic dacryocystitis, dacryocystorhinostomy An acute infection is usually treated with an antibiotic taken by mouth. If a fever is present or if the infection is severe, antibiotics given by vein may be required. Applying warm compresses to the area several times a day also helps. After the acute infection resolves, doctors recommend that people have surgery to bypass the blockage (dacryocystorhinostomy [DCR]) so that infection does not recur. DCR is also the main treatment for chronic dacryocystitis.

ECTROPION

Ectropion is the turning out of the eyelid so that the inner surface is exposed. It most often affects the lower eyelid.

Causes

The aging process very often causes Ectropion. The connective tissue of the eyelid becomes weaker, which causes the lid to turn out so that the edge of the lower lid is no longer against the eyeball. It can also be caused by:

* A defect that occurs before birth (for example, in children with Down syndrome)

* Facial palsy

* Scar tissue from burns

Symptoms

Symptoms include:

* Dry, painful eyes

* Excess tearing of the eye (epiphora)

* Eyelid turns outward

* Long-term (chronic) conjunctivitis

* Keratitis

* Redness of the lid and white part of the eye

Exams and Tests

The health care provider will make a diagnosis by doing an exam of the eyes and eyelids. Special tests are not needed most of the time.

Treatment

Artificial tears (a lubricant) may ease dryness and keep the cornea moist. Surgery to tighten the muscles that hold the eyelids in place is very often effective. It may be done as outpatient surgery using medicine to numb the area (local anesthesia).

Prognosis

The outcome very often good with treatment.

Possible Complications

Corneal dryness and irritation may lead to:

* Corneal abrasions

* Corneal ulcers

* Eye infections

Corneal ulcers can threaten vision.

ENTROPION

Entropion is the turning in of an edge of an eyelid, causing the lashes to rub against the eye. It usually is seen on the lower eyelid.

Causes

Entropion can be present at birth (congenital).In babies, it rarely causes problems because the lashes are very soft and do not easily damage the eye. In older people, the condition is usually caused by a spasm or weakening of the muscles surrounding the lower part of the eye.Although rare in North America and Europe, trachoma infection can cause scarring of the inner side of the lid, which may cause entropion. Trachoma scarring is one of the three leading causes of blindness in the world. Risk factors for entropion are:

* Aging

* Chemical burn

* Infection with trachoma

Symptoms

* Decreased vision if the cornea is damaged

* Excessive tearing

* Eye discomfort or pain

* Eye irritation

* Redness

Exams and Tests

Your health care provider can usually diagnose this condition by looking at your eyelids. Special tests are usually not necessary.

Treatment

Artificial tears can keep the eye from becoming dry and may help you feel better. Surgery to correct the position of the eyelids usually works well.

Prognosis

The outlook is usually good if the condition is treated before eye damage occurs.

Possible Complications

Dry eye and irritation may increase the risk of:



* Corneal abrasions

* Corneal ulcers

* Eye infections

BOTOX

Botox is a drug made from a toxin produced by the bacterium Clostridium botulinum. It’s the same toxin that causes a life-threatening type of food poisoning called Botulism. Doctors use it in small doses to treat health problems, including

* Temporary smoothing of facial wrinkles and improving your appearance

* Blepharospasm – uncontrollable blinking

* Strabismus – misaligned eyes

Botox injections work by weakening or paralyzing certain muscles or by blocking certain nerves. The effects last about three to twelve months, depending on what you are treating. The most common side effects are pain, swelling, or bruising at the injection site. You could also have flu-like symptoms, headache, and upset stomach. Injections in the face may also cause temporary drooping eyelids. You should not use Botox if you are pregnant or breastfeeding.

You are in a good hands....