A wide variety of surgical and non-surgical procedures are performed by Oculoplastic Surgeons. These may be performed in the Office, minor procedure room or Operating theatre as indicated. Anasthesia required include topical creams, regional local anesthetic injections or general anaesthesia. Your Oculoplastic surgeon will provide details of the above as indicated on clinical examination.
The following list is not meant to be exhaustive but highlights some of the common procedure provided by your Oculoplastic Surgeon. More complex and extensive procedures may be performed as a multidisciplinary approach along with other surgical teams.
All procedures around the eyes may be associated with potential risks and complications which include but are not limited to the following: bleeding, infections, visual loss, overcorrections, undercorrections, need for repeat procedures, risks of anaesthesia and other complications. Ask your Oculoplastic surgeon regarding the risks, benefits and complications of these procedures.
Minimally Invasive Procedures
Muscle Relaxant Injections: Various neuromodulator agents which weaken or paralyze muscles around the eyes and the face may be injected for functional and cosmetic indications. Some of the common agents injected include Botox®, Dysport®, Xeomin®, etc. These may be administered for various functional indications (Blepharospasm, Hemifacial Spasm, etc) or for cosmetic indications ( Laugh lines, frown lines, etc).
Tissue Filler Injections: These are synthetic materials that may be injected around the eyes and face to fill up hollows and depressions and commonly indicated as a cosmetic procedure. Some of the common agents injected include Restylane®, Hylaform®.
Surgeries of the Eyelid, Tear Ducts and Orbits
Eyebag surgery & Droopy eyelid correction – Blepharoplasty and Ptosis Surgeries
Blepharoplasty: This is a surgical procedure done to remove excess eye lid skin and/or fat. The surgery can be performed for patients with upper lid dermatochalasis obstructing the visual axes, or it can be done for cosmetic enhancement through the creation of a double eye lid or for the improvement of eye bags.
Congenital Ptosis Surgeries: Ptosis can be present at birth in cases where the levator muscle, a muscle within the eye lid responsible for opening the eye, is maldeveloped and weak. Surgery may be necessary when the visual axis is obstructed, interfering with visual development in young children. In such cases, the forehead muscle (frontalis) is recruited to help lift the eye lid by placing a sling material buried under the skin, between the forehead and the eyelid. The material can either be taken from the patient (tendon in the outer thigh), or a synthetic material can be used (silicone rod).
Adult Ptosis Surgeries: Stretching of the levator aponeurosis, a tendon found in the upper lid responsible for opening the eyes, is usually the underlying problem causing upper lid droopiness. This is commonly due to age-related wear and tear (involutional) or long-term contact lens use. In some cases, this can happen as a consequence of eye surgery or eye lid injury. Management can be conservative, such as taping the upper lid in cases where the patient is not fit for surgery, or an eye lid surgery can be performed to advance and tighten the levator aponeurosis with good outcomes in the majority of cases.
Brow ptosis & Browlifts
Aging and paralysis of the upper face may result in droopy forehead and eyebrows resulting in descent of the heavy eyebrow tissues exacerbating a preexisting droopy / baggy upper eyelid which may affect visual function. A browlift may then be indicated to reset and stabilize the forehead/eyebrows, often performed before or during upper eyeid surgery. Incisions for these may be placed anywhere from the upper eyelids, above the eyebrow, the forehead region, infront of the hairline or behind the hairline.
Epiblepharon: A commonly encountered condition in children and young adults of East Asians, this results in eyelashes being directed and often rubbing against the cornea causing irritation, tearing, discharge, frequently blinking and rarely in infections and scarring of the cornea. This affects the lower eyelid more than the upper eyelid. While most children may be managed conservatively with a trial of lubricants, not infrequently surgery may be required, to turn the eyelashes away from the eyeball providing relief with minimal morbidity.
Entropion: A commonly seen condition in the elderly resulting in in-turning of the lower eyelid causing irritation, infection, scarring of the cornea and rarely blindness. This is usually treated by a minor surgery of the lower eyelids with tightening.
Ectropion: Less commonly seen in the elderly in our population, with outward turning of the lower eyelid causing redness, tearing, irritation, infection, scarring of the cornea and rarely blindness. This is usually treated by a minor surgery of the lower eyelids with tightening.
Growths of the eyelid margin and adjacent region are frequently encountered in young healthy adults and the elderly population. While a vast majority of them are inflammatory or benign, requiring conservative management or simple procedures, not infrequently these may be a form of eyelid cancers (Basal cell carcinoma, Sebaceous gland carcinoma, Squamous cell carcinoma, Melanoma, etc) which may require an extensive work up with more radical surgical removal with reconstruction.
Tear duct bypass surgeries (DCR)
Indications: Symptomatic partial or complete tear duct obstructions with recurrent tearing, infections, etc.
- External DCR: Often performed under local anasthesia as a day surgery, this involves creating a rhinostomo through a skin incision. Silicon intubation may be used.
- Endonasal DCR: The same surgery is performed under general anasthesia through the nose.
Other Lacrimal Surgeries
Other procedures that may be performed for tearing based on the nature and level of tear drainage system narrowing and/or obstruction include:
Syringing and Probing: Typically performed in infants with congenital upper and/or lower tear duct developmental obstructions. This may be combined with canalicular silicone intubations, balloon dacryoplasty etc.
Punctoplasty: Usually an office procedure, this is performed for patients with symptomatic severe punctal stenosis with an otherwise patent tear duct. Infrequently, the puncta may be closed temporarily or permanently for management of severe dry eyes.
Canalicular Intubations: This is performed for patients with canalicular injuries, obstructions and often with tear duct drainage procedures.
Endoluminal Duct Recanalization (ELDR): This is performed in suitable patients with partial or complete symptomatic tear duct drainage obstructions. This may be performed with the aid of a lacrimal microendoscope and may be combined with balloon dacryoplasty, turbinoplasties, etc.
Orbital Fracture Repairs: A common condition from injuries from falls, assaults, road traffic and industrial accidents, repair and reconstruction may be indicated for persistent deformities or its consequences: limitation of eye movements resulting in double vision, sunken eyes (enophthalmos), etc. Complex orbitofacial fractures are commony managed along with a craniomaxillofacial or plastic surgeon.
Orbitotomies: These are procedures performed either to obtain a diagnosis with biopsy of the orbital soft tissues (eg lacrimal gland, orbital fat, extraocular muscle or other infiltrative tumors) or more commonly as a therapeutic procedure (complete removal of benign orbital tumors).
Socket Reconstructions: These are performed in patients who require their eye balls to be removed for various reasons: severe infections, untreatable cancers in the eye, irreparable globe injuries, blind and disfigured or painful eyes, etc.
- Enucleation: This is a procedure where the entire eyeball (globe ) is removed for various indications. The lost volume is often replaced with an alloplastic implant followed by a customized artificial eye (prosthetic) fitting 6-8 weeks later.
- Evisceration: This procedure is indicated when the eyes are irreparably damaged or in untreatable severe infections. Socket reconstruction may be performed at the same sitting or delayed with an artificial eye (prosthetic) fit 6-8 weeks later.
- Exenteration: Rarely indicated, this procedure is indicated in advanced cancer of the eye or adjacent structures involving the eye socket and involves removal of the eyeball, the eyelids, the orbital structures with the intent of saving life despite physical morbidity.
- Contracted Socket Management: This is a condition where an eye has been severely injured and removed and the patient is unable to wear an artificial eye (prosthesis). Management often requires both a combination of orbital volume replacement (with implants or fat grafts), surface reconstruction ( mucous membrane grafts) followed by the best fit artificial eye fitting.
- Orbital Decompression: This is a procedure performed to either increase the volume of the eye socket (orbit) or reduce its contents (mainly orbital fat) to provide both cosmetic and functional benefit in patients with moderate to severe Thyroid Eye Disease with disfiguring bulging of the eyes (proptosis) or progressive loss of vision from compression of the nerve of the eye (compressive optic neuropathy). Based on the goals, various techniques may be considered approached either from around the eye or through the nose (endoscopic surgery). When indicated, additional surgery of the muscles of eye to straighten them (Strabismus surgery) and eyelid surgery (for eyelid retraction) may be performed.
The above listed procedures are only a brief list of the range of various Eye Plastic Surgeries performed by your Oculoplastic Surgeon and not meant to be exhaustive. Please contact your doctor for more details regarding the potential risks, benefits and complications – both major (which may include death, blindness, double vision etc) and minor (bruising, swelling, infections, residual deformity, etc).