What is Oculoplasty?

Ophthalmic plastic surgery or 'Oculoplasty' is the branch of ophthalmology that deals not only with the diseases of the eye, but also important structures around the eyes like eyelids, eyebrows, orbit and the tear system which are vital to the normal appearance and function of our eyes.

Common conditions needing Oculoplasty :

Oculoplasty helps correct abnormalities of eyelids like:

Drooping of the lids (ptosis)
In-turning (entropion) of lid margin
Out-turning (ectropion) of lid margin.
Lid deformities resulting from trauma.
Problems related to excessive watering from the eyes.

Pre and post operative photos of a child who underwent correction of ptosis (droopy eyelid)

Pre and post operative picture of a patient who underwent a scar free orbital
fracture repair with no external skin incision

Anatomy of the tear drainage system of eye

Patients who suffer paralysis attack often have difficulty in eyelid closure, which can also be dealt effectively.

Loss of an eye as a result of trauma or surgery used to leave the person with a disfigured face and much emotional trauma in the past. But with advances in modern ophthalmic plastic surgery, these patients can now be rehabilitated to a great extent cosmetically by means of socket surgeries and custom made artificial eyes.

How are Oculoplasty and cosmetic appearance ?

Our eyes are by far the most important feature on our face. Overtime, their beauty can be greatly reduced by aging, creases and eyebags. The cosmetic aspect of ophthalmology deals with rejuvenation and enhancement of facial features with the help of various surgical and non surgical methods.

Some of the procedures include Botox injections, which is a simple non surgical treatment for wrinkles around eyes, forehead and crowlines. With aging, one may start noticing hollows and folds around eyes which occur due to loss of tone and sagging of tissues around the eyes. For this fillers like Hyaluronic acid gel are injected in problem areas. These procedures are simple, convenient and results are visible immediately.

Correction of hollows around lower lid with fillers (Hyaluronic acid gel)

Correction of lower lid retraction Pre and Post Fillers (Hyaluronic acid gel injection)

Almost everyone develops sagging around their eyes. Loose excess skin or weak muscle can cause upper lid sagging. Also bags may develop under the eyes with age. The procedure called blepharoplasty is performed for such a condition. Incision in the eyelid is small and is hidden in the natural eyelid skin crease.

Correction of Upper eyeild loose skin with Blepharoplasty

Can cancer affect the eyes?

Yes. Cancers are known to arise from structures inside the eye as well as in tissues around the eyes like lids, conjunctiva or from soft tissues surrounding the eye within the bony orbit.

What are some common eye cancers?

Some common ocular cancers include retinoblastoma , choroidal melanoma, choroidal hemangioma, eyelid tumors, conjunctival tumors and orbital tumors.

White pupillary reflex seen in a child with Retinoblastoma

How is eye cancer diagnosed?

An ocular oncologist (an eye cancer specialist) can determine if you have an eye cancer by performing a complete clinical examination. The examination may include asking questions about your medical history, examining both eyes, looking into the eye at the tumor, doing an ultrasound examination, and obtaining specialized photographs.

MRI of an Orbital tumor in right orbit pushing the eyeball outwards

Biopsy is often indicated to diagnose tumors involving soft tissue structures around the eye.

What is the treatment of eye cancer?

Your doctor will recommend treatment based on your medical history and the findings from the eye examination. Many options are now available to deal with eye cancers. Surgery in eye and periocular tumors is performed to establish diagnosis, remove the tumor in toto or sometimes to debulk the disease so that other modalities mentioned below can become useful.

Pre and post surgery photos of a child following removal of an orbital tumor

Chemotherapy is the treatment of disease by means of drugs that have a specific toxic effect upon the cancer cells. Chemotherapy selectively destroys cancerous tissue.

Cryotherapy is the use of low temperatures to treat disease. Cryotherapy is applied under local anesthesia. The goal of cryotherapy is to freeze the cancer cells and cause their destruction.

Radiation therapy uses high-energy radiation from x-rays and other sources to kill cancer cells and shrink tumors. Radiation that comes from a machine outside the body is called external-beam radiation therapy as opposed to radiation that is administered by placing a radiation plaque over or very near the tumor (internal radiation therapy or brachytherapy). External beam radiation therapy may be recommended for some lymphomas and orbital tumors. Radiation plaque therapy is recommended for retinoblastoma or choroidal melanomas.

List of Procedures

Eyelid

Eyelid malpositions
Surgery for droopy eyelids (Ptosis)
Abnormalities of lid margin/ eyelashes: (Entropion, ectropion, trichiasis, distichiasis)
Eyelid reconstruction
Eyelid tumor management
Gold weight implants for inability to close eyelids (facial nerve paralysis)

Lacrimal system (treatment of watery eyes)

Surgery for nasolacrimal duct obstruction: Dacryocystorhinostomy / Dacryocystectomy
Surgery for blocked canaliculi (tear drainage tubes): Conjunctivo-dacryocystorhinostomy
Probing for children having watery eyes since birth
Opening up of narrow tear drainage passages: Punctoplasty
Repair of injuries to tear drainage passages

Orbit

Orbitotomy for orbital tumors
Orbital fracture repair
Orbital volume augmentation
Surgery for bulging / prominent eyes: Orbital decompression
Optic nerve sheath decompression

Socket

Removal of damaged, diseased eyes: Enucleation/ Evisceration with implant
Removal of orbital contents for tumor management: Orbital exenteration
Reconstruction of small, contracted sockets for fitting of artifical eye
Custom artificial eye

Aesthetics:

Botox for various cosmetic and functional problems
Fillers (Restylane) for periocular hollows and depressions
Surgery to correct loose eyelid skin or eye bags (Blepharoplasty)
Correction of sagging eyebrows: Brow lift
Cosmetic fat transfer procedures
Treatment of scars

Oncology: Management of eye tumors

Types of Tumors Managed

Eyelid tumors
Conjunctival tumors
Other ocular surface tumors
Iris tumors
Ciliary body tumors
Chorodal tumors
Orbital tumors
Optic nerve tumors
Retinal tumors including Retinoblastoma

Tie up with a Medical-Radiation Oncologist for patients needing chemotherapy and radiotherapy for comprehensive management of cancer patients.