Oculoplastic surgery has been prominent in the United States
since the Second World War. The specialty deals with conditions of the
eyelids, lacrimal system and orbit including basal cell carcinomas, burns,
trauma, congenital deformities, nasolacrimal obstruction, thyroid eye disease
and eyelid malpositions such as ectropion, entropion and ptosis.
In children, treatment of congenital ptosis may need to be carried out urgently to prevent the development of amblopia (lazy eye), particularly when the eyelid falls over the pupil.
In adults,a drooping upper eyelid may have to be investigated for serious causes affecting the third cranial nerve or sympathetic nervous system. If serious causes are excluded, surgery can be carried out to lift the eyelid.
Ectropion, entropion and trichiasis can cause severe irritation, especially when the lashes are lying on the surface of the eye. The eyelid can be repositioned by surgery, or the lashes can be removed by freezing.
Lumps and bumps
Various benign and inflammatory lid lesions can be removed from around the eyes and sent to the Pathology lab for clarification of the exact diagnosis.
These are frequent in the eyelids, especially basal cell carcinoma ( rodent ulcer ) . They are treated by wide excision, and the eyelid is then reconstructed. In very large tumours, this may require the use of advanced techniques using flaps or grafts of skin and other body tissues, such as hard palate.
Weakness of the facial muscles interferes with normal blinking, such that the eye becomes exposed, painful and infected. The blink can be augmented by placing a gold weight in the upper lid, or the lower lid raised by using a fascial graft from the thigh.
In babies, a watering eye will usually get better by the age of two years, but if watering persists after that age it is sometimes necessary to probe the tear duct under anaesthesia.
In adults who develop tear duct obstruction, this strategy does not work, and a watering eye has to be treated by creating a bypass channel into the nose.
Thyroid problems cause build up of fat around the eyes, resulting in discomfort and a characteristic bulging appearance. This may, in severe cases, threaten vision. Thyroid eye disease can be treated by a variety of techniques including orbital decompression.
Artificial eyes
Ocular prosthetics are very common in the community, and their appearance and movement can be improved by placing implants within the socket.
Orbital tumours
John Pitts is an oculoplastic surgeon in full-time privatepractice in London and Barbados following a substantive NHS consultantposition. He graduated MB ChB from Glasgow University in 1983 and,in 1987, after working in pathology and neurology, he trained in ophthalmologyin Glasgow, Nottingham and London. He has travelled extensively, workingin centres of excellence in Los Angeles, New Orleans, Melbourne, Barbados,Brunei and Vancouver. He has undertaken Fellowship training inoculoplastics at Moorfields Eye Hospital.
