Oculoplastic and Orbital Surgery

The Oculoplastics/Orbital Service offers the examination, diagnosis, and treatment of diseases, abnormalities, and damage of the eyelids, tear ducts, and orbit (the bony framework that surrounds the eye). This includes diagnosing oculoplastic/orbital issues before surgery, during surgery, and throughout recovery.

Oculoplastic surgery offers evaluation and surgery for both children and adults with abnormalities of the eyelids or brows brought on by genetics, aging, disease, trauma, or prior surgery. (1)

Definition and Overview

Oculoplastics is a field within ophthalmology that focuses primarily on the surgical repair of the area surrounding the eye. Oculoplastic surgeons are responsible for restoring or modifying the muscles and structures of the eye in order to restore vision. The visual function can be compromised for a variety of reasons, including 

• disease (for example, orbital tumors or Graves' disease), 
• trauma (including fractures), 
• functional defects affecting alignment (such as strabismus and nystagmus), 
• lacrimal system problems (related to the lacrimal glands). 

Oculoplastic surgeons are also skilled in treating uncontrolled blinking of the eye called blepharospasm. Cosmetic procedures such as eyebrow lifting, filling, eyelid surgery, and botox injections are routinely applied by these surgeons to reduce the appearance of aging.

The surgical expertise of oculoplastic surgeons includes treatment of orbital tumors, socket reconstruction, eyelid repair, orbital decompression, correction of paralytic strabismus, and botox treatment in medically necessary cases of blepharospasm. (2)

Procedures

Oculoplastic is a field of ophthalmology that deals with the surgical repair and correction of tissues around the eyes. Orbit surgery is a sub-branch that covers the surgical treatment of bones and soft tissues around the eye. Orbit surgery can involve many different procedures to treat many different problems around the eyes. (3)

• Eyelid surgery (Blepharoplasty)

Eyelid surgery (blepharoplasty) is cosmetic surgery to remove excess fat or skin from the eyelids. The goal is to improve hooded or droopy eyelids or eye bags. Surgery can be performed on the upper eyelid, the lower eyelid, or both. (4)

• Lacrimal apparatus surgery

The tear duct system, which typically removes tears from the eye surface, is the focus of lacrimal surgery. Depending on where the closure (stenosis) or obstruction occurs, this may entail the exploration and reconstruction of any systemic component. (5)

• Eye removal

In circumstances of painful blindness, eye cancer, or after a serious eye injury or infection, eye removal surgery may be used. (6)

• Orbital reconstruction 

Orbital reconstruction is utilized to repair or realign pinched or injured soft tissues, return the patient to their previous state and function, and return the external and internal orbital architecture to its pre-disease form. (7)

• Cosmetic plastic surgery of the brows and orbital area

Plastic surgery that targets the eyelids, orbit (the bones of the eye socket), lacrimal system (the system of tear ducts), forehead, and midface region is known as oculoplastic and orbital surgery. (8)

Candidates

The right procedure should be chosen to meet the general health status and needs of the patient. The surgeons select the appropriate treatment for which they will be candidates for ophthalmic patients who meet the following:

• Conditions that require enucleation
• Eyelid and Orbital Injuries
• Eyelid Abnormalities including ectropion (outward turning of the lower eyelid) and entropion (inward turning of the lower eyelid)
• Graves' Disease, Thyroid Eye Disease, Ptosis
• Involuntary Eyelid Blink (9)

Risks and Side Effects

As with any surgery and procedure, oculoplastic surgery has some risks and complications. These can be listed as 

• severe pain, 
• excessive bleeding, 
• infection, 
• failure to improve the function and appearance of the eyes and eyelids. 

Surgeons provide detailed information about any procedure, including its benefits, risks, potential complications, and alternatives. (10)

Post-Procedure and Follow-up

Pain after surgery is usually mild to moderate and can be controlled with over-the-counter or prescription pain medications. Generally, the patient gets discharged from the hospital, an outpatient clinic, or a general practitioner's office on the same day of surgery. Depending on the procedure, either local anesthetic, which causes numbness at the surgical site, or general anesthesia, which results in temporary unconsciousness, will be used.

Furthermore, the surgeon may place special opaque contact lenses on the patient's eyes to safeguard them against intense surgical room lighting and any potential laser use. Follow-up appointments are set at regular intervals. It is important for patients not to delay these appointments in order to obtain good results.

Recovery

Oculoplastics/orbit surgeries and procedures are a safe and advanced surgical method. The healing process and time may vary depending on the type of procedure. In general, patients may experience swelling, bruising, and discomfort in the affected area after surgery.

Pain relief medications and ice compresses may be recommended to relieve pain and swelling. In addition, it is very important to avoid touching or scratching the affected area and protect it from the sun. The surgeon gives the necessary instructions to the patient to speed up the recovery process after the treatment. It is important to follow these instructions given by the surgeon after the operation. 

Results

The goal of oculoplastic surgery is to treat conditions ranging from droopy eyelids and blocked tear ducts to tumors and orbital fractures in the eye. While oculoplastic surgery is often medically necessary, many people choose to have oculoplastic surgery for cosmetic reasons. As a result of these treatments, healthy eyes and vision and a good appearance are aimed. If unexpected signals are encountered after the treatment, medical help should be sought immediately. These can be listed as follows:

• Pain that doesn't go away after taking painkillers,
• Signs of infection (increased swelling and redness, fluid coming out of the eye or cut)
• An incision that does not heal or separate
• Worsening vision