oculoplastics

What is Oculoplastics?

Oculoplastics covers a broad spectrum of eyelid, orbit and peri-ocular abnormalities including:

• Eyelid and periocular tumours
• diagnosis
• biopsy
• excision
• eyelid reconstruction
• monitoring for recurrence

Eyelids are at particular risk of sun-exposure related skin cancers, as the importance of wearing eye protection has only become emphasised upon recently.

Eyelid skin can develop any benign or malignant lesions as skin anywhere else in the body. However, it is more difficult to excise these lesions on the eyelid as proper structure and function must be maintained in order to protect the eye.

• Eyelid malpositions (ectropion, entropion, ptosis, dermatochalasis, retraction)

Ectropion

An ectropion is where the lower eyelid turns outwards away from the eye, exposing the inner surface of the eyelid. Symptoms include discomfort, watering, and poor vision from exposure of the cornea.

Entropion

An entropion is where an eyelid turns inwards towards the eye, causing the eyelashes to rub against the front of the eye (the cornea). Symptoms include discomfort, pain, watering, and poor vision from damage to the cornea

Ptosis

Ptosis is a condition where the upper eyelid droops over the eye. It can block the upper field of vision and detract from one's appearance.

Dermatochalasis

Dermatochalasis is excess eyelid skin which overhangs the eyelid margin. It often restricts peripheral vision and gives a sleepy or drowsy appearance.

Ptosis and dermatochalasis often appear together.

Lid retraction

Lid retraction can occur in either the upper or lower lid. It means the eyelid is “too open” and can give the appearance of a stare or a surprised look. It can also be associated with inability to close the eyes fully, allowing the surface to dry out. This can lead to discompfort and loss of vision.

Exposure/lagophthalmos

Lagophthalmos is a term used to describe the inability to close the eye fully. Blinking helps distribute the tears over the surface of the eye and maintains the health of the eye’s surface. If the eye is left open for too long (especially during sleep), the surface dries out and can lead to serious problems including loss of vision.

Eyelash abnormalities

Inturned or abnormal lashes can rub on the surface of the eye, resulting in scarring and loss of vision

Lacrimal system abnormalities

The tear drainage pathway can become blocked anywhere from the eyelid openings called punctae through to the inside of the nose. This can lead to excessive tearing, mucous discharge into eye, and recurrent infections.

Thyroid Eye Disease

Thyroid Eye Disease can manifest in many different ways. The main eyelid abnormalities are lid retraction (causing the typical “thyroid stare” or surprised expression) and lagophthalmos (the inability to close the eye fully, resulting in dehydration of the eye surface and loss of vision). The eye may bulge forward and contribute to these problems.

The most significant problem is compression of the optic nerve by swollen muscles which can lead to loss of vision.

Cellulitis

Infections of the eyelids from trauma, cysts, or bites are common. Deeper infections of the eye socket can have serious visual consequences.

Artificial Eyes

Unfortunately, sometimes, eyes must be removed due to trauma, tumours, or other eye pathology. Removal of a blind, painful or unsightly eye and replacing it with an artificial eye often provides significant relief. A ball of plastic or coral is placed internally to replace the eye, whilst a removable/cleanable disc is placed superficially between the eyelids. This disc is painted by an artist to match the other eye exactly, to provide very good cosmetic results.

Orbital tumours and inflammation

The structures surrounding the eye (muscles, tendons, glands, fat, even the linings of the eye itself) can become inflamed or may be involved in, or compressed by a tumour. Often this will manifest itself as the eye protruding forwards or sideways.

Trauma and Reconstruction

The bones surrounding the eye can be involved in trauma. The most common scenario is called a “blow-out fracture” of the walls beneath the eye and those on the nasal side of the eye. Sometimes muscles can be pulled into the breaks causing double vision.

The eyelids can also be involved in trauma, and require specific reconstruction to maintain their proper structure and function.

Brow ptosis

Brow Ptosis is a condition where the eyebrows drop downwards due to stretching of the forehead skin with age, or due to problems with the nerves in the area. It can give the appearance of frowning or sadness, and can lead to difficulties with opening the eyelids.

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