Orbit and Oculoplasty


Treatment depends on how severe the problem is and what is causing it. If the underlying cause is dry eye syndrome, try avoiding reading, watching TV and using a computer continuously for long hours – you are likely to blink less during these activities, which can make symptoms worse.

The use of lubricating eye drops can help ease the discomfort of dry eye. These can be bought over the counter from a pharmacy and your healthcare professional can advise which product is best for you.

It might help to hold a warm, damp, clean cloth over the affected eye for five minutes and at the same time, gently massage your eyelids with the cloth to loosen any material that might be blocking the eye glands.

If a bacterial infection such as conjunctivitis is causing watering eyes, your doctor may prescribe a course of antibiotic eye drops. If they suspect a virus is the cause, it may take a little longer to resolve, sometimes maybe even a month.
If your eyes are watering because of an allergy, antihistamine medication may be prescribed to help reduce the inflammation.

In cases where irritation is caused by an inward-growing eyelash or a foreign object, such as a piece of grit, these can be removed by your eye specialist. If your lower eyelid rolls inwards (entropion) or sags outwards (ectropion), a minor operation carried out under local anaesthetic may be recommended. The most common procedure involves tightening the tendon that holds the outer eyelid in place to give it extra support.

Tear ducts allow excess tears to drain away. If a blocked tear duct is causing watering eyes, it can be treated with surgery.
If you have an infection in your tear sac (where excess tears from your eyes drain into), it will need to be treated with antibiotics first, before surgery. Left untreated, the infection could spread to your eye socket.

Dacryocystorhinostomy (DCR) is a common surgical procedure used to treat blocked tear ducts. It involves creating a new channel from the tear sac to the inside of your nose. This channel allows tears to bypass the blocked part of your tear duct.

The treatment for eyelid drooping based on the specific cause. If the condition is the result of the age or something you were born with, you wont receive any treatment. Your doctor will explain that nothing needs to be performed because the condition is not generally harmful to your health. Even though, you can opt for the plastic surgery if you want to reduce the drooping of eyelids.

If your eyelid blocks the vision, you need a medical treatment. Your doctor will recommend for surgery. Glasses which can hold the eyelid up are another possible option. This treatment is usually most effective when the eyelid drooping is occurs only temporary by that you dont have to wear glasses all the time. Glasses may also recommend by the doctor if you aren’t a suitable candidate for the surgery.

Your doctor may recommend for ptosis surgery. During this surgery, the levator muscle will be tightened. This will lift the eyelid up into a desired position. Another alternative is a “sling” surgery, in which the forehead muscles are been used to elevate the eyelids.

For children who undergone ptosis, doctors rarely recommend for the surgery to prevent the onset of the amblyopia or lazy eye. If your doctor finds that the eyelid drooping is caused by an underlying condition, then you will be treated for that. This will typically stop the eyelids from the sagging.

Entropion is usually treated by surgery. It is not major surgery. Sometimes other forms of treatment may be used to temporarily correct the entropion.
This can include:
Tape on the eyelid: Tape can be very carefully placed to stop the eyelid turning in, but this needs to be done very carefully after being shown how to do this by your doctor to avoid the tape itself scratching your eye.
Injections of botox: This can be helpful for some weeks whilst an operation is organized.
Temporary stitches in the eyelid: Occasionally stitches can be put in to the eyelid as an office procedure. This may be effective for some months.

What is done during an entropion operation will depend on the causes of the entropion. In most cases the eyelid will be "tightened", usually by making a very small incision at the outer corner of the eye and pulling the eyelid across to reattach it just inside the rim of the bony eye socket at the outer corner (this is sometimes called a “tarsal strip” operation). In combination with this, there may be other procedures performed.
These can include the following:
Repairing the lower eyelid retractors. This is usually done through an incision just under the eyelashes which heals very well and does not leave a noticeable scar
Special sutures through the eyelid to help turn it outwards.
After surgery, your doctor may prescribe eye drops and use of an eye patch overnight to protect the eye. You should notice improvement within a day or so.

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Eye Socket Reconstruction is the recreation of the normal eye appearance in patients who have diseased eyes that require removal of the eye. It involves volume replacement with a spherical implant and the subsequent wear of a customized prosthesis that looks like the other eye.

In ophthalmology mucous membrane graft (MMG) has unique application in reconstruction of ocular surface, posterior lamella of lid, contracted socket and as a spacer for lid retraction. Today ophthalmologists are keen to explore these applications of MUCOS MEMBRANE GRAFTING.

NEOSTIGMINE TEST : is an important test to rule out myasthenia gravis
PARALYTIC SQUINT FRESNEL PRISM : Fresnel prism help relieve

double vision due to paralytic squint or your double vision that expected to change over time, or as a trial before a more permanent prism can be built into new glasses.

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An evisceration is the removal of the eyes contents, leaving the scleral shell and extraocular muscles intact. The procedure is usually performed to reduce pain or improve cosmesis in a blind eye, as in cases of endophthalmitis unresponsive to antibiotics.

Procedure :
Careful pre-operative evaluation should be performed to ensure there is no intraocular malignancy in the operative eye when planning an evisceration. Evisceration may be performed under general anesthesia, or in some cases, intravenous, monitored sedation. The patient is appropriately prepared and draped in a sterile manner, and the procedure is performed.

The surgeon evaluates and chooses the best implant size to restore orbital volume while ensuring appropriate position.. Implant material is surgeon-dependent and includes spherical implant choices of acrylic, PMMA, silicone, and hydroxyapatite.. A pressure patch may be applied and kept in place for approximately 5 days following surgery. The patient will be on antibiotics for a certain period of time after surgery usually around 10 days.The patient may visit an ocularist for prosthesis fitting 6-8 weeks following surgery.

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The orbital tumors are the tumors which appear somewhere around the orbit. The orbit is the bony socket that defend the eye from any threat. The orbital tumors may appear anywhere in the orbit, & they leads to the displacement of the eyes – generally, the eyes will look bigger, a disease known as proptosis, or they will be lower or higher than the normal, a condition called as dystopis. This kind of the tumor is very dangerous, if not treated in correct time, it may leads to the complete loss of the vision.

The orbital tumors will be treated by an orbital tumor surgery. Orbital tumours can be removed by a surgery called as orbitotomy, an orbit opening procedure is to access the tumor. This kind of the surgery will be done through a lateral, anterior, medial or posterior route & it is then called as lateral orbitotomy, anterior orbitotomy, medial orbitotomy or posterior orbitotomy. If multiple approaches were used, then the surgery is called as combined orbitotomy.

The orbitotomy generally consists of a surgery by which the orbit is opened & the tumor is removed. The anterior orbitotomy, used for tumors which are located in anterior orbit, is performed with a transseptal, transperiosteal incision (by the conjunctival surface of eyelid), from which the tumor is removed. The lateral orbitotomy is used to remove the masses which are located deeper in the orbit, or lesions of lacrimal gland. The cut or incision is placed this time under the brow, higher in the eyebrow or in small crease in the eyelid. After the cut or incision, the periorbita needs to be opened after a small section of the bone has been removed.

Once the periorbita is opened, the oculoplastic surgeon will remove the tumor, closes the periorbita back & replace the bone. When it comes to posterior orbitotomy, it was done as same as the lateral one, by a same, lateral approach. The recovery time will be based on the patient & on the type of the surgery that is done; like, how complicated it was, or how large the tumor was, but it generally takes roughly 2 weeks to go back to normal life, as the surgery will give bruises & swelling that will take time to disappear. 1st week after the surgery, patient should minimize doing very difficult sports & general efforts.

It is recommended by the doctor not to travel during the first 4 weeks after the surgery is done, even though patient will be discharged in just one day after the orbitotomy surgery.

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