Oculoplastics, one of the subspecialties of ophthalmology, covers the surgical treatment of problems that occur in and around the eye, the correction of shape disorders, and the correction of some hereditary conditions.
Problems around the eye that sometimes appear hereditarily and sometimes become visible with advancing age can affect individuals’ physical and psychological health. Oculoplastics aims to resolve all of these problems through surgical methods. In addition to being performed for aesthetic concerns, it also treats diseases such as eyelid tumors that may pose health risks.
Which Diseases Does Oculoplastic Surgery Cover?
Oculoplastics deals with a wide range of conditions, from eyelid diseases to tear duct obstructions. These can be listed as follows.
Eyelid diseases
Eyelid Drooping (Blepharoptosis)
Eyelid drooping treatment is the most frequently preferred procedure in oculoplastic surgery. In a healthy individual, the eyelid covers 1–2 mm of the cornea. When the muscle that lifts the eyelid works little or not at all, a larger area of the cornea remains covered, and eyelid drooping occurs. Eyelid drooping, also known as ptosis, can cause amblyopia (lazy eye) in children and visual impairment in adults. It is also not a condition chosen for aesthetic reasons. In some individuals, other diseases may accompany this problem. For this reason, patients with eyelid drooping are advised to be examined by a specialist physician.
What Causes Eyelid Drooping?
It may occur hereditarily or with advancing age.
Prolonged use of contact lenses may trigger it.
It may develop as a result of trauma or neurological muscle diseases.
Masses forming on the upper eyelid may cause the eyelid to droop.
How Can You Tell Whether the Eyelid Is Drooping?
The symptoms of eyelid drooping are as follows:
A feeling of the affected eye becoming smaller
Fatigue
Narrowing of the visual field
Amblyopia (lazy eye) in children
How Is Eyelid Drooping Treated?
If the condition has not developed due to neurological diseases, the treatment of eyelid drooping is surgical. The type of surgery is determined according to the range of motion of the eyelid muscle and the cause of the drooping. In those with adequate muscle movement, the aim is to lift the eyelid by strengthening the levator muscle.
Surgical treatment:
Can be performed under local or general anesthesia in individuals of all ages.
Can be performed through the skin crease or from beneath the eyelid, leaving no visible scar.
The patient may be discharged on the same day.
It is performed by an ophthalmic surgeon who specializes in oculoplastics.
After surgical treatment, bruising and swelling are expected.
In those with inadequate muscle movement, the suspension technique is applied. In this method, although rarely, situations may arise such as the eye remaining partly open during sleep or the eyelid staying higher than the other eye when looking downward. Artificial tear drops may be given in case of dry eye.
Eyelid Wrinkles, Sagging, and Puffiness
As age advances, the skin loses its elasticity under the influence of genetic factors or environmental factors such as cosmetic use and sun exposure, and begins to sag under the effect of gravity. Over time, wrinkles, puffiness, folds, or swelling appear around the eyes. When these changes occur particularly in the eyelids, they cause a person to look older, more tired, and sadder than they are.
With aesthetic eyelid surgery, excess fat, skin, and muscle tissue in the upper and lower eyelids are removed, and the area around the eyes is tightened. Depending on the procedure performed, the surgery, which lasts 1–2 hours, is carried out in the presence of an anesthesiologist. Edema and bruising of the eyelid after surgery are possible complications that do not last long. The aim of the operation is to correct the problems that appear in the person through surgery, giving them a younger and more dynamic appearance.
Eyelid Tumors
Eyelid tumors are mostly benign and generally arise from the uncontrolled proliferation of cells in the eyelid and surrounding area.
What Are the Symptoms of an Eyelid Tumor?
Individuals who have been experiencing any of the following symptoms for a long time are advised to consult an eye doctor.
Non-healing wounds and stye (hordeolum) around the eye
Swelling of the eye
Vision loss
Blurred vision
Redness of the eye
A feeling of pressure in the eye
How Is an Eyelid Tumor Treated?
The first-choice treatment for an eyelid tumor is surgical intervention. After determining whether the tumor is benign or malignant, the tumor is removed surgically. In some cases (in advanced-stage tumors), it may be necessary to remove the entire eye and place a prosthetic eye. After the tumor is removed, the eyelid is reconstructed using a graft (tissue taken from another part of the body) or flaps (sliding of adjacent tissue) in place of the removed tissue. To preserve a natural appearance, aesthetic surgery may be used.
Inward (Entropion) and Outward (Ectropion) Turning of the Eyelids, Deformities
Entropion
This refers to the inward turning of the eyelids. It may be caused by genetics or trauma, but most commonly occurs as a result of tissue loosening due to aging. Because the eyelids turn inward, the eyelashes may cause irritation to the eye. Oculoplastic surgery is used to restore the eyelids to their former position.
Ectropion
This refers to the outward turning of the eyelids. It usually occurs in old age, but it may also develop due to facial paralysis, trauma, or eyelid masses. Oculoplastic surgery is the preferred treatment.
Eyelid Deformities
Trauma can cause aesthetic and functional impairments in the structure of the eyelids. This condition is eliminated using various reconstruction methods.
Eyelash Disorders
Trichiasis
This refers to eyelashes growing in the wrong direction. The eyelashes grow inward from the edge of the eyelid so that they touch the eyeball.
Distichiasis
This refers to the appearance of a second row of eyelashes, different from the normal eyelash arrangement, with the emerging lashes directed toward the eye. Sometimes occurring in one eye and sometimes in both, this condition causes a stabbing sensation with each blink. Treatment options include epilation (mechanical removal of the eyelash), cryotherapy (freezing and destroying the eyelash roots), laser, or electrolysis (destruction of the eyelash roots with electric current). If these methods fail, surgical treatment is applied.
Blepharospasm
Blepharospasm, a neurological disease, occurs when the muscle responsible for closing the eyelid involuntarily contracts strongly. It is seen more often in people over the age of 50. As the disease progresses, spasms appear along with an increase in the frequency of blinking. Spasms sometimes affect only the muscles around the eye, and sometimes may also affect the eyebrow, forehead, or cheek muscles.
Blepharospasm is a condition that can negatively affect a person’s daily life and, consequently, their mental health. In addition to the physical discomfort caused by frequent blinking, complaints such as dryness or watering of the eye, irritation, and light sensitivity are among the symptoms of blepharospasm.
As a treatment, contractions can be prevented with Botox application.
Eyelid Disorders Related to Facial Paralysis
Because the facial mimetic muscles and the muscles that close the eyelid are connected to the same nerve, in facial paralysis, difficulty closing the upper eyelid and drooping of the lower eyelid may occur. Because the eyelid does not close, drying may develop on the surface of the eye. To prevent this, artificial tears are used. In cases where facial paralysis is permanent and there is a situation that threatens the eye, surgical intervention on the eyelid is an effective method.
Tear Duct Obstructions
Excess tears produced pass sequentially through the lacrimal punctum, the canaliculus, and the common canaliculus before draining into the nose. If these channels become blocked for any reason, excess tears flow out onto the face. In such a case, the first symptoms are excessive watering and discharge in the eye. The obstruction may be congenital, or may occur as a result of trauma or inflammation later in life.
What Are the Symptoms of a Tear Duct Obstruction?
Excessive watering of the eye
Frequently recurring discharge
Pus flowing from the eye upon pressing the base of the nose
Swelling at the base of the nose
Frequent eye infections
How Is a Tear Duct Obstruction Treated?
Congenital Tear Duct Obstructions
In newborn babies, there is a membranous structure that prevents tears from passing into the nose. This membrane usually opens spontaneously during the first months. If it does not open, the membrane can easily be opened during the first year, upon medical advice, with a special massage over the tear sac. If it still does not open, channel patency is achieved with a procedure called ‘probing’. In rare cases where even this does not open the channel, a tube must be placed inside the canal.
Acquired Tear Duct Obstructions
A new channel is created by placing a tube in the tear duct or through a surgery called ‘dacryocystorhinostomy’. In this way, the tear sac is connected to the nose. The type of treatment is determined according to the site of the duct obstruction.
Tear Duct Obstructions Resulting from Trauma
In such cases, the application of a special tube is one of the preferred methods. In addition, the integrity of the tear drainage system is restored through repair of the canaliculus laceration.
Diseases of the Tissues Around the Eye
Thyroid Ophthalmopathy
Depending on the goiter (enlargement of the thyroid gland) caused by iodine deficiency, various conditions may develop in different parts of the eye, such as the extraocular muscles, eyelids, and surrounding tissues. In medical literature, this condition is called ‘thyroid ophthalmopathy’, while among the general public it is known as bulging eyes.
What Does Thyroid Ophthalmopathy Cause?
The eye symptoms vary according to the type of goiter. In the early stages, redness of the eyes, eyelid edema, or swelling of the eyelids in the morning may be seen. In more advanced stages, findings such as protrusion of the eye and vision loss are encountered. On the other hand, because the protruding eye makes it difficult to close the eyelids, dryness of the eye and corneal melting may occur. Symptoms may occur in both eyes or in only one eye.
How Is It Treated?
Findings may develop in different tissues. Because the widening of the eyelid opening is thought to result from eyelid involvement, and the protrusion of the eye results from orbital edema, various drug treatments and surgical methods may be preferred depending on the cause of the finding.
Vascular or Tumoral Lesions
Lesions that may signal cancer can be located on the front of the eye or in the eye socket called the orbit. The preferred method for treating lesions on the front of the eye is surgery. A transcutaneous (through the skin) approach may be followed in treatment. However, if the lesions are located on the eye socket, larger orbital surgeries are performed.
Socket Surgery
Depending on genetic or environmental factors, individuals may experience vision loss. Due to pain or aesthetic concerns, removal of the non-seeing eye may be necessary. To correct the shape disorder that occurs after the eye is removed, socket surgery is used.
On the other hand, two methods stand out for removing the eye.
Evisceration
This refers to emptying the contents of the eyeball. The treatment is performed by entering through an opening created in the cornea and emptying the contents of the eye while leaving the white of the eye in place.
Enucleation
This refers to the removal of the entire eyeball. It is generally a surgical method preferred in the presence of tumors or infection in the eye, or as a result of trauma.
Because after either of these surgical interventions the volume of the eye socket may decrease and the eyelids may sink inward, orbital implants (spheres) are placed during surgery. Afterward, a custom-made prosthesis is fitted over the socket with the aim of achieving an appearance similar to the healthy eye.
