Bangladesh Eye Hospital

Orbit & Oculoplasty

What Is Oculoplasty?

Oculoplasty is the art and science of plastic surgery around the eye. The eyeball is a delicate structure, protected from harm by eyelids in front and the bony cup (socket) behind. Behind the eyeball run the nerves, arteries and muscles, which carry messages to the brain, move the eyeball, and provide nutrition to the eye. Oculoplasty deals with all these structures surrounding the eyeball.

Why Should An Eye Surgeon Do Plastic Surgery?

Oculoplastic surgeons first train as ophthalmologists, when they learn in details about the eye. During further higher training, they start to handle plastic surgery. They have the best knowledge about the eye and its surrounding; as eye surgeons, they are also ready to handle the most delicate of structures. This combination of skills makes the oculoplastic surgeons the best to do plastic surgery around the eye.

SERVICES AVAILABLE:-

EYELID

Ptosis– Ptosis is drooping of the upper lid. It may be present by birth, or appear later in life. Ptosis is usually corrected by surgery.

Entropion– Entropion is in-turning of the eyelid. The eyelashes rub on the eye and cause pain and watering; treatment is by surgery

Ectropion– Ectropion is turning outwards of the eyelid margin, causing redness and watering (Link to gallery) Lagophthalmos- where the patient cannot close his eye; this can cause danger to the eye, pain and infection.
Eyelid tumors
Lid tearrepairs with grafts and flaps

ORBIT

Orbital fractures– A fracture in the bones around the eye can cause double vision, and a sunken small appearance of the eye. The fracture is repaired with an implant or plate. The best results are obtained in surgery within 2 weeks of injury, but surgery can also be done later.
Thyroid decompression
Orbital tumors

SOCKET

Enucleation/ evisceration– A highly damaged eye may be replacedwith an orbital implant; this restores the comfort and appearance.
Socket reconstruction– where the eye has been removed for a serious disease, the socket of the eye may get shrunken. The socket is reconstructed to improve comfort and appearance
Customised prosthesis
Lacrimal (eye watering) DCR, probing, intubations.

AESTHETIC

Blepharoplasty– Correction of eyelid bags
Scar modification
Ptosis
Eyelid retraction
Wrinkle treatment

SPECIAL CLINICS

Thyroid eye disease: Thyroid disease can have a serious effect on the eye. The eye develops a bulging look; the patient can have itching and burning, discomfort, corneal ulcers, double vision, and even loss of vision.

Our thyroid eye disease clinic monitors the eye health regularly, so that any danger to the eye is prevented. By injection and surgery, the changes done by the disease can be reversed back to normal.

Botox clinic hemifacial spasm, essential blepharospasm, wrinkle treatment. Due to over-action of muscles around the eye, the eyes can go into spasm – where the face and eyes twitch; patient is not able to open the eyes comfortably. This can be treated safely and effectively by injection of botulinum toxin.

Botulinum toxin can also be used to treat wrinkling and aging around the eye.

Trauma– Eyelid tear repairs.

Pediatric oculoplasty– Probing, Ptosis

FAQS

PTOSIS

What is ptosis?

Ptosis is drooping of the eyelid. The eye appears smaller, there is difficulty opening th e eye. Ptosis may occur in one eye or both eye. There is obstruction of vision and a sleepy and tired appearance.

Why does ptosis occur?

There is a muscle in the upper lid, called the levator- the function the levator is the lift the eyelid open. If the levator is not working well, the eyelid droops.

In many patients who have ptosis since birth, the levator muscle is weak since birth.

In patients where ptosis starts later in life, there may be multiple causes: injury, age, use of contact lens for many years, some neurological diseases.

How important is it to correct ptosis?

For an adult, a ptosis can block part of the visual field, obstructing the vision. There can be strain by lifting the brow muscles to compensate. More and more people opt for ptosis correction to avoid looking tired, sleepy and unhappy.

In a child, the ptosis may cause delay in the development of vision, and a lazy eye (amblyopia). This has to be corrected at a young age, and appropriate glasses and exercise started. Once the patient is older, vision correction cannot be achieved. It is extremely important to have an accurate assessment of vision in a child with ptosis.

What are the methods of correction of ptosis?

The oculoplasty surgeon assesses the measurements of the eye. If the natural muscle can be strengthened with stitches, that is the method of choice. If the natural muscle levator is too weak for correction, an implant (most commonly silicone) is places to connect the forehead muscles and the eyelids. The patient can then effectively use the forehead muscle to lift the eyelid.

Some neurologic diseases such as myasthenia can be treated by oral medicines.

SQUINT OR STRABISMUS:-

What's to know about squint or strabismus?

A squint, or strabismus, is a condition in which the eyes do not align properly. One eye turns inwards, upwards, downwards, or outwards, while the other one focuses at one spot.

It can happen all the time or intermittently.

This usually occurs because the muscles that control the movement of the eye and the eyelid, the extraocular muscles, are not working together.

As a result, both eyes are unable to look at the same spot at the same time.

It can also happen because a disorder in the brain means that the eyes cannot correctly coordinate.

Strabismus also makes binocular vision impossible, so it is harder for the person to appreciate depth perception.

TYPES OF STRABISMUS:

There are different types of strabismus. They can be described by the cause or by the way the eye turns.

The following terms describe strabismus by the positions of the eye:

Hypertropia is when the eye turns upwards
Hypotropia is when the eye turns downwards
Esotropia is when the eye turns inwards
Exotropia is when the eye turns outwards

An early diagnosis of strabismus will enable more effective treatment. In the past, it was thought that after a “critical period”, strabismus could not be treated.

While treatment up to the age of 6 years is believed to be most effective, strabismus can be treated at any time.

SIGNS AND SYMPTOMS IN CHILDREN:

The sign of a squint is fairly obvious from an early age. One of the eyes does not look straight ahead. A minor squint may be less noticeable.

Infants and newborns may go cross-eyed, especially if they are tired. This does not mean that they have a squint. Parents can check with their doctor.

PROBING

Why is my child’s eye watering?

Every eye has a fine pipe leading from the eye into the nose. This is like a drain-pipe, and the tears go into the throat through this pipe. This is called the nasolacrimal duct. A child may be born with a block in the naso-lacrimal duct; this condition is called congenital dacryostenosis. The water and sticky material come out of the eye, and the chil’d eyes appear to the tearing all the time. This condition is seen within a few weeks after birth.

What are the treatment options available?

Many of the children with congenital dacryostenosis will heal only with antibiotic drops and sac massage. The oculoplastic surgeon will show you the correct technique of sac massage for your child. If the condition has not healed by 9 to 12 months, it will probably not respond to further massage and a surgery will be required.

What surgical options are there for the tear duct block?

The first step of surgery is called probing. It is very safe, can be done as a day-care procedure (night stay in hospital not required). There is no external wound or stitches, no bandage required, and normal activities can be continued from the next day.

How effective is probing?

The best results are achieved at about one year of age. Nine out of ten babies have the problem corrected if probing is done within this time. As the child grows older, success chances decrease to about 7 or 8 out of 10.

If the watering does not improve with probing, what is the next step?

A probing can be repeated 3 months later, putting silicone intubation in to prop open the nasolacrimal duct. For children older than 3-4 years, we recommend using silicone intubation routinely at the time of probing. If this too does not resolve the watering, the next step is a bigger surgery (see DCR) where a new nasolacrimal duct is constructed. But do not worry, the vast majotity of children will recover only with probing.

DACRYOCYSTORHINOSTOMY (DCR)

What is DCR?

Each eye has a fine pipe which drains the tears from the eye. This is a nasolacrimal duct (drain-pipe of the eye). If it gets blocked, the tears and stickiness come out of the eye. The treatment is by dacryocystorhinostomy (DCR). This is a technique by which a new passage is created from the eye into the nose, and the tears can drain out.

Is it necessary to undergo DCR?

When a nasolacrimal duct is blocked, the dirt and discharge accumulate in the lacrimal sac next to the eye. There is the risk of severe eye infection if the condition is left untreated. There may be swelling, pain, and watering. If a cataract surgery is planned, a blocked nasolacrimal duct increases the risk of dangerous infection; a DCR should be done before the cataract surgery.

How is DCR performed? What are the outcomes?

DCR can be performed in three ways- externally, through a small (less than half inch) line next to the nose; endonasally- through the nose; and trans-canalicular using Laser DCR.

The external DCR leaves a fine mark near the eye; it has the highest success rates, more than 95 out of 100 patients have the problem completely solved after external DCR. An endo nasal DCR is done through the nose, so there is no mark outside. The success rates are a little lower; all nose space inside is not suitable for endonasal surgery, and it can be done well in selected patients only. Trans-canalicular Laser DCR is a very rapid procedure, with hardly any pain and swelling. However, some of the DCR done with laser may close down again.

THYROID EYE DISEASE:

The clinic we offer surgical options such as orbital decompression to place the eye back in its socket, alleviation of retracted eyelids, loosening of the eyelid muscles and muscle surgery to correct diplopia and even Botox therapy for upper lid retraction and eye alignment disorders.