Oculoplasty

What is Oculoplasty?
This is the subject which deals with plastic surgery and reconstruction of eyes and related parts of the eye along with the face in cases where the problem is by birth or acquired.

• Orbital & Face reconstruction
• Orbital eyelids tumors
• Advanced prosthesis fitting
• Endoscopic DCR

Entropion and Ectropion (lid abnormalities) Entropion is a disorder of eyelids causing in turning of lid margin. This condition is caused by scarring of tarsus and conjunctiva. Common causes Trachoma Chemical/Thermal Burns Infectious diseases Herpes zoster Lid trauma and surgery	Techniques Skin muscle excision Wedge resection Tarsal fracture (tarsotomy with tarsal rotation). Jones procedure Full thickness blepharotomy and tarsal rotation (Wies technique) Mucous membrane grafting with anterior lamellar repositioning. Posterior lamellar eyelid reconstruction using: a. Hard palatal mucosa b. Auricular cartilage c. Nasal septal cartilage d. Banked sclera

Ptosis

Ptosis means drooping of eyelids. It predominantly occurs in upper lid and is mostly congenital in nature. It is the result of the weakness or paralysis of levator or muller’s muscle (the muscle which elevates the upper eye lid). Management of the condition requires a thorough understanding of the surgical anatomy and a meticulous surgical technique based on a proper evaluation. It is associated with various anomalies. It can be congenital or acquired.

Functions of lid

Reflex closure of the eye - protects the eye ball (loud noise, glare, flying foreign object)

Prevents cornea from dryness, (Keeps the cornea wet and moist).

Blinking keeps cornea moist and warm.

Cilia mainly of upper lid protect the eye from flying objects.

Any disorder that disturbs the upper lid anatomy and physiology becomes not only a cosmetic blemish, but a serious physiologic impediment requiring correction.

Preoperative Examination :
This is the most important step in the treatment of Ptosis. The choice of surgery and degree of correction to be carried out at time of surgery depends on this.

History

• Age of onset
• Improvement / Worsening
• Trauma / birth injury
• Family history
• Previous surgery

Examination
Bilaterality (Involvement of both eyes)

Degree of Ptosis
In case of unilateral Ptosis, the difference in aperture in primary position. In case of bilateral Ptosis, the relation lid margin to the limbus & pupil in the primary position.

• Mild Ptosis 2mm or less
• Moderate Ptosis of 3mm
• Severe Ptosis of 4mm or more.

Surgery
It is done to elevate the upper eye in relation to the normal eyelid.

Depending upon

Whether the Ptosis is unilateral or bilateral

Severity of Ptosis

Levator muscle action

Procedures : Broadly it is divided into

1. Sling procedures (brow suspension with fascia lata) ; in cases of poor LPS action special material is used to elevate the eye lid.
   Fasanella Servat Operation
2. Levator muscle resection : shortening of the LPS muscle to elevate the eye lid.
3. In complicated cases many other procedures are done, when associated abnormalities are present. Presence of associated problems of ocular motility like squint, Blepharophimosis syndrome or jaw winking phenomena.

Post-Operative care :

1. Broad spectrum antibiotics and anti-inflammatory drugs are given for five days.
2. Local hot fermentation for one week if required.
3. Cornea is kept moist with lubricant and antibiotics ointment day and night.
4. Frost suture is kept for 3-4 days depending on circumstances.
5. Local hygiene is maintained by keeping the wound clean by daily clearing with wetswab stick and betadine application.
6. Stitches are removed after 5 days.