Oculoplastic surgery (ophthalmic plastic and reconstructive surgery), is a subdivision of ophthalmology (eye health and diseases). This branche deals with the diagnosis and treatment of issues about eyelids, tear system and orbital diseases (bone and soft tissues surrounding the eye).
The oculoplastic surgeon is an eye disease specialist in the treatment of all the tissues about the eye (eyelids, tears, orbita, forehead, eyebrows, cheeks, scalp). An oculoplastic surgeon has in addition to general ophthalmology education, information about oculoplastic surgery.
Plastic is a Greek word and has the meaning of shaping. Ophthalmic plastic surgery applies the ocular deformation operations.
Below you will find information about some of the most common diseases treated by oculoplastic surgeons. You can obtain the most appropriate and detailed information about your situation by talking to your doctor.
The eyelids are fine, delicate and complex tissues necessary for continued viewing. Its basic functions are to protect the eye and to help the tears spreading to the superficial layer of the eye. In terms of appearance, the shapes and sizes of the eyelids are important. Disturbances in the shape, function and appearance of the eyelids may be congenital or may develop in the aging years for various reasons. The treatment of deformity may be functional or aesthetic.
Sagging eyelids and under-eye bags
This issue is usually due to hereditary and/or aging. Smoking or allergies can cause sagging at a younger age. The bags around the eyelids contain loose skin, muscles, fat and in some cases liquid.
Blepharoplasty is a surgical procedure performed to correct these abnormal structures. It may be functional or of cosmetic purposes.
Supraorbital ans forehead wrinkles
Supraorbital and forehead wrinkles are dependent on changes in the skin that occur with age. Excessive contraction of the muscles under the skin also increases skin wrinkles. Botulinum toxin injections, fillers and various surgical methods can be used to correct skin wrinkles. Botulinum toxin injections prevent excessive muscle contraction while replacing the filler material with tissue loss on the skin. Both treatments are administered remotely and after treatment the patient can continue to normal daily life.
Involuntary Contraction of the Eyelids (Blepharospasm)
This problem is more common at women, usually after 40 years of age. The reason is that the muscles that close the eyelids are excessively contracted unintentionally. Because of this, even if the patient does not want, the eyelids get closed. Patients have difficulties in maintaining their daily lives and need the help of others. For the treatment, a medicine called botulinum toxin is used at first. This medicine is injected into and around the eyelid and prevents the muscles from contracting excessively. The duration of the effect is usually 3-4 months. After this, the treatment may need to be repeated.
Eyelid looseness (PTOZİS)
At eyelid looseness (ptosis) the upper eyelid level is lower than normal. This abortion can cover the pupills and hinders the vision. In such a case the head position can be changed or the eyelid can be raised manually.
Eyelid looseness may be congenital or related to the age due to the insufficiently developed muscle of the lid. In congenital ones, it is necessary to shorten the weakness or use a hanger in more severe cases. After eye surgerys such as cataract, eyelid looseness may develop.
Like other parts of the face, eyebrows can lose their tension with age and become saggy. The lowness of the eyebrows can be violent enough to prevent the opening of the upper eyelid. Surgical procedures like forehead or eyebrow streching can bring the eyebrows back to their normal sight. This procedure may be applied sole or with blepharoplasty and can be functional or cosmetic.
Eversion of the eyelids (EKTROPİON)
If the lower eyelid rotates outward and the eye contact is cut off, the tear distribution will not be enough. This can lead to dry eyes and infections. Lacrimation, sinking, burning may occur. Surgical intervention provides the normal eyelid position again.
Introversion of the eyelids (ENTROPİON)
The introversion of the eyelids and the eyelashes can cause the formation of a wound in the cornea (transparent layer of the eye) and vision loss in the superficial layers such as irritation, stinging, lacrimation, pain, etc. So it should be surgically corrected.
Too opened eyelids (EYELID RETRACTION)
Normally there is a large eyelid gap and this can lead to dry eyes. It is mostly a thyroid (goitre) disease. It can also occur as a result of overcorrection after a eyelid looseness surgery. It can be corrected by a surgery.
Oculoplastic surgeons can remove scars with a surgery, laser or dermabrasion.
Oculoplasty is a branch that is competent with eyelid surgery. Oculoplastic surgeons can repair eyelids, surrounding injuries and associated deformities in a most aesthetic and functional manner.
The incidence of cancer in the eyelid skin is pretty much and increasing. New or growing masses in the eyelids should be carefully examined for possible tumor. The oculoplastic and reconstructive surgeon uses various techniques to remove these tumors and repair the eyelids. As with all tumors, early diagnosis and treatment is very important.
Eyes have to be wet. Tears are secreted from the tear glands around the eye. The most important of these glands is the main tear gland, which is located under the eyelid in the upper-outer part of the eye. At each blink, some tears spread to the superficial layers of the eye and at the same time, it is pumped into the lacrimal duct from small holes in the lower and upper lid near the bur. Lacrimal ducts open in the nose. This duct is the reason why it flows when we cry. Any congestion of this tear discharge system causes the tears to flow out instead of the nasal cavity. At the treatment of this disease we create e new way for the tears to flow. If it is not possible to open the lacrimal duct, an artificial channel is formed extending from the inside of the eyelid to the mouth. The Jones-Payreks tube is used to achieve this.
Tear system diseases are the subject of an oculoplastic surgeon. An oculoplastic surgery specialist will determine the optimal treatment for the condition.
Baby’s and children’s eye watering (Congenital Dacryostenosis)
The tear gland makes enough production, but if the duct is blocked, the tear flows to the face. Newborn’s tears can become blocked in the active ducts. It usually opens automatically in a few months. If not, massaging, probing, silicone tubing, intubation or a surgery should be selected by choosing the most appropriate method. Early treatment (first 12 months) can be applied with simple methods. Neglected and / or poorly treated patients may get infections over time. In this case, if it continues up to the first year of age, ducting should be applied under sedation. If the watering continues; this can be repeated or a silicone tube can be applied. With this application 95% success is achieved.
If the tear gland cannot produce enough tears, the eyes will dry out. Burning, stinging, foreign body sensation in the eye will apper. Artificial tear drops are used as a treatment. If this isn’t enough, the endings of the tear ducts get closed. Other treatment modalities may be applied in later periods.
The bone and soft tissue surrounding the eye is called Orbita. Many diseases can affect this. Due to the expanding tissues around and/or behind the eye cure, it is displaced and there may be a limitation in its movement. Accordingly, the patient may complain of double vision.
Thyroid related eye diseases
In this disease the thyroid gland and the tissues around the eye (orbita) are affected. A typical patients thyroid gland grows (goitre), the calming thyroid hormones increase and the eyes move forward (proptosis). The reason why it stands out is the thickening of the eye muscles and the increase of the fat around the eyes. Eye movements can be restricted by this and the patient can have double vision. In extreme cases, vision may be reduced due to excessive pressure on the eye’s nerve. This disease is treated with various medicins and surgical methods. As a result of the treatment, the patient can regain his health and normal vision.
The tumors of the orbital tissues push the eyes out or squeeze them in. Eye movements are restricted by this. Diagnosis and treatment of orbital tumors may require complex surgical procedures. Most of these tumors are benign and can be surgically removed.
Orbita injuries and fracture
The most important factor for the protection of the eye is the bone frame and the fat pads (orbita). Orbital injuries and fractures should be treated at the appropriate time before it’s too late.
Surgical eye removal
Injury, tumors or other eye diseases may require the removal of the eye tissues or even the removal of the eye. This is a psychologically difficult situation. An artificial eye (prosthesis) which can move in harmony with the other eye in the same color and size can facilitate this situation. Nowadays, moving eye prostheses can be applied even to patients whos eye has been taken years ago.
As a general rule, health insurance institutions support the costs of oculoplastic surgical operations. Conversely, it can not afford the costs of aesthetic initiatives.
Eyelid aesthetic – Blepharoplasty
Due to aging of the eyelid, wrinkles can occur with our without bagging. The skin of the eye is the thinnest and moving part of our eye and it is rapidly affected by gravity, it slowly fades and the muscle layer beneath it weakens and ages. Depending on the weakness of the tissues supporting the eyelids, the fat pads around the eyes come forward and baggage occurs. Together with aging, the upper lid fold often rises or disappears altogether. Eyelid aesthetic surgery (blepharoplasty), is a procedure applied to the eyelid. It corrects all of these problems. Blepharoplasty is functional in the elderly and cosmetically in the young. The duration of this operation with local anesthesia is short and provides an excellent result in rejuvenation.
Bagging and sagging of the eyelids is also an eye health problem. Occasionally, the abundant upper lid skin slips through the eyelashes, which can lead to heavy eyes and visual problems. Depending on aging, elastic tissue loss occurs in the forehead and most importantly it causes eyebrows to fall. This is called eyebrow ptosis. Patients can unintentionally stretch their forehead muscles to lift their eyebrows for a long time, which can cause wrinkles to appear at the same headaches. Eyebrows and skin overhang on the upper cover can narrow the upper and outer parts of the field of view. This narrowing of the visual field also makes it difficult to read and drive at the same time. In order to correct the narrowing of the visual field, the patient is forced to lift his eyebrows unintentionally, which causes tiredness, especially in the evening hours. The plenum in the lower eyelid causes the white of the eye to be seen more by pulling the edge of the lid downward. With weakening and looseness in aging tissues, the lower lid edge can turn outward and cause the lid outer angle to shift inward. These changes cause a tired expression on the patient’s face. The oculoplastic surgeon performs the necessary surgical procedures to correct these problems.
Patients who will do blepharoplasty, should question diseases such as thyroid disease, heart failure, hypertension and tendency to bleeding. Also be careful with patients who do not produce enough tears to moisten their eyes. This procedure should be performed by an experienced oculoplastic surgeon. People with mild eye irritation should do blepharoplasty, skin and fat should be removed less than normal eye moisturizers. Otherwise the eye area will increase and vision problems may occur. At the same time, it should be explained that this disease may be irritate the eyes for a long time and that they may need to use tear drops for a period. Aspirin, anti-inflammatory medicine, vitamin E, anticoagulants and herbal medicines shouldn’t be taken one week in advance, because they may cause bleeding during and after surgery. Patients using contact lenses should be told that they may not be used for a while after the blepharoplasty surgery.
Blepharoplasty is often performed under local anesthesia and is completed within an average of an hour. To avoid bleeding after surgery, pain medication outside aspirin can be taken by consulting a doctor. Cold compresses should be applied on the same day to avoid swelling on the eyelids and the head should be placed high for 2-3 weeks. 5-7 days after surgery, sutures are taken by the doctor. Topical artificial tear remedies are used to protect the eye for 2-4 weeks after surgery.
Patients with problems such as eyebrow or upper eyelid looseness or eversion can also be operated with blepharoplasty.