Orbital Lacrimal System and Eyelid Surgery

Oculoplastic surgery (ophthalmic plastic and reconstructive surgery) is a subdivision of ophthalmology (the science of eye health and diseases). It deals with the diagnosis and treatment of diseases of the eyelid, lacrimal system and orbit (the bones and soft tissues surrounding the eye).

An oculoplastic surgeon is an ophthalmologist and surgeon who specializes in the diagnosis and treatment of all the tissues around the eye (eyelids, tear ducts, orbit, forehead, eyebrows, cheeks, scalp, etc.). In addition to his general ophthalmology training, he is also trained in oculoplastic surgery.

Plastic is a Greek word and means to shape. Ophthalmic plastic surgery performs shape changing operations around the eye.

Eyelids

The eyelids are thin, delicate and complex tissues necessary for the maintenance of vision. Their main function is to protect the eye and to distribute tears to the superficial layer of the eye. In terms of appearance, the shape, size and posture of the eyelids are important.

Disorders related to the shape, function and appearance of the eyelids may be congenital or may develop in later years due to various reasons. Treatment of deformity can be for functional or aesthetic (appearance) purposes.

Sagging Eyelids and Under Eye Bags

It is usually hereditary and/or due to aging. Smoking or allergies can cause sagging eyelids at a younger age. Bags around the eyelids contain loose skin, muscle, fat and in some cases fluid.

Blepharoplasty is a surgical procedure to correct these abnormal structures. It can be for functional or cosmetic purposes.

Eye Contour and Forehead Wrinkles

Wrinkles around the eyes and on the forehead are due to changes that occur in the skin with age. Excessive contraction of the muscles under the skin is also a factor that increases skin wrinkles. Botulinum toxin injections, fillers and various surgical methods can be used to correct skin wrinkles. Botulinum toxin injections prevent excessive contraction of the muscles, while fillers replace tissue loss in the skin. Both treatments are performed on an outpatient basis and the patient can resume normal daily life after the treatment.

Involuntary Tightening of the Eyelids (Blepharospasm)

This problem is more common in women, usually after the age of 40. The cause is excessive contraction of the muscles that close the eyelids against the patient's will. Therefore, the eyelids close even when the patient does not want them to. Patients have difficulty in maintaining their daily lives and need the help of others.

For treatment, drugs called botulinum toxin are used. This drug is injected into the eyelid and surrounding area at specific points and prevents excessive contraction of the eyelid muscles. The duration of action of the drug is usually 3-4 months. After this period, the treatment may need to be repeated.

Eyelid drooping (PTOZIS)

A droopy lid (ptosis) is when the upper eyelid level is lower than normal. This drooping can block the pupil and prevent vision. In severe cases, head position or manual lifting of the eyelid is used to restore vision.

Low eyelid may be congenital due to underdevelopment of the muscle that lifts the eyelid or it may be due to aging. In congenital cases, it is necessary to shorten the weak muscle or use a sling in more severe cases. Low lids may also develop after eye surgeries such as cataract and detachment.

 Left Lid drooping - Preoperative

 After Surgery

 Preoperative Left Valve Low

 After Surgery

Eyebrow drooping

Like other parts of the face, eyebrows lose their tension and sag with age. Eyebrow drooping can be severe enough to prevent the upper eyelid from opening. Forehead and/or brow lifts are surgical procedures that restore the eyebrow to its former state. This procedure can be performed alone or in combination with blepharoplasty. It can be for functional or cosmetic reasons.

 

Outward turning of the eyelids (ECTROPION)

If the lower eyelid turns outward and is no longer in contact with the eye, tear distribution is not sufficient. This can lead to dry eye and infection. Symptoms such as tearing, stinging and burning may occur. Normal lid position is restored with surgical intervention.

Inward turning of the eyelids (ENTROPION)

Inverted eyelids and eyelashes can cause damage to the superficial layers of the eye, symptoms such as stinging, tearing, pain, and in advanced cases, scarring of the cornea (the transparent layer of the eye) and loss of vision. This should also be treated surgically.

Very Open Eyelids (LID RETRACTION)

It has a wider than normal lid gap and can lead to dry eyes. The cause is often thyroid (goiter) disease. It can also occur as a result of overcorrection after droopy lid surgery. It can be corrected with surgery.

 

Scar tissue 

Oculoplastic surgeons can eliminate scars with methods such as surgery, laser or dermabrasion.

Eyelid Injury

Oculoplastic surgery is a branch of science that specializes in the eyelid. Oculoplastic surgeons can repair injuries and related deformities in and around the eyelid in the most aesthetically and functionally appropriate way.

 

Eyelid Cancers

Cancer of the eyelid skin is not uncommon and is increasing. New or growing masses on the eyelids should be carefully examined for the possibility of tumors. The oculoplastic and reconstructive surgeon uses various techniques to remove these tumors and repair the eyelid. As with all tumors, early diagnosis and treatment are important.

Tear System

The eye needs to be wet for eye health. Tears are secreted from the tear glands around the eye. The most important of these glands is the main lacrimal gland, located under the eyelid on the upper-outer part of the eye. With each blink, tears spread to the superficial layers of the eye and are also pumped into the tear duct through small holes in the upper and lower lid near the nose. The tear duct opens into the nose. This duct is the reason why fluid comes into the nose when we cry. A blockage in any part of this tear drainage system causes tears to flow out instead of into the nasal cavity. In order to treat it, a new pathway is created by various methods. If it is not possible to open the tear duct, an artificial duct is made through the eyelid to the nose. A Jones-Payreks tube is used for this purpose.

Diseases of the lacrimal system are the subject of oculoplastic surgery. An oculoplastic surgeon will determine the best treatment for your case.

Watery Eyes in Infants and Children (Congenital Dacryostenosis)

If the lacrimal gland is producing enough but the duct is blocked, tears flow towards the face. In newborns, the ducts through which tears flow may be blocked. They usually open spontaneously in a few months. If it does not open, it should be treated with massage, probing, intubation with a silicone tube or surgically by choosing the most appropriate method. In the early period (first 12 months), treatment can be achieved with simple methods.

In neglected and/or inadequately treated patients, infection is added over time and may affect other parts of the eye. In this case and in watery eyes that persist until the age of 1 year, probing the canal under sedation should be applied first. If watering persists; probing can be repeated or a silicone tube can be applied to the canal at the same time. 95% success is achieved with this application.

Dry Eye

If the lacrimal gland cannot make enough tears, dryness occurs in the eyes. There is burning, stinging and foreign object sensation in the eye. Artificial tear drops are used to treat this. If this is not enough, the mouth of the tear duct is closed. Other treatment methods can be applied in more later periods.

 

Orbita

The orbit is the bone and soft tissues surrounding the eye. Many diseases can affect the orbit. Due to enlarged tissues around and/or behind the eyeball, the eyeball is displaced and its movements may be restricted. As a result, the patient may complain of double vision.

Thyroid-Related Eye Disease

In this disease, both the thyroid gland and the tissues around the eyes (orbit) are affected. In a typical patient, the thyroid gland is enlarged (goiter), thyroid hormones increase in the blood and the eyes protrude forward (proptosis). The protruding eye is caused by thickening of the eye muscles and increased fatty tissue around the eye. Eye movements may be restricted and the patient may see double. In advanced cases, vision may be reduced due to excessive pressure on the optic nerve. This disease is treated with various medications and surgical methods. Aesthetic problems can be corrected when the acute period is over.

 

Orbital Tumors

As tumors of the orbital tissues grow, they push the eye out or, rarely, squeeze it in. Eye movements are restricted. Diagnosis and treatment of orbital tumors may require complex surgery. Most of these tumors are benign and can be surgically removed.

Orbital Injuries and Fractures

The most important factor in protecting the eye is the orbit, the bone frame and the fat pads within it. Orbital injuries and fractures should be treated promptly and without delay.

Loss of the eye

Injury, tumors or other eye diseases may require the removal of intraocular tissues or the complete removal of the eye. This can be psychologically difficult to adjust to. An artificial eye (prosthesis) that is the same color and size as the other eye and can move in harmony with it can make this situation easier. Today, mobile eye prostheses can be applied even to patients who had their eyes removed years ago.

As a general rule, health insurance companies cover the costs of functional oculoplastic surgery. In contrast, they do not cover the costs of aesthetic operations.

Eyelid Aesthetics - Blepharoplasty

Depending on aging or hereditary, bagging, sometimes only sagging and wrinkles without bagging may occur in the eyelid at a younger age. Since the eyelid skin is the thinnest and most mobile part of our face, with the effect of gravity, it rapidly thins, sags, the muscle layer underneath weakens and ages. Due to the weakening of the tissues supporting the eyelids, the fat pads around the eyes come forward and bagging occurs on the lids. With aging, the upper lid fold often increases or disappears completely. Eyelid aesthetic surgery, blepharoplasty, is a surgical procedure applied to the eyelid to correct all of these problems. Blepharoplasty is performed for functional reasons in elderly people and for cosmetic reasons in young people. This surgery is performed under local anesthesia and the patient's recovery time is short and provides an excellent result in the rejuvenation of the face.

Bagging and sagging eyelids are not only cosmetic but also an eye health problem. Sometimes the loose upper lid skin sags past the eyelashes, which can lead to a feeling of heaviness in the eye and vision problems. Loss of elastic tissue in the forehead skin due to aging causes the forehead and most importantly the eyebrow to fall. This condition is called brow ptosis. Patients involuntarily contract their forehead muscles for a long time in order to raise their eyebrows, which can cause eyebrow and headaches as well as prominent forehead wrinkles. Brow ptosis and excess skin on the upper lid can narrow the upper and outer part of the visual field. This narrowing of the visual field also makes reading and driving difficult. To correct the narrowing of the visual field, the patient is forced to involuntarily raise their eyebrows, which causes fatigue, especially towards the evening hours. Loosening of the lower eyelid skin pulls the lid margin downwards, causing the white of the eye to be seen more, giving a different meaning to the patient's gaze. With the weakening and looseness in the tissues due to aging, the lower lid edge may turn outward and cause the outer angle of the lid to be displaced inward-downward. These changes in the lid also cause a tired expression on the patient's face. While performing blepharoplasty in these patients, the oculoplastic surgeon also performs the necessary surgical procedures to correct these problems in the lower lid.

Thyroid disease, heart failure, hypertension and bleeding tendency should be questioned in people undergoing blepharoplasty surgery. In addition, patients who cannot produce enough tears to moisturize the eyes should be careful and this procedure should be performed by an experienced oculoplastic surgeon. When performing blepharoplasty in people with mild dry eye, a smaller amount of skin and fat tissue should be removed compared to those with normal eye moisturization. Otherwise, dry eye increases and vision problems may occur. At the same time, these patients should be told that they may have irritation in their eyes for a long time and may need to use tear drops for a long time. Aspirin, anti-inflammatory drugs, vitamin E, anticoagulants and herbal medicines should be discontinued one week in advance as they may cause bleeding during and after surgery. Patients who wear contact lenses should be told that they may need to stop wearing them for a while after blepharoplasty surgery.

Surgery

Blepharoplasty surgery is usually performed under local anesthesia and is completed in an average of one hour. Painkillers other than aspirin can be taken after the surgery in consultation with the doctor to prevent bleeding. Cold compresses should be applied the same day to prevent swelling of the valves and the head should be elevated for 2-3 weeks. After the surgery, the stitches are removed by the doctor after 5-7 days. Topical tear drops are used for 2-4 weeks after surgery to protect the eye.

In patients with age-related problems such as drooping eyebrows or upper eyelids, and outward rotation of the lower eyelid edge, blepharoplasty can also be performed at the same time.