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ORBIT AND OCULOPLASTY |
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The Orbit & Oculoplasty subspecialty at Shroff Eye Centre is a
distinct subspecialty in ophthalmology, which deals with the various
diseases of the eyelids and orbits (sockets). These include a vast
spectrum of disorders and are managed by Oculoplastic surgeons who
are highly trained in the field.
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Learn about various diseases of
the eyelids and orbits |
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Anatomy of the Eyelids
and Orbit |
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Ptosis |
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Lid margin abnormalities
- Trichiasis |
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Lid margin abnormalities
- Ectropion |
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Lacrimal passage diseases |
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Lid injury |
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Lid tumors |
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Orbital diseases |
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Socket surgery |
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Anatomy of the Eyelids
and Orbit |
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Before some of the common problems are discussed, it is important
to understand the anatomy of the structures around the eyeball.
The delicate structure of the eyeball is protected, against injury,
on the sides and in front by bony walls of the orbit and eyelids
respectively.
 The
orbit is the bony cage or the socket in the skull, which houses
the eye. In front of the eye, the eyelids open and close by reflex
or voluntary action to distribute tear fluid so as to keep the cornea
(the front surface of the eye) moist, to shut out light, and to
protect the eyes from foreign bodies and exposure. The outer surface
of the lids is a layer of skin continuous with the skin of forehead
above and that of the cheeks below. The outer layer of the lids
contain muscles that elevate and lower the lids, a firm tissue plate,
or tarsus, that maintains their shape, and eyelashes that prevent
perspiration or small foreign bodies from entering the eye and damaging
the transparent sensitive surface of the cornea. The inner surface
of the lids is lined by a mucous membrane called the conjunctiva;
this is continuous with the conjunctiva covering the white of the
eyeball. The conjunctiva has a rich supply of blood vessels, which
accounts for the bloodshot appearance of the eye after irritation.
It also contains lubricating glands that permit the lids to move
easily and the eye to rotate smoothly. Behind the upper eyelids
are present the main tear-producing glands (the lacrimal glands).
The orbit contains, apart from the eyeball, nerves, blood vessels,
fat, eye-muscles (to move the eyes freely and harmoniously in both
directions), and the optic nerve, which transmits visual sensation
from the eye to the brain. The orbit also forms the wall to the
adjacent sinuses, which are air spaces in the skull lined by the
same kind of membrane as the nose. Canals connecting the eyelids
to the sinuses (Lacrimal system) allow secretions and tears to drain
through the nose. Some of the problems frequently encountered by
an Oculoplastic surgeon include:
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Ptosis |
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 'Drooping'
of the eyelid can be present from birth or develop later in old
age. It is a cosmetic blemish but if severe, it restricts vision
as well. The treatment in majority of cases consists of surgical
correction. Surgery involves either strengthening the muscle, which
elevates the lid, called LPS resection, or lifting up the lid with
the help of a graft. This graft can be taken from the patient's
thigh area or can be an artificial sling material. This procedure
is known as 'Frontalis Sling'.
When ptosis occurs in adults, it may be the result of a systemic
disease, such as myasthenia gravis, which can be treated medically.
It can also follow muscle or nerve damage in other parts of the
body, or tumors of the lid. When ptosis occurs suddenly in one eye,
disease of the brain itself must be considered, and the patient
should be seen at once by a neurologist.
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Lid margin abnormalities
- Trichiasis |
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Trichiasis is a condition in which there is misdirection
of eyelashes. If the eyelashes turn in toward the eyeball and scratch
the cornea, they produce a sensation like a foreign body. This condition
may result from trachoma (an eye infection), burns or injuries to
the lids. Removal of the offending lashes or corrective plastic surgery
on the lid relieves the symptoms. |
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Lid margin abnormalities
- Entropion |
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a condition known as entropion there is inward turning of the eyelids,
causing the eyelashes to scratch the cornea and produce irritation.
Tearing and secondary infection as well as an unpleasant looking eye
cause the patient to seek medical care. Entropion may be the result
of spasm or secondary contracture or strictures from burns, injury
or trachoma infection. It may involve the upper or lower lids. An
adhesive tape applied to the skin of the lid temporarily may straighten
the lid and relive the annoying symptoms. Corrective surgery is usually
required for a permanent cure.
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Lid margin abnormalities
- Ectropion |
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Ectropion is the opposite condition, and the lower lid usually turns
away from the eyeball. Ectropion may be due to laxity of the tissue
in elderly people or to paralysis of the seventh cranial nerve (the
nerve which controls the facial expressions), which causes the weakness
of the muscles of the lid. It may also follow cuts, infections, or
burns of the lids and face that heal poorly; the resultant scar tissue
forms adhesions that cause the lids to turn out. Besides being cosmetically
unpleasant, ectropion is accompanied by troublesome tearing and infection.
Treatment is surgical rotation of the lid margin and its alignment
with the eyeball. |
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Lacrimal passage
diseases |
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Normally tears from the eye drain to the nose through
the lacrimal passage. In case of any blockade in this passage, watering
results. The causes can be incomplete development, seen in young children,
or infection, which occurs in adult life. Treatment varies from performing
a relatively simple procedure like 'probing' the pathway to open it,
to more complex surgery of fashioning an alternative pathway to drain
the tears to nasal cavity. This procedure is known as dacryocystorhinostomy
(DCR).
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Lid injury |
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 Apart
from being cosmetically unacceptable, any irregularity of the lid
margin is functionally detrimental to the eye, as lid defects may
fail to cover the cornea fully and provide adequate lubrication.
An oculoplastic surgeon repairs the injury in a way to make the
lid as close to normal as possible.
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Lid tumors |
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A suspicious lid mass needs excision, examination under
microscope and reconstruction of the resultant lid defect. Histopathological
examination determines whether the lesion is cancerous or not, and
the chances of its recurrence. Reconstruction in the form of suturing,
tissue flaps from neighboring areas & other lid, and grafts preserve
the lid function. |
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Orbital diseases |
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Orbital diseases involve the tissues lying in the bony socket. Generally
the eyeball protrudes from its socket, producing a widening of the
eyelids. Sometimes the patient does not blink frequently, developing
a staring gaze. This may be the result of an endocrine disorder (thyroid
disease), inflammation in the orbit or a tumor. Generally these lesions
require investigations including CT scan and MRI. Treatment varies
from case to case and may involve medical treatment, surgery, radiotherapy,
chemotherapy or a combination of these. |
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Socket surgery |
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Any painful blind eye needs removal. The deep 'socket'
left behind is not ideal for artificial eye fitting. Therefore, at
the time of eye removal, an implant is placed in the orbit, which
occupies the space taken by the normal eyeball. This reduces the hollowness
of the socket seen with the artificial eyes placed without an implant.
In some people, the artificial eye fit changes with passage of time.
Socket surgery aims at giving the best possible 'bed' for artificial
eye fitting, with or without an orbital implant. The above-mentioned
list of disorders is by no means exhaustive. Lack of space prevents
description of all conditions seen by an oculoplastic surgeon. Do
not hesitate to contact your eye specialist for further information.
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For further information consult the Orbit & Oculoplasty
Service at Shroff Eye Centre |
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