Reconstructive surgical procedures are carried on abnormal structures on various body parts which are caused due to trauma, tumors or other diseases, congenital defects or abnormality in development. The aim of reconstructive procedure is to improve functions as well as to work upon the aesthetic aspects of various body parts.
Oculoplasty is a specialty under the discipline of ophthalmology that is aimed at the plastic surgery of the structures around the eye and the eye area as well. So, by definition, reconstructive oculoplastic eye surgery involves reconstruction of the area around the eyes, such as orbit, eye socket, tear duct etc. In most cases the surgery is done post trauma or excision of a tumor.
The various oculoplastic procedures treat various disorders like:-
- Eyelid disorders such as trauma, tumors on eyelids, ptosis, eyelid malposition such as entropion and ectropion, abnormalities in the eyelids, blepharospasm etc.
- Disorders in the orbital area of the eyes such as orbital inflammatory syndrome, fractures, tumors, Thyroid Eye Disease.
- Problems in the lacrimal or the tear duct such as blocked tear duct known as nasolacrimal duct obstruction, trauma to the lacrimal system, unexplained tearing of the duct etc.
Removal of the skin cancer surgical is one of the standard procedures. How much loss is caused in the eyelids of a patient is dependent upon the dimension and location of the tumor. During surgery, all surgeons aim at minimizing the scarring by preserving the skin as much as possible while ensuring the elimination of all cancerous cells. Removal of large tumors generally requires reconstructive surgery where skin flaps or skin grafts may require to be used. In this procedure, the flaps or the grafts are borrowed from the immediate area around the eye.
Oculoplastic surgery solely pertains to the areas and structures around the eyes. It is a type of super-specialty which involves both the precision and understanding of various aesthetic aspects of face surgery.
In some cases, where the defects are superficial in nature because of small growths or mild trauma, progressive healing may take place with the need of very small sutures. But in the cases, where the tumors are very large or the trauma is severe, the eyelids may be suffering from major defects which may require the use of borrowed tissues. The treatment which involves the use of borrowed tissues is known as skin grafting. Skin grafts are generally are thin pieces of skin taken from site of the body and planted on the graft site to cover the site where the surgery may have been done.
One of the most commonly carried out reconstructive oculoplastic procedure is to treat Ptosis. Ptosis is the condition which causes drooping eyelids which is caused by weak eyelid muscles, damage to the nerves that control the muscles of the eyelids or loose skin of the eyelid. Ptosis can be due to an injury, can be due to aging or can be congenital. Surgery can be done where the condition is mild, to improve the appearance of the eyes. In severe cases, it may be done to improve the vision. The procedure which involves removal of excess skin and fat deposits from the upper and/or lower eyelids is known as Blepharoplasty. This surgery can rectify droopiness of the eyes and also remove puffiness but it doesn’t treat dark circles, wrinkles or sagging eye brows.
Reconstructive oculoplastic surgery can also treat Entropion, the condition in which the edge of the eyelid turns in thereby causing the eyelashes to rub against the white part of the eyes. The condition generally affects the lower eyelids. Ectropion, on the other hand, is the condition in which the eyelash is turned out which exposes the eyes. The condition may be caused due to ageing or because of weak connective tissues in the eyelids which can cause the eyelids to turn out. The condition may cause painful and dry eyes, chronic and long term conjunctivitis or excessive tearing of the eyes. But the treatment is an outpatient procedure, which means the patient is generally released from the hospital later in the same day.
Orbital reconstruction is also carried out in the case where the tumors of the orbit are excised. The surgery is performed to prevent any tumor to become life threatening, to save the eye and vision as well. The excision the tumor may require reconstruction of the orbital rim and the surrounding areas.
Fractures to the orbit may be caused by blunt trauma or force to the face. Not only bones of the orbit, but the orbital floor bones may also get fractured. The fractures can lead to pain, bruising, numbness near the area around the eyes, droopy eyelids etc. The fractures are repaired by fixing the bones around the orbit by the means of surgery, though not all type of orbit fractures require surgery.
Cancers of eyelid can be inflammation (stye’s), malignant tumors (skin cancers) or benign cysts. The most commonly occurring type of eyelid cancer is the basal cell carcinoma which can be easily removed surgically. If not treated in time, the cancers may metastasize in to the brain, the sinuses and the orbit. There are different surgical approaches for differently sized tumors of the eyelid. Small tumors are removed by the pentagonal wedge resection method whereas medium sized tumors demand reconstruction by transposition flaps like tenzel, mustarde and glabellar.
Soft tissue injuries can occur to the eyes during sports. Also, foreign debris entering the eye can also cause the tissues to get damaged. Commonly occurring black eye can be treated with a cold compress. A surgery may be required if there is excessive swelling or discoloration around the eye which causes deformities or discoloration. In case, there is damage to the cornea an ophthalmologist should be contacted immediately.
Most of the conditions can be diagnosed by physical examination. The condition of the eyelids generally gives away the nature of condition and special tests are generally not required.
Any type of surgery carries some risk. But if the procedure is performed by a qualified practitioner and in an established facility, the complications are generally nil. It is imperative to follow the instructions of the doctor religiously to avoid any possibility of post-operative complications. A patient might, very rarely, develop complications from anesthesia or may acquire an infection.
In case of blepharoplasty, he patient may experience blurred vision, swelling which is temporary, scarring or asymmetric healing of the eyelids.
Reconstructive Oculoplastic procedures should be only carried out by a qualified specialist. It is very important to have realistic goals and expectations about the outcomes of the surgery. A patient should communicate with the surgeon prior to the surgery and ask all the questions pertaining to the same without hesitation.