Oculoplasty and Orbit Unit                                                                                                                                                                              

 

 

 

Oculoplasty, orbit and lacrimal gland unit treats all pathologies affecting the periocular area. It includes plastic surgery on the palpebral conjunctiva (tumours, droopy eyelids or any abnormality in the ocular adnexa), nasolacrimal anomalies (dry eye inconveniences,    permeability-related problems in the duct) and orbital diseases (orbital tumours, thyroid-associated orbitopathy), among others.

This Unit boasts the active involvement of medical specialists (plastic surgeons, otorhinolaryngologists, pathologists) who contribute the knowledge necessary to afford the multidisciplinary approach required to treat these maladies.

Diagnostic techniques:

1. Complete through-the-eyelid exploration:

Study of laxity, position, palpebral indentation, macro – and also slit-lamp- photography..

2. Lacrimal duct exploration

Diagnostic probe, fluorescein eye stain, Schirmer's test, Jones test, etc. The nasolacrimal duct owes its name to the subtle system of tubes that carry the tears from the lacrimal sac into the nasal cavity, where final drainage occurs. Tears are mainly secreted in a gland located in the outer portion of the orbit, hidden behind the actual orbital bone. In front of the cornea, a lacrimal film will drain through an excretory duct into the nose.  

In most cases, children are born with an unperforated (e.g, “closed-up”) lacrimal apparatus; as a result of this, tears will barely flow into the nose and roll down the cheeks. If the passage of days does not facilitate drainage, surgical intervention will be necessary.

Regarding adults, there are many causes of lacrimal duct obstruction, which triggers stagnation of tears and infection of the lacrimal sac. All this explains the development of new techniques, which are meant to reconstruct the lacrimal drainage system. An accurate problem analysis will help opt for straightforward interventions (intubation, laser, dacryocystectomy) or more complicated surgical procedures (dacryocystorhinostomy, implant of infusion pumps) in order to deal with -and alleviate the effects of- the patient's symptoms.

3. Nasal endoscopic examination.

Feasibility study of transcanalicular laser-assisted surgery, pediatric probing, etc.

4. Comprehensive orbital examination

Hertel exophthalmometer, Ishihara and Fanswroth-Musell color vision test, visual field test, etc.

Treatments:

1. Mohs micrographic surgery

Nowadays, this technique is associated with the lowest recurrence rates for cutaneous tumours. During surgery, tissues around the tumoral zone are object of microscopic examination, which will also include the tumour-free resection margins.

Ensuing reconstruction is instantly undertaken and involves skin repair (grafts or flaps) according to the eyelid defect.

2. Transcanalicular diod laser-assisted dacryocystorhinostomy

Nasolacrimal surgery in order to establish communication between the lacrimal duct and the nasal cavity, which prevents tear stagnation due to obstruction.

3. Ptosis surgery

A piece of surgery intended to elevate the eyelid to its normal position (levator resection, Putterman's technique on Muller's muscle, suspension of the eyelid using frontalis muscle).

4. Blepharoplasty

Upper and lower blepharoplasty. It involves removal of excess fat or excess skin by means of cutaneous or conjunctival incisions so as to improve functionality and appearance of the eyelid.

5. Eyelid surgery

The eyelids are widely believed to condition perception of facial appearance; in addition, they constitute a protective curtain which, apart from influencing our external image, protects visual apparatus from exogenous foreign bodies: hence the need to correct any eyelid alteration.

Such anomalies range from simple wrinkles, fat pockets, excess or sagging skin to important eyelid eversions with ocular dryness amd exposure. At the same time we must not neglect the existence of several tumours that demand study, extirpation and reconstruction.

The two-fold importance of the eye contour requires the role of an ophthalmologist duly specialized in this periocular pathology; more specifically, someone who can study, treat and propose diagnostic criteria as well as treatment and collaboration initiatives with other professionals (radiology, radiotherapy, etc).

As soon as your case has been carefully examined, you will be given all the therapeutic options so you, along with your opthalmologist, can choose the most appropriate one.  

Eyelid surgery comprises a number of interventions aimed at solving problems like ptosis (droopy eyelids), malposition of the free edge of the eyelid (ectropion, entropion), alterations on the eyelashes (distichiasis), palpebral spams (blepharospams), etc.