Orbitofacial
Orbitofacial conditions relate to the orbital region of the face – the upper and lower eyelids, forehead and brow, and the upper regions of the nose. Conditions include watering eye, eyelid and perio-ocular skin cancer, and ectropion of the eyelid.
Optegra offers oculoplastic surgery to correct a wide range of orbitofacial conditions. Our oculoplastic Consultant Surgeons are experts in their field and skilled in the latest techniques. We have covered some of the treatments below but your Consultant will be able to discuss all aspects of your individual treatment options with you.
Eyelid hooding
When hooded upper eyelids and puffy lower eyelids impair vision, a procedure called blepharoplasty is used to remove the excess tissue. Upper eyelid blepharoplasty is usually carried out under local anaesthetic as an outpatient procedure. The Consultant uses eye drops and a small injection of anaesthetic to numb the area, then carefully removes the excess tissue, ensuring that optimum eyelid function and comfort remain. The procedure to correct the lower eyelid may be carried out under local or general anaesthetic. Your Optegra Consultant will discuss what is best for you. The excess tissue is removed through a small incision, made just below the lower eyelashes. Any scars are usually inconspicuous once healed.
Watering eye
Tears keep our eyes moist and healthy, but infections such as conjunctivitis, or a foreign body cause the eye to water excessively as a way of protecting the eye. Watering eye can also occur when there is a blockage in the eye’s drainage channel – preventing the tears from draining away. If the watering eye is caused by an obstruction of the drainage channels, surgery can be undertaken to overcome the obstruction. This is called dacryocystorhinostomy (DCR). It involves creating a new tear duct to allow tears to drain away. A DCR is usually carried out under general anaesthetic as an out patient procedure. There are two methods of operating, either inside of the nose - using a special endoscope, light source and fine instruments - or by making a small incision on the outside of the nose.
Your Optegra Consultant will discuss the best option for you. Once the new drainage pathway is created, a tiny plastic tube (stent) is temporarily placed inside it to prevent it closing as it heals. The stent is removed a few months after surgery.
Eyelid and peri-ocular skin cancer
Eyelid skin cancers can occur anywhere on the eyelid margins, corner of the eye, eyebrow, or adjacent areas of the face (the peri-ocular). They can appear as lumps, depressions, patches of redness, scaliness, or light or dark discolouration. The most common eyelid cancer is basal cell carcinoma (BCC). Other, less common cancers are squamous cell carcinoma (SCC), sebaceous gland carcinoma, and malignant melanoma. The latter two are more serious forms of skin cancer as they can spread to other parts of the body, while BCC and SCC tend to stay localised. Treatment involves surgery to remove the tumour and may be followed by further surgery to reconstruct the damaged eyelid or peri-ocular area.
At Optegra, we offer a specialist procedure called Mohs’ micrographic technique to treat BCC and SCC cancers. This involves the oculoplastic Consultant working closely with a surgical Dermatologist. The tumour is removed one layer at a time and microscopically analysed to make sure all the cells are extracted. The oculoplastic Consultant then reconstructs the damaged area.
Ectropion of the eyelid
Ectropion is sagging and outward turning of the lower eyelid, which leaves the eye exposed and dry. It can occur as a result of ageing, trauma to the eye, or from previous eye surgery. Symptoms include irritation, a gritty or burning feeling, excessive tearing, and a red, irritated eyelid. The irritation can be temporarily relieved with artificial tears and ointments to lubricate the eye, however surgery to tighten the lid is usually necessary.
Ectropion surgery is usually an out patient procedure, carried out under local anaesthetic. The Consultant shortens and tightens the eyelid to return it to its natural position. Usually only a few stitches are needed at the lateral corner of the eye. These are often removed 7 to 14 days later.
Following the procedure, there may be mild bruising or swelling. This will clear up in around two weeks. Normal daily activities can usually be resumed within four days or so. The eye may feel a little gritty and ache at the corner while it is healing.
Entropion of the eyelid
Entropion is an inward turning of the lower eyelid. The skin of the eyelid and the eyelashes come into contact with the surface of the eye, causing intense discomfort. It can occur as a result of ageing, or because of scarring to the inner surface of the eyelid from trauma, allergic reactions, or inflammation from diseases such as ocular pemphgoid. Discomfort can be relieved temporarily with lubricating eye drops, or by temporarily paralysing the muscle that turns the eyelid in with a tiny injection of Botulinum Toxin. In the long term, surgery is recommended. Entropion surgery is usually an out patient procedure, carried out under local anaesthetic. The Consultant tightens the eyelid and returns it to its natural position.
Eyelid ptosis
Eyelid ptosis is a condition where the upper eyelid droops and covers part of the pupil. This causes impairment of vision. People with severe ptosis have to tilt their head back or lift their eyelid with a finger in order to see. It can be present at birth, or occur as the muscle that lifts the eyelid thins with ageing. Other causes can be trauma to the eye and neurological problems such as nerve palsy or muscle weakness.
Eyelid ptosis surgery is usually an out patient procedure, carried out under local anaesthetic. The Consultant uses eye drops and a small injection of anaesthetic to numb the area. The natural skin crease and eyelid raising muscle is then shortened to lift the eyelid.
Thyroid eye disease
Thyroid eye disease, or orbitopathy is an auto-immune condition in which the body’s immune system produces factors that stimulate the enlargement of the muscles that move the eye. This can result in bulging eyes, retracted eyelids, double vision, decreased vision and ocular irritation. The condition is often associated with abnormalities in thyroid gland function. Mild cases can usually be treated with artificial tears and lubricating ointment to reduce irritation. In more severe cases, eye surgery may be necessary. Misalignment of the eyes and double vision can be improved with eye muscle surgery to reposition the enlarged muscles that control eye movement. Eyelid surgery to adjust the position of retracted lids can improve eyelid closure and restore eyelid function. Orbital decompression (removing part of the orbital bone and fat behind the eye) can prevent damage to the optic nerve and allow the eyes to move back to a more normal position within the socket. Optegra offers a wide range of treatments for thyroid eye disease, all carried out by a specialist oculoplastic Consultant.
Frequently asked questions
Can eyelid and peri-ocular skin cancers return?
If you have had one BCC you could develop others, so make sure you examine your skin regularly to check for any signs of change. You should protect your skin from sunlight with a high factor sun cream and 100% UV sunglasses.
What can I do to prepare for orbitofacial surgery?
If you smoke or use any form of nicotine, stop now. Eat well-balanced meals and drink plenty of water. Get lots of sleep and exercise regularly. You could also consider taking a multi-vitamin supplement. Three weeks before surgery, stop all vitamin E, aspirin, ibuprofen and other over-the-counter blood thinners. Your Optegra Consultant will advise you regarding the use of prescriptive drugs.
Will my eye look normal following ptosis surgery?
Your Consultant will make every effort to make the lid appearance as good as possible. Your lid may be swollen for a week or two after the operation and the final height of the lid is often not apparent until then. There is often a continued improvement in the appearance for several months.
How do I prevent thyroid eye disease getting worse?
Giving up smoking and careful checks of the thyroid blood level may help to prevent eye problems getting worse.
