Orbit and Oculoplasty

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Oculoplasty and Orbit is a discipline in ophthalmology that deals with plastic and reconstructive surgery around the eyeball, including the eyelids, orbit and lacrimal system.

Most of the oculoplastic conditions need surgical correction. One important indication is cosmetic, but many times these may be vision or sometimes even life threatening. So the oculoplastic surgeons should give equal attention to all perspectives.

The department of orbit and oculoplasty of Disha Eye Hospital is well equipped with modern diagnostic and therapeutic facilities. The faculty comprises of a team of well-trained oculoplastic and orbital surgeons. Patients referred for oculoplasty and orbit procedures are treated with good care and compassion by the team. Disha eye hospital is well equipped with exclusive laminar flow modular operation theatres dedicated for oculoplasty surgeries equipped with operating microscope, surgical light, endonasal endoscope, bipolar, unipolar cautery units, radio frequency cutting-coagulating system, microdrill etc.

Conditions managed by us

OPD

  • Naso lacrimal duct abnormalities
  • Ptosis, Entropion, Ectropion, Trichiasis, Distichiasis
  • Eye lid & orbital tumours
  • Thyroid related eye diseases
  • Anopthalmic and contracted socket
  • Orbital infections
  • Fracture of the periorbital bone
  • Pterygium

Ocular Prosthesis

We have a skilled Ocularist to make customized artificial eye shells to rehabilitate patients who have lost an eye due to various reasons. We also provide cretch spectacles for rehabilitation of insepearble cases of ptosis.

Investigations done or advised in Oculoplasty department:

  • Intra Ocular Pressure
  • Lacrimal Syringing
  • CT scan/ MRI (advised ,to be done from outside)
  • USG -orbit
  • Thyroid Blood Investigations (advised ,to be done from outside)
  • Blood Investigations (advised ,to be done from outside)
  • Biopsy (tissue sample harvested in OT by surgeon and sent to laboratory for histopathology examination)
  • Prostigmine & Ice pack tests to excude Myasthenia Gravis

Infrastructures available in the department of Orbit-Oculoplasty Disha Eye Hospital :

  • Exophthalmometer
  • B – Scan
  • UBM
  • AS-OCT
  • OCT
  • Humphrey perimetry
  • Ishihara chart for color vision

Procedures done in the department

  • Visual acuity examination
  • Refraction
  • Slit lamp examination
  • Fluorescein dye disappearance test
  • Schirmers test
  • Intraocular pressure
  • Dilated fundus examination
  • USG B-scan
  • Exophthalmometry
  • Anterior Segment & Face photography

List of invasive procedures done

  • Lacrimal duct syringing, probing
  • Suture removal
  • Conformer removal
  • Stock shell fitting
  • Custom fit prosthesis
  • Surgical dressing
  • Nasal Endoscopy

IPD

LIST OF SURGERIES

  • DCR (Adult & Pediatric)
  • DCR with intubation
  • DCT
  • Lacrimal probing and syringing under general anaesthesia
  • Snip procedures
  • Mini-Monoka Stent
  • Punctal plugs
  • Punctal cautery
  • Ectropion and entropion correction
  • Ptosis correction
  • Lid tear repair/with canalicular stenting
  • Lid reconstruction
  • Lid biopsy
  • Chalazion (Incision & Curettage)
  • Abscess I & D
  • Orbitotomy(lateral/anterior)
  • Orbital decompression
  • Optic nerve sheath decompression
  • Tumor debulking
  • Orbital floor repair(prolene mesh,implants)
  • Enucleation(with /without implant)
  • Evisceration (with/without implant)
  • Exenteration (total/lid sparing)
  • Dermis fat graft
  • Scar release with skin graft
  • Amniotic membrane grafting
  • Scleral patch graft
  • Buccal mucosal graft
  • Blepharoplasty
  • V-Y Plasty
  • Z plasty
  • Botox chemodenervation
  • Tarsorrhaphy
  • Lid rotation suture
  • Lateral canthoplasty
  • Medial canthoplasty
  • Spacers (upper/lower lid)
  • Fornix deepening sutures

FAQ

  • How important is entropion/ectropion/trichiasis correction?

    All these conditions are capable of damaging the cornea and thereby vision. Immediate attention must be given to these problems.

  • What should be the ideal timing for ptosis surgery in a child?

    When you find the drooping eyelid covering half or more part of the cornea, or the child has started to develop vision deficit, you will have to take advice from an eye specialist regarding immediate surgery.

  • What is DCR?

    DCR or dacryocystorhinostomy is a surgery performed to create a new channel between the eye and nasal cavity, designed to drain tears.

  • How to manage a case after removing the eyeball?

    After removal of eyeball, the lost volume should be replaced with an orbital implant. On top of which, a perfectly matched artificial eye wins a good cosmetic benefit.
     

  • What is BOTOX injection?

    BOTOX injection is used to paralyze specific eye muscles to give temporary relief in some neuromuscular conditions. The treatment has to be repeated after certain time.
     

  • Why does proptosis or bulging eyeballs occur?

    Thyroid diseases can cause it, or a tumor behind the eyeball could also be responsible for it. A CT scan or an MRI is a very important test for the diagnosis.

  • What are the common oculoplastic conditions?

    Trichiasis - Inwardly directed eyelashes. Should try to remove permanently by applying low voltage current to the roots of the lashes (Electropilation).

    Entropion - Inward turning of eyelid margins towards the eyeball.

    Ectropion - Outward turning of eyelid margins.In both the conditions patient may suffer from redness, watering, discharge, foreign body sensation, etc. Entropion may cause vision damaging corneal ulcers also due to rubbing of the eyelashes.

    Ptosis - Drooping of the upper eyelid, one or both. It might be present since birth, and can lead to vision deficit due to light obstruction, causing “lazy eye” (Amblyopia). It requires prompt intervention. Adult ptosis might need correction for cosmetic betterment, or removing sight obstruction.

    Eyelid tumors – Like tumours of any body parts these may be benign, malignant or inflammatory (styes). Inflammations are treated medically. Tumours need surgical removal with reconstruction. Biopsy to confirm nature of tumour. Eyelids are essential for healthy functioning of the eyes. So gaps in the lids have to be reconstructed immediately.

    Orbital tumours - Tumours between the eyeballs and the bony orbits. They can push the eyeball to abnormal positions. They can damage vision by pressing on the eye nerve. Surgical removal of these tumours require very special skills.

    Evisceration and Enucleation - Surgeries to remove non-functioning eyeballs, which may be painful, disfigured following trauma, or having tumours inside them.

    Anophthalmic socket - Socket without eyeball. May be a defect since birth, or created after surgical removal of eyeballs. Cosmetic surgery to improve the looks of the patient is often psychologically very important.

    Lacrimal passage obstruction - Tear drainage passage from eye to nose is blocked. Can be present since birth. Needs intervention within 1- 2 years of age before the surrounding bones become hard. In adult cases, most common surgery (DCR) creates an artificial passage through the bone into the nose. In few extreme cases the infective sac is removed.