Oculoplasty or oculoplastic surgery deals with many eye problems with eyelids. Oculoplastic surgery, which is applied medically and cosmetically, aims to treat all areas of the eye and its surroundings as needed.

What is oculoplasty?

Oculoplasty or oculoplastic surgery is a term used to denote a variety of procedures involving the eyelids, eyebrows, eyeball, tear ducts, and face. The branch, whose real name is ophthalmic plastic and reconstructive surgery, covers cosmetic interventions as well as medically necessary interventions, and sometimes it can be both. Oculoplasty literally refers to a wide variety of procedures, from correcting drooping eyelids to tear duct obstruction, eye stealing and prosthetics. These procedures can be used to rejuvenate or reconstruct the eye and related structures.

One of the most common oculoplastic procedures is blepharoplasty, also known as eyelid aesthetics. This procedure removes the excess skin from the eyelid and reduces the drooping appearance that comes with age. Brow lift can also be added to this surgery. Most oculoplastic procedures are done on an outpatient basis and are performed on people of all ages. Tumor formations in and around the eye are also included in the application area of ​​oculoplasty.

In which diseases are oculoplastic procedures applied?

Most oculoplastic procedures are done on an outpatient basis and are performed on people of all ages. Oculoplasty includes:

Ptosis: It means droopy eyelid. A droopy upper eyelid can also affect vision by narrowing the visual field. It also has negative cosmetic effects. Ptosis correction is carried out by various surgical procedures. The best option for the patient should be decided after consultation with the oculoplastic surgeon.

Blepharoplasty: Sagging and bagging of the eyelid skin gives the face a tired and aged look. The blepharoplasty procedure rejuvenates the face and restores youth. It is applied on both the upper and lower eyelids. While this term refers to the removal of sagging and loosening skin on the upper eyelid, it refers to the correction of under-eye bags on the lower eyelid and the removal of excess skin around the eyes.

Entropion: It refers to the eyelids folded inward towards the eye. Entropion is a condition in which an eyelid turns inward, rubs against the eye, reddens the eye, irritates the cornea, and becomes sensitive to light and wind. This situation can be optimally corrected by eyelid surgery.

Ectropion: It is the condition of the eyelids turning outward from the eye. This can cause the cornea of ​​the eye to be exposed and cause dryness.

Thyroid eye disease: In this disease, the body sees the thyroid tissue as foreign and attacks it while also targeting the eye tissues. There are active and inactive periods in the disease. As a result of swelling of the muscles and fats in the back of the eyes, prominence, redness, and edema of the lids can be seen. Double vision and opening of the lids and even vision loss may occur. After appropriate tests, intravenous cortisone therapy can be initiated during the active period. Surgery is required in inactive and vision-threatening situations.

Eyelid retraction: It can affect the upper or lower eyelid. Eyelid retraction occurs when the eyelid is pulled too far above the eyeball on the upper eyelid and too low on the lower eyelid. Common causes of eyelid retraction include thyroid eye disease, trauma, or previous surgery on the eyelids.

Cancer and other growths: Tumors or lesions in or around the eye can be treated with oculoplastic methods. At this point, early diagnosis and treatment can save life and vision.

Blocked tear ducts: Usually found in infants, but can also occur in adults from infection, trauma, or tumors. While the problem is mostly resolved with probing and/or tube insertion in children, tube insertion and/or channel opening surgery is required in adults.

Injuries: Physical or chemical injuries can pose a serious threat to vision if not treated in a timely manner.

Some common situations are:

• Cornea/conjunctival damage of the eye

• Eyelid tear

• Foreign body in the eye

• Chemical burn

• Subconjunctival hemorrhages

• Fractures in the bones around the eyes

Depending on the cause and nature of the injury, appropriate treatment is carried out.

Orbitotomy: This procedure is performed for removal of orbital tumors, orbital tissue biopsy, and removal of orbital foreign bodies. Orbitomies can be made through hidden or small incisions for better cosmetic results.

Orbital Decompression: It is performed in cases of thyroid ophthalmopathy where the eyes come forward and the muscles press on the optic nerve. Bone and fat decompression is performed and each procedure is customized according to the patient’s clinical condition.

Prosthetic eye applications: Eyes can be taken in the presence of blind, painful eye, in the presence of an aesthetically impaired eye, in case of shrinkage and collapse of the eyeball due to surgery or trauma, and in case the damaged eye causes damage to the other eye. While the implant is placed on the removed eye, the placement of a prosthetic eye after the wound heals is among the application areas of oculoplasty.

Eyelash problems: Eyelashes can sometimes grow in the wrong direction, which means the eyelashes are touching the eyeball. This condition is called trichiasis. There is also the case of the second row of eyelashes coming out differently from the normal eyelash pattern. This can cause a stinging sensation in the eye and is called dysticiasis.

Facial paralysis: Difficulty in closing the eyes, drooping of the lower eyelid and drooping of the eyebrows may occur in patients with permanent facial paralysis . With oculoplastic surgery methods, all surgical interventions are performed to close the patient’s eye and to protect the eye.

How is oculoplastic surgery done?

Oculoplasty includes a number of different techniques, regardless of a specific operation. In addition to cosmetic methods such as Botox injections, fat removal, blepharoplasty, it is applied with different methods such as orbital surgery and canal occlusion. Techniques that vary from patient to patient and to the problem are used.

Frequently asked questions about oculoplasty 

What is the difference between oculoplastic surgery and plastic surgery?

While many of the services provided by oculoplastic surgeons are also performed by plastic surgeons, there are important differences in the trainings related to these two specialties. As a result, working with an oculoplastic surgeon can be very beneficial when researching these treatments. Oculoplastic surgeons must complete a residency in ophthalmology. This tutorial provides a very detailed, solid background on the structures of the eyelids, eye and surrounding facial area.

A significant portion of this training focuses on eye surgery, allowing oculoplastic surgeons to gain an in-depth knowledge of the delicate structures that make up the human eye. After this residency, oculoplastic surgeons must complete training that focuses on the cosmetic aspects of eyelid and eye plastic surgery, covering tear duct occlusion and orbital surgery.

Plastic surgeons begin their residency training with a specialization that provides a broad surgical background covering almost every area of ​​the body. This is then followed by a plastic surgery residency focusing on the cosmetic aspects of the surgical process. The primary difference in these backgrounds includes the level of eye expertise.

What aesthetic procedures are performed by oculoplastic surgeons?

The most common cosmetic procedure performed by oculoplastic surgeons is eyelid surgery (blepharoplasty). This procedure removes signs of aging that affect the eyes to give them a more youthful appearance. Eyelid surgery can address:

  • Sagging or wrinkling of the eyelid skin
  • Fat hernias in the lower eyelid
  • hollows under the eyes
  • Eyelid drooping and asymmetry
  • Excess skin on the eyelid that is blocking your field of vision

In addition to eyelid surgery, oculoplastic surgeons offer the following aesthetic procedures:

  • eyebrow lift
  • Excision of lesions around the eyes and face
  • Botox treatment to remove crow’s feet and forehead wrinkles
  • Filling treatment
  • Chemical peeling

What medical procedures are performed by oculoplastic surgeons?

In addition to facial rejuvenation services, oculoplastic surgeons also address a wide variety of medical issues affecting the eye. These include:

  • Removal and biopsy of tumors in and around the eyelid
  • Tear drainage system surgery
  • Reconstructive surgery around the eyes
  • Bone fractures in the eye area
  • Treatment of thyroid-related orbitopathy
  • Repair of eyelid entropion and ectropion that causes the eyelid to turn in or out of the eye

Why are oculoplastic surgeons important for the eye area?

Oculoplastic surgeons are trained ophthalmologists who understand how eyelid surgery can affect the eye’s comfort and clarity of vision. Experience is important for operations to be performed around the eyes and face.

What are the risks of oculoplastic surgery?
As with any surgery, there are risks in eye surgery as well. However, the risks are low in surgeries performed in the right centers by a good ophthalmologist. However, the risks can be listed as follows:

Bleeding: If the blood vessels in the operation area are damaged, various bleedings may occur. When these hemorrhages develop behind the eye, vision loss may develop.

Pain: Pain may be felt in the operation area for a certain period of time.

Infection: If the surgical area is not sterile, the surgical site may become infected.

Inability to Close the Eye: This may lead to the loss of the eye as it will cause damage to the eye structures.

What is orbit?

The orbit is the pit formed by the facial bones in which the eye and its appendages are located. Tumors may occur in the orbit. There may be thyroid-related eye problems and inflammations in the orbit. All these problems are of interest to oculoplastic surgery.

What is ptosis?

Ptosis can be defined as a droopy eyelid that may occur due to trauma, age or various medical diseases. It is also seen in children. This is because the levator muscle does not develop properly. If vision is impaired due to ptosis, lazy eye may also develop in children. Age, long-term use of lenses, traumas, masses in the upper eyelid, congenital anomalies may be among the causes of ptosis. Those with ptosis often tilt their head back or raise their eyebrows to see comfortably.

How is ptosis treated?

Ptosis is a problem that includes treatment systems according to the condition and severity of the disease. The doctor may recommend surgery for ptosis. Ptosis surgeries vary widely depending on the function of the muscle that lifts the valve.

What is tear duct obstruction?

Tears reach the nasal cavity through the tear ducts and sac. However, sometimes these channels can become clogged. This condition may be congenital or may develop due to trauma, infection or nasal surgery. In people with lacrimal occlusion, tears constantly flow out, so inflamed discharge in the eye and redness and swelling in the inner part of the eye may occur. It is a common problem in babies. The most classic method is surgery. Tear duct occlusion operations are also included in the field of oculoplasty.

What is entropion?

The inward turning of the eyelid is called entropion. This condition can damage the cornea as the eyelashes on the eyelid rub against the eye. If left untreated, it can cause serious problems. This problem may be congenital, or it may occur due to eyelid surgery and shrinkage in the eye socket due to the prosthetic eye. And in this disease, oculoplastic surgery is recommended.

Why is an eye prosthesis fitted?

Sometimes the eyeball can be removed for different reasons. Sometimes, babies’ eyes are not fully formed when they are in the womb. In this case, the eye socket remains empty. For this reason, an eye prosthesis is attached. An eye prosthesis is applied according to the person. It is generally made and fitted according to the structure of the patient’s eye socket. This procedure is also included in the field of oculoplastic surgery.

Does an eye prosthesis allow to see?

Eye prostheses do not provide visual functions, they only improve the aesthetic appearance.

Do you have eye cancer?

Eye cancer is a serious problem that can develop in the eye. It is a rare tumor that also affects the inside of the eyeball and the eyelid. It is a problem that should be detected at an early stage. There are symptoms such as glaucoma, vision loss, eye swelling, flashes of light, and changes in iris color. Here, too, oculoplastic surgery methods come into play. Eye sparing surgeries, iridectomy, iridotrabeculectomy, eye reconstructive surgery, enucleation, orbital exenteration are some of these surgical methods.

What is the role of oculoplasty in eye injuries?

Small eyelid tears can be treated locally. But larger injuries require immediate stitches and reconstruction. It may be necessary to properly position the eyelid margins and stitch the eyelid in layers. This is where oculoplastic surgery comes into play. In major eye injuries, restoring the structures that make up the skeleton of the lower and upper eyelids is extremely important to restore normal eyelid structure and function.

Injuries to the inner part of the eyelids may be accompanied by damage and cuts in the tear duct. In this case, the tube should be attached and stitched to the end. Orbital injuries can range from orbital hematomas to orbital bone fractures. Treatment of orbital fractures depends on the type of fracture. The timing of the repair is very important. Fractures with muscle compression require immediate correction. Repair of fractures is done with various materials.

Is oculoplastic surgery just an aesthetic operation?

No, oculoplastic surgery is not just about plastic surgery. All kinds of functional problems affecting the eye, outside the eyeball, namely the orbita and its muscle and fat tissues, tear glands and ducts, and eyelids are among the intervention areas of oculoplastic surgery.

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