Eye Disease and Trauma
Traumatic lacerations may result in injury to the face and eyelids. Ocular trauma can also result in orbital or facial fractures. Such fractures may result in deformities of the face, poor movement of the eye, and may cause the eye to sink deeper into the orbit. A full eye exam needs to be performed immediately, because precise evaluation and repair is necessary to insure the best possible protection, function and cosmetic outcome.
Two of the most common fractures are Orbital Floor Fracture, also known as a Blowout fracture, and Trimalar Fracture, also known as Tripod fracture. Blowout fracture is the most common fracture around the eye area. It is usually caused by the impact of an object against the eye or upper cheek. The force generates increased pressure within the orbit causing the orbital floor to blow out at its weakest point – the thin bony floor beneath the eye. This may cause orbital fat or one of the eye muscles to move toward or into the roof of the maxillary sinus which is located directly below the bony orbit. This movement causes the symptoms often seen in blowout fracture – double vision and/or a recession of the eye deeper into the eye socket. If these symptoms are significant and not improving at 10 to 14 days, surgery is usually necessary. This oculoplastic surgery involves covering and closing the orbital floor bony defect with a secured implant.
Thyroid Eye Disease
Thyroid eye disease, also known as Graves’ disease is a medical problem that causes enlargement of the muscles that move the eye and opens the eyelids too wide. As these muscles slowly enlarge, the eye is pushed forward and its movement is restricted. This causes the patient to have bulging eyes that move poorly and to have a wide stare. The swelling of the muscles can become so severe that the blood flow to the optic nerve is strangled resulting in a slow loss of vision. The appearance and function of the eyes can usually be improved with eyelid and orbital surgery.
Eyelid and Periorbital Skin Cancer
Eyelid cancer is common and is increasing in frequency. With eyelid cancers there is a significant risk for tissue damage to nearby vital ocular structures and even blindness. The skin around the eyelid is thin and connections to the underlying bone in the region speed up the spread of tumor into the nasal and orbital cavities. All new or growing eyelid bumps and sores that will not heal need to be evaluated to ensure that they are not cancer. Early diagnosis and surgical removal offers the best probability of permanently eliminating the tumor.
The oculoplastic surgeon has many special methods to surgically rebuild the affected eyelid and surrounding facial structures. One such method is Mohs micrographic surgery, which allows for the total microscopic control of tissue. Mohs micrographic surgery is the most effective treatment for these skin cancers. Mohs surgery is performed by removing thin layers of affected tissue, freezing them, and microscopically examining the edges and surface of each layer. Mohs surgery allows the minimum amount of tissue to be removed, allowing the patient to achieve the best functional and cosmetic result.
Tear Drainage Reconstruction
If the eye produces tears properly and the “pipe” that drains the tears from the eye into the nose becomes non-functioning, the tears will back up and spill over the eyelids and cause tears to run down the face. If the “tear pipe” is plugged, not only will tears spill over the eyelids and run down the face, but the stagnant tears within the system can also become infected.
An infection within the “tear pipe” can cause a painful swelling in the inner corner of the eyelids. Surgery to remove the obstruction is necessary to eliminate the tearing and infection that can result from the blockage. This is known as Nasolacrimal Duct surgery or Dacryocystorhinostomy (DCR). Occasionally, the “tear pipe” obstruction will be beyond repair. If this happens, it is necessary to surgically implant an artificial “tear pipe” behind the inner corner of your eyelids to drain the tears into your nose.
Tumors may affect the structures within the orbit. As these tumors slowly enlarge, the eye bulges forward and its movement may be limited. Management of these tumors usually requires a diagnostic evaluation and surgical exploration. Fortunately, most orbital tumors are not malignant and can be treated surgically.
Eye Socket Reconstruction
If an eye has become severly damaged through ocular disease or injury, it may become necessary to surgically remove the eye. This can be emotionally upsetting and difficult to accept. A properly fitting eye that moves well can help the situation. The oculoplastic surgeon works together with the ocularist to construct and fit the prosthesis to insure the patient is comfortable.
Please contact Wolfe Eye Clinic at 1-800-542-7956 to ask any oculoplastic, eyelid disease or eyelid trauma-related questions or for an appointment with our oculoplastic surgeon, Dr. Douglas Casady.