Reconstructive Services
Ectropion
Ectropion is an outward turning of the eyelid. As a result of this condition, the eyelid and the eye itself are exposed to the air, causing irritation, light sensitivity and tearing. The inside of the eyelid becomes visible and is often quite red. There are many causes of ectropion, but the most common is associated with a gradual loosening of the eyelid tendons with age. Surgery is performed to tighten and reattach the eyelid tendon, returning it to a more normal position.
Entropion
Entropion is an inward turning of the eyelid. This condition results in the eyelashes of the lower eyelid scratching the eye itself, causing severe irritation, tearing, light sensitivity and pain. If left untreated an ulcer may form. A muscle typically pulls loose inside the eyelid causing this problem. Surgery involves reattachment of the loose muscle, and tightening of the eyelid tendon. This returns the eyelid to a normal position.
Eyelid Tumor’s and Mohs Surgery
There are many types of growths which can be found on the eyelids. Most of these are benign (non-cancerous), but several types of malignant (cancerous) growths can occur. They are most commonly associated with sun exposure. Because it is difficult to differentiate between benign and malignant growths, it is best to have these examined. A biopsy sometimes is necessary to establish the diagnosis. Surgical removal is often required for growths that are suspicious in nature or increasing in size. Biopsies are often performed as an office procedure, or may be removed in an outpatient surgical setting if more extensive. A word of caution: skin cancer can affect the eyelid area, so if you have a new or suspicious-appearing growth, please have it checked by a specialist.
Orbital Trauma
Orbital trauma can result in fractures of the bones surrounding the eye. Various forms of trauma can contribute to these fractures known as blowout or tripod fractures depending on which bones are involved. Not all orbital fractures need to be repaired. A careful examination helps determine when surgery is necessary. Symptoms can include double vision and a sunken appearance of the eye. When necessary, surgery releases any tissue which may be entrapped within a fractured bone. A thin plate is frequently placed to take place of the fractured bone. At times, small metal plates are needed to hold bones together. Surgery will usually eliminate double vision and keep the eye in its proper position.
Orbital Inflammation and Tumors
Although rather uncommon, the orbit (eye socket) is susceptible to a variety of diseases. These include tumors, infections, various inflammatory conditions and thyroid related problems. Symptoms can include pain, double vision and protrusion of the eye. They are too numerous and extensive to list here. Prompt investigation of orbital problems is important. This can include a CT or MRI scan as well as a detailed office examination. At times a biopsy is necessary. Treatment can range from the use of antibiotics to oral steroids to surgical removal.
Tearing (Epiphora) and Tear Drainage Blockages
Epiphora (tearing) can be caused by a variety of problems. Often, dry eye and allergies can cause eye irritation, producing "reflex" tearing. Using allergy drops and artificial tears can help this problem. Occasionally, tearing may be caused by excess tear production, but more often it is caused by decreased drainage or obstruction of the tear duct drainage system. Punctal stenosis or narrowing of the tear duct opening can prevent tears from entering the drainage system. This can be corrected by an office procedure called a punctoplasty, where the tear duct opening is enlarged to facilitate tear flow.
Dacryocystitis is an inflammation of the lacrimal or tear sac. It is often caused by blockage of the nasolacrimal duct (the duct connecting the tear sac to the inside of the nose). Treatment of dacryocystitis often involves antibiotics and surgery. The surgery, termed a DCR, involves making a new connection between the tear sac and the inside of the nose, bypassing the obstructed area.
Eye Removal
Enucleation is the surgical removal of the eye. It is performed when an eye has poor or no vision and has become painful. Occasionally, enucleation is performed to remove an eye with a malignant tumor. The eye is removed and replaced by a round implant which fills the volume of the orbit. The eye muscles are often attached to the implant, which allows for movement of the prosthetic eye. Evisceration is a less invasive alternative to enucleation, whereby the cornea and the eye contents are removed, leaving the scleral shell behind. A round implant is placed to fill the volume of the orbit, much like enucleation. Once complete healing has occurred an ocularist fits a prosthetic eye. Usually, the patient is comfortable and a remarkably good fit is obtained with the prosthesis.