Orbital Lacrimal System and Eyelid Surgery

Oculoplastic surgery (ophthalmic plastic and reconstructive surgery) is a subspecialty of ophthalmology (the science of eye health and diseases). This field deals with the diagnosis and treatment of diseases of the eyelids, lacrimal (tear) system, and orbit.

An oculoplastic surgeon is a physician who, in addition to specializing in eye diseases, has received training in the diseases and treatments of the tissues around the eye. In addition to general ophthalmology training, they have been trained in oculoplastic surgery. Ophthalmic plastic surgery performs reshaping operations related to the eye area.

Eyelids

The eyelids are structures that help protect the eye and distribute the tear film over the ocular surface. The shape, size, and position of the eyelids are important both functionally and cosmetically. From an aesthetic standpoint, the shape, size, and position of the eyelids are significant.

Disorders related to the shape, function, and appearance of the eyelids may be congenital or may develop later in life due to various causes. Treatment of deformities may be functional or aesthetic (appearance-related) in purpose.

Droopy Eyelids and Under-Eye Bags

Sagging and bagging of the eyelids may be related to aging and hereditary factors. Smoking or allergies may cause eyelid sagging at a young age. Bags around the eyelids contain loose skin, muscle, fat, and in some cases fluid.

Blepharoplasty is the surgical procedure performed to correct these abnormal structures. It may be carried out for functional or cosmetic purposes.

Wrinkles Around the Eyes and on the Forehead

Wrinkles around the eyes and on the forehead are related to age-related changes in the skin. Excessive contraction of the underlying muscles is another factor that increases skin wrinkling. Botulinum toxin injections, fillers, and various surgical methods can be used in the treatment of skin wrinkles. While botulinum toxin injections prevent excessive muscle contraction, fillers replace tissue loss in the skin. The time to return to daily activities after the procedure may vary depending on the type of intervention and the patient’s condition.

Involuntary Eyelid Closure (Blepharospasm)

This problem is seen more frequently in women and usually appears after the age of 40. The cause is excessive involuntary contraction of the muscles that close the eyelids. Therefore, the eyelids close even when the patient does not intend them to. In severe cases, the condition may make it difficult for the person to maintain daily life.

For treatment, drugs called botulinum toxins are used as first-line therapy. This medication is injected into specific points on the eyelid and its surrounding area and prevents excessive contraction of the eyelid muscles. The effect of the medication usually lasts 3–4 months. After this period, the treatment may need to be repeated.

Drooping of the Eyelid (Ptosis)

Eyelid drooping (ptosis) is a condition in which the upper eyelid margin is lower than normal. This drooping can cover the pupil and obstruct vision. In advanced cases, the person may feel the need to change head position or lift the eyelid with a finger in order to see better.

Ptosis may be congenital due to underdevelopment of the muscle that elevates the eyelid or may be age-related. In congenital cases, surgical options targeting the levator muscle or suspension techniques may be considered depending on the patient’s condition. Ptosis may also develop after eye surgeries such as cataract or retinal detachment (detachment) surgery.

• Left eyelid ptosis – preoperative
• Postoperative
• Preoperative left eyelid ptosis
• Postoperative

Brow Ptosis

Like other parts of the face, the eyebrows lose their tension with age and droop. Brow ptosis may become severe enough to hinder opening of the upper eyelids. Forehead or brow lift procedures are surgical methods that can be used to correct brow ptosis. This procedure may be performed together with or independently of blepharoplasty, and may be carried out for functional or cosmetic reasons.

Outward Turning of the Eyelids (Ectropion)

If the lower eyelid turns outward and loses contact with the eye, tear distribution becomes inadequate. This may lead to dry eye and infection. Symptoms such as tearing, foreign body sensation, and burning may occur. In appropriate patients, surgical treatment may be performed to correct the eyelid position.

Inward Turning of the Eyelids (Entropion)

Inward turning of the eyelids and eyelashes may cause damage to the ocular surface, symptoms such as foreign body sensation, tearing, and pain, and in advanced cases may lead to corneal (the transparent layer of the eye) ulceration and visual loss. Surgical treatment may be considered in appropriate patients.
 

Excessive Eyelid Retraction (Lid Retraction)

The palpebral fissure is wider than normal and this may lead to dry eye. Lid retraction may develop in association with thyroid disease. It may also occur as a result of overcorrection following ptosis surgery. Surgical treatment options may be considered in appropriate patients.

Scar Tissue (Cicatrix)

Surgical procedures, laser treatments, or dermabrasion may be used in order to reduce the appearance of scars.

Eyelid Trauma

Oculoplastic surgery is a discipline specialized in eyelid conditions. Oculoplastic surgeons can treat eyelid and periocular injuries and related deformities by taking both cosmetic and functional aspects into consideration.

Eyelid Cancers

Cancer can also develop in the eyelid skin. Newly appearing or enlarging masses on the eyelids should be examined carefully because of the possibility of tumor. The oculoplastic and reconstructive surgeon uses various techniques to remove these tumors and reconstruct the eyelid. Early diagnosis and appropriate treatment are of great importance in eyelid tumors.

Lacrimal (Tear) System

Tears help keep the ocular surface moist and protected. Tears are secreted by the lacrimal glands around the eye. The most important of these is the main lacrimal gland, located under the upper outer eyelid. With each blink, tears spread over the superficial layers of the eye and are simultaneously pumped into the tear duct through small openings in the upper and lower eyelids near the nose.

The tear duct opens into the nose. Any obstruction in this tear drainage system causes the tears to flow outward instead of into the nasal cavity. For treatment, a new pathway is created by various methods to restore tear flow. If it is not possible to open the tear duct, an artificial channel extending from the inside of the eyelid into the nose is created. A Jones-Pyrex tube is used to achieve this.

Diseases of the lacrimal system fall within the scope of oculoplastic surgery. The treatment to be applied is determined according to the type of disease and the patient’s condition.

In Infants and Children Tearing of the Eye (Congenital Dacryostenosis)

If the lacrimal gland produces an adequate amount of tears but the duct is blocked, tears flow down the face. In newborns, the channels that drain tears may be closed. They usually open spontaneously within a few months. If they do not open, the most appropriate method—massage, probing, intubation with a silicone tube, or surgery—should be selected for correction. During the first 12 months, simpler treatment methods may be considered depending on the patient’s condition.

In neglected and/or inadequately treated patients, infection may develop over time and may affect other parts of the eye. In this case, and in tearing that persists up to 1 year of age, probing of the duct under sedation should be the first step. If tearing persists, probing may be repeated or a silicone tube may be placed in the duct at the same time.

Dry Eye

If the lacrimal gland does not produce enough tears, dry eye develops. There is burning, stinging, and a foreign body sensation in the eye. Artificial tear drops are used for treatment. If these are not sufficient, the openings of the tear ducts are closed. Other treatment methods may be used in more advanced stages.

Orbit

The orbit consists of the bone and soft tissues surrounding the eye. Many diseases can affect the orbit. Due to expansion of tissues around and/or behind the eyeball, the globe may be displaced and its movements may be restricted. As a result, the patient may complain of double vision.

Thyroid-Related Eye Disease

In this disease, both the thyroid gland and the orbital tissues around the eye are affected. In a typical patient, the thyroid gland enlarges (goiter), thyroid hormones in the blood increase, and the eyes protrude forward (proptosis). The reason for the protrusion of the eyes is thickening of the eye muscles and an increase in the orbital fat tissue. Eye movements may be restricted and the patient may experience double vision. In advanced cases, excessive pressure on the optic nerve may lead to decreased vision. This disease is treated with various medications and surgical methods. After the active phase of the disease, treatments aimed at cosmetic and functional problems may be considered when necessary.

Orbital Tumors

As orbital tumors grow, they push the eye outward or, rarely, compress it inward. Eye movements become restricted. The diagnosis and treatment of orbital tumors may require complex surgical procedures. In orbital tumors, treatment is planned according to the type and location of the tumor and the patient’s condition.

Orbital Trauma and Fractures

The most important factor in the protection of the eye is the bony frame and the fat cushions within it, namely the orbit. Timely evaluation of orbital injuries and fractures and planning of necessary treatment are important.

Loss of the Eye

Trauma, tumors, or other eye diseases may necessitate removal of the intraocular tissues or complete removal of the eye. This is a situation that is psychologically difficult to adapt to. Ocular prostheses can help provide an appearance similar to that of a natural eye. In suitable patients, mobile (motile) ocular prostheses can be considered.

Eyelid Aesthetics (Blepharoplasty)

Sagging, wrinkling, and bagging of the eyelids may develop due to aging and hereditary factors. Progressive weakening of the tissues that support the eyelids may lead to prominence of the orbital fat pads and changes in eyelid structure. Blepharoplasty is a surgical procedure applied to correct these changes and may be planned for functional or aesthetic purposes according to the individual’s needs.

In some individuals, eyelid sagging and excess skin affect not only appearance but also visual function. Excess skin on the upper eyelids and brow ptosis may lead to narrowing of the visual field and a feeling of heaviness around the eyes. Tissue changes in the lower eyelid may affect eyelid position and the appearance of the periocular area.

Before blepharoplasty, factors such as the patient’s general health status, medications used, dry eye, and tear production should be evaluated. The use of medications and supplements that may affect the risk of bleeding should be assessed by a physician; medication regimens should not be altered without medical advice. In patients who use contact lenses, the timing of resuming lens use after surgery should be determined by the physician. The procedure and recovery process may vary from person to person.

Surgery

In suitable patients, blepharoplasty can be performed under local anesthesia. After surgery, swelling and tenderness around the eyes may occur. During the recovery period, cold compresses, keeping the head elevated for a certain period, and regular use of prescribed medications may be recommended in line with the physician’s advice.

The timing of suture removal and the return to daily activities may vary depending on the procedure performed and the individual’s healing process.

Current Approaches in Orbital Lacrimal System and Eyelid Surgery

Oculoplastic surgery is a specialized surgical field that combines ophthalmology and plastic surgery, applied for the preservation of eye health and improvement of cosmetic appearance. In this field, a wide range of conditions, including eyelid surgery, eyelid operations, orbital lacrimal system diseases, under-eye bags, and droopy eyelids, are treated.

Under-Eye Bags and Droopy Eyelids

Under-eye bags and droopy eyelids usually occur due to aging, genetic factors, or lifestyle habits. They can give the person a tired and aged appearance. These problems can be corrected with surgical procedures such as blepharoplasty, resulting in a younger and fresher appearance.

Points to Consider After Eyelid Surgery

Certain precautions should be taken to ensure a rapid and uneventful recovery. In the postoperative period, it is important to apply cold compresses to the eye area, keep the head elevated, and use the medications prescribed by the physician regularly. In addition, strenuous physical activities should be avoided after surgery, and attention should be paid to eye hygiene.