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 eyelid, tear system, and orbital diseases (the bones and soft tissues surrounding the eye).
An oculoplastic surgeon is an ophthalmologist and surgeon who specializes in the diseases and treatments of all tissues surrounding the eye (eyelids, tear ducts, orbit, forehead, eyebrows, cheeks, scalp, etc.). In addition to general ophthalmology training, they have specialized in oculoplastic surgery.
Plastic is a Greek word meaning to shape. Ophthalmic plastic surgery performs reshaping operations related to the eye area.
Eyelids
The eyelids are delicate and complex tissues necessary for continuous vision. Their primary functions are to protect the eye and to ensure the distribution of tears across the superficial surface of the eye. The shape, size, and posture of the eyelids are important for appearance.
Disorders in the shape, function, and appearance of the eyelids can be congenital or develop later in life due to various reasons. The treatment of structural disorders may be for functional or aesthetic (appearance-related) purposes.
Drooping Eyelids and Under-Eye Bags
These are usually due to hereditary factors and/or aging. Smoking or allergies can cause drooping of the eyelids at a younger age. Eye bags contain loose skin, muscle, fat, and in some cases, fluid.
Blepharoplasty is the surgical procedure performed to correct these abnormal structures. It can be for functional or cosmetic purposes.
Lines around the Eyes and Forehead
Wrinkles around the eyes and forehead are due to age-related changes in the skin. Excessive contraction of the muscles beneath the skin is also a factor that increases skin wrinkles. Botulinum toxin injections, fillers, and various surgical methods can be used to correct skin wrinkles. While botulinum toxin injections prevent excessive muscle contractions, fillers replace tissue losses in the skin. Both treatments are outpatient, and the patient can continue their daily life after the treatment.
Involuntary Eyelid Closing (Blepharospasm)
This issue is more common in women and usually occurs after the age of 40. It is caused by excessive contraction of the muscles that close the eyelids, against the patient's will. Therefore, the eyelids close even if the patient does not want them to. Patients may have difficulty carrying out daily activities and may require assistance.
Initially, the treatment involves using drugs known as botulinum toxin. This drug is injected into specific points on the eyelid and surrounding area to prevent excessive contraction of the eyelid muscles. The effect of the medication usually lasts 3-4 months, after which the treatment may need to be repeated.
Eyelid Ptosis (PTOZIS)
Eyelid ptosis is the condition where the upper eyelid is lower than its normal position. This drooping can cover the pupil, obstructing vision. In severe cases, a head position or manually lifting the eyelid might be used to facilitate seeing.
Ptosis may be congenital due to underdevelopment of the muscle lifting the eyelid, or it may occur with aging. In congenital cases, either shortening the weak muscle or using a sling may be necessary for more severe cases. Ptosis can also occur after eye surgeries like cataract and detachment operations.
- Left eyelid ptosis - pre-surgery
- Post-surgery
- Pre-surgery left eyelid drooping
- Post-surgery
Eyebrow Drooping
Like other parts of the face, eyebrows lose tension and sag with age. Drooping eyebrows can be severe enough to obstruct the opening of the upper eyelid. Forehead and/or eyebrow lifting are surgical procedures that restore the eyebrow to its original position. This procedure can be done alone or with blepharoplasty, and it may be for functional or cosmetic reasons.
Ectropion (Outward Turning of the Eyelids)
If the lower eyelid turns outward and loses contact with the eye, tear distribution becomes inadequate. This can lead to dry eye and infection. Symptoms like tearing, stinging, and burning may occur. The normal position of the lid can be restored through surgery.
Entropion (Inward Turning of the Eyelids)
When the eyelids and eyelashes turn inward, it can cause damage to the superficial layers of the eye, leading to symptoms like stinging, tearing, pain, and in severe cases, corneal ulcers and vision loss. This condition should be corrected surgically.
Lid Retraction (Overexposure of the Eyelids)
There is an abnormally wide lid gap, which may cause dry eye. The cause is often thyroid (goiter) disease. It can also occur as a result of overcorrection from a droopy eyelid surgery. It can be corrected surgically.
Scar Tissue (Cicatrix)
Oculoplastic surgeons can remove scar tissue using surgery, laser, or dermabrasion techniques.
Eyelid Injury
Oculoplastic surgery is a field specialized in the eyelid area. Oculoplastic surgeons can repair injuries and related structural deformities around the eyelid in the most appropriate way, both aesthetically and functionally.
Eyelid Cancers
The occurrence of cancer on the eyelid skin is not uncommon and is increasing. Any newly developing or enlarging masses on the eyelids should be carefully examined for tumor possibilities. An oculoplastic and reconstructive surgeon uses a variety of techniques for the removal of these tumors and repair of the eyelid. As with all tumors, early diagnosis and treatment are crucial.
Tear System
For eye health, the eye needs to be moist. Tears are secreted from the tear glands around the eye. The main tear gland, located under the upper outer part of the eyelid, is the most significant of these glands. With each blink, tears spread over the superficial layers of the eye and at the same time are pumped into the tear duct through small openings located near the nose on the lower and upper eyelid.
The tear duct opens into the nose, which explains why fluid comes to the nose when crying. Any blockage in this tear drainage system causes tears to flow outside instead of into the nasal cavity. Treatment involves creating a new passage for flow using various methods. If opening the tear duct is not possible, an artificial channel extending from the inside of the eyelid to the nose is made. A Jones tube is used to achieve this.
Tear system diseases belong to the field of oculoplastic surgery. An oculoplastic surgery specialist will determine the most suitable treatment for your case.
Watery Eyes in Infants and Children (Congenital Dacryostenosis)
If the tear gland produces sufficient secretion but the duct is blocked, tears run down the face. Tear ducts may be closed in newborns. They usually open naturally within a few months. If not, correction is needed using massage, probing, intubation with a silicone tube, or surgery, choosing the most appropriate method. Simple methods can provide treatment in the early period (first 12 months).
In cases where the condition is neglected and/or insufficiently treated, infection can develop over time and affect other parts of the eye. In such cases, and if watering persists up to 1 year of age, probing should be first applied to the canal under sedation. If watering continues, the probing might be repeated or a silicone tube can be applied to the canal simultaneously. A success rate of 95% is achieved with this application.
Dry Eye
If the tear gland cannot produce enough tears, dryness occurs in the eyes, leading to burning, stinging, and a foreign body sensation. Artificial tear drops are used for its treatment. If insufficient, the openings of the tear duct are closed. More advanced treatment methods may be applied in later stages.
Orbit
The orbit is composed of bones and soft tissues surrounding the eye. Many diseases can affect the orbit. Tissues expanding around and/or behind the eyeball can shift the position of the eyeball, possibly restricting its movement, which can result in double vision for the patient.
Thyroid-Related Eye Disease
In this condition, both the thyroid gland and the tissues around the eye (orbit) are affected. In a typical patient, the thyroid gland enlarges (goiter), thyroid hormones in the blood increase, and the eyes protrude forward (proptosis). The anterior protrusion of the eyes is because of the thickening of the eye muscles and an increase in the fat tissue around the eyes. Eye movements may be restricted, and the patient might experience double vision. In advanced cases, excessive pressure on the optic nerve can lead to reduced vision. This disease is treated with various medications and surgical methods. After the acute inflammatory phase is over, aesthetic problems can be corrected.
Orbital Tumors
As tumors of the orbital tissues grow, they push the eye outward, or in rare cases, compress it inward. Eye movements become restricted. The diagnosis and treatment of orbital tumors may require complex surgical interventions. Most of these tumors are benign and can be surgically removed.
Orbital Injuries and Fractures
The most critical factor in protecting the eye is the bony rim and the fatty cushions within, the orbit. Orbital injuries and fractures should be treated without delay at the appropriate time.
Loss of the Eye
Injury, tumors, or other eye diseases may necessitate the removal of intraocular tissues or the entire eye. This is a psychologically challenging situation. A prosthetic eye that matches the color and size of the other eye and moves in harmony can help ease this condition. Today, even patients who had their eye removed many years ago can have a moving eye prosthesis fitted.
As a general rule, health insurance institutions cover the costs of oculoplastic surgery procedures aimed at functionality. However, they do not cover the costs for cosmetic purposes.
Eyelid Aesthetics - Blepharoplasty
Due to aging or hereditary factors at younger ages, puffiness and sometimes just drooping and wrinkling can occur in the eyelids without puffiness. As the eyelid skin is the thinnest and most mobile part of our face, it rapidly thins, sags, and the muscle layer beneath weakens and ages due to the effect of gravity. Due to the weakening of the supporting tissues around the eyelids, the fat pads around the eye protrude forward, creating bags in the lids. With aging, the upper lid crease often rises or disappears entirely. Eyelid aesthetic surgery, or blepharoplasty, is a surgical procedure applied to the eyelid to correct all these problems. Blepharoplasty is performed for functional reasons in older individuals and for cosmetic reasons in younger individuals. This surgery, done under local anesthesia, takes a short time and the recovery time for the patient is brief, providing excellent results in facial rejuvenation.
The puffiness and sagging in the eyelids are not only cosmetic but also an eye health issue. Sometimes the loosened upper eyelid skin sags beyond the lashes, causing a feeling of heaviness in the eyes and vision problems. With age-related loss of elastic tissue in the forehead skin, the forehead and primarily the eyebrows droop, a condition known as brow ptosis. Patients involuntarily tighten their forehead muscles for long periods to lift their eyebrows, leading to brow and headaches, and pronounced forehead wrinkles.
Brow ptosis and excess skin on the upper lid can narrow the upper and outer part of the visual field. Such narrowing of the visual field also makes reading and driving difficult. To correct this narrowing in the visual field, the patient involuntarily raises their eyebrows, leading to fatigue, especially towards the evening. Loosening of the lower eyelid skin causes the lid margin to be pulled downward, revealing more of the white of the eye, giving the patient’s look a different meaning. Age-related tissue weakening and laxity can cause the lower lid margin to turn outward, resulting in internal-downward displacement of the lateral corner of the lid. These changes in the lid cause the patient’s face to have a tired expression. During blepharoplasty in these patients, the oculoplastic surgeon also performs necessary surgical procedures to correct these issues in the lower lid.
Before undergoing blepharoplasty, questions regarding thyroid disease, heart failure, hypertension, and bleeding tendencies should be asked. Furthermore, careful consideration should be given to patients who cannot produce enough tears to sufficiently moisten their eyes, and this procedure should be performed by an experienced oculoplastic surgeon. In individuals with mild dry eyes, during blepharoplasty, less skin and fat tissue should be removed compared to those with normal eye moisture. Otherwise, eye dryness increases, potentially leading to vision problems. Patients with this condition should also be informed that they may experience irritation in their eyes for a prolonged period and may need to use artificial tears for a long time. Aspirin, anti-inflammatory, vitamin E, anticoagulants, and herbal medications should be stopped a week before, as they can cause bleeding during and after surgery. Patients using contact lenses should be informed that they may need to refrain from using them for some time after blepharoplasty surgery.
Surgery
Blepharoplasty surgery is often performed under local anesthesia and is completed within about an hour. After surgery, pain relievers other than aspirin can be taken under the doctor's advice to prevent bleeding. Cold compresses should be applied on the same day to prevent swelling of the lids, and the head should be kept elevated for 2-3 weeks. After surgery, stitches are removed by the doctor 5-7 days later. To protect the eyes, topical artificial tear medications are used for 2-4 weeks after surgery.
In patients with age-related eyebrow or upper lid ptosis, and outward turning of the lower lid margin, blepharoplasty can be performed concurrently with surgery for these issues.
Current Approaches in Orbital Lacrimal System and Eyelid Surgery
Oculoplastic surgery is a specialized surgical field arising from the combination of ophthalmology and plastic surgery aimed at preserving eye health and improving aesthetic appearance. In this area, treatments for various conditions such as eyelid surgery, orbital lacrimal system diseases, under-eye bags, and droopy eyelids are carried out.
Modern Techniques in Eyelid Surgery
Eyelid surgery is performed to address both aesthetic and functional issues. Blepharoplasty is a commonly preferred method to correct the signs of aging such as droopy eyelids and under-eye bags. During this procedure, muscle, excess skin, and fat tissue are removed to achieve a younger and more vigorous appearance.
Treatment of Orbital Lacrimal System Diseases
The orbit consists of bones and soft tissues surrounding the eyeball. Tumors, infections, or traumas occurring in this region can affect the position and movements of the eye. Orbital surgery plays a crucial role in diagnosing and treating such conditions.
The lacrimal system is responsible for the production and drainage of tears. Blockages in the tear ducts can lead to tearing and infections in the eye. Lacrimal surgery addresses these blockages and ensures normal tear flow.
Under-Eye Bags and Droopy Eyelids
Under-eye bags and droopy eyelids usually form due to aging, genetic factors, or lifestyle habits. They can give a tired and aged appearance to the individual. These issues can be resolved through surgical procedures like blepharoplasty to achieve a younger and fresher look.
Post-Eyelid Surgery Care
Certain precautions should be taken to ensure a fast and trouble-free recovery process. In the postoperative period, cold compresses should be applied around the eyes, the head should be kept elevated, and the medications prescribed by the doctor should be used regularly. Additionally, strenuous physical activities should be avoided, and attention should be paid to eye hygiene in the postoperative period.
Frequently Asked Questions
Who is suitable for eyelid surgery?
Eyelid surgery is suitable for individuals with aesthetic or functional issues such as droopy eyelids, under-eye bags, and eyelid ptosis. Individuals experiencing lid problems affecting their field of vision could also benefit from this surgery. However, suitability for surgery should be evaluated considering the patient's overall health status and expectations.
What are the symptoms of orbital lacrimal system diseases?
Orbital lacrimal system diseases present with symptoms such as swelling in the eye, pain, double vision, restricted eye movements, and persistent tearing. These symptoms may be indicative of conditions such as orbital tumors, infections, or tear duct obstructions.
What is the recovery process after blepharoplasty surgery?
The recovery process after blepharoplasty surgery is typically quick. Light swelling and bruising may occur in the first few days post-surgery. Stitches are usually removed within 5-7 days. Most patients can return to their normal daily activities within 2 to 3 weeks, but complete recovery time varies from individual to individual.
What should be considered after eyelid surgery?
In the postoperative period, it is essential to apply cold compresses around the eyes, keep the head elevated, and use the medications recommended by the doctor regularly. Strenuous physical activities should be avoided, and care should be taken concerning eye hygiene during the postoperative period.