Ophthalmic Plastic and Reconstructive Surgery/
Oculofacial Cosmetic Surgery

Oculofacial plastic and orbital surgery (also known as oculoplastic surgery or ophthalmic plastic and reconstructive surgery) is a specialized field that deals with the management of deformities and abnormalities of the eyelids, lacrimal (tear) system, orbit (eye socket), and the adjacent face. Oculoplastic surgery can be reconstructive (medically necessary) or cosmetic in nature.

The word "plastic" is derived from a Greek word that means "to mold" or "to give form." Plastic surgery is surgery that molds or reconstructs parts of the human body. Ophthalmic plastic surgery is dedicated to the structures surrounding the eye. Since this delicate surgery can affect one's eyes and the ability to see, oculofacial plastic surgeons are uniquely qualified to treat the eyelids, eye sockets, and the periocular face.

Membership in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) ensures your surgeon has completed rigorous training and passed examinations in oculofacial plastic surgery. Fellow status in ASOPRS is restricted to surgeons that have been board certified by the American Board of Ophthalmology, who have completed 6 years of advanced training (including at least 2 that are dedicated to the eyes and plastic surgery as it relates to the structures surrounding the eyes), who have had a thesis accepted, and who have passed rigorous written and oral examinations. For more information, see www.asoprs.org.

Dr. Jeremiah Tao is a fellow of ASOPRS and is the Director of Oculofacial Plastic and Orbital Surgery at the Gavin Herbert Eye Institute, UC Irvine

Conditions - Click for more details
Physicians

Anophthalmos
Anophthalmos is the absence of an eyeball within the eye socket. Anopthalmos usually occurs after surgical eyeball removal for cancer of the eye or for an eye that is blind and painful. Very rarely, babies are born without an eye.

Eye sockets without an eye are treated with implants or tissue grafts to fill the space. When the socket is healed, a prosthetic eye can be worn. The eye prosthesis is usually custom-made by an ocularist. It is usually clam-shaped and rests under the eyelids and looks like a real eye. If the muscles in the eye socket are not damaged, the prosthetic eye can move in concert with the other eye.

In children, anophthalmia may lead to serious problems due to not only the absence of a seeing eye but also the secondary disfigurement of the orbit, the lids, and the eye socket. Proper growth of the orbital region is dependent on the presence of an eye, which stimulates growth of the orbit and proper formation of the eyelids. Early treatment with various expanders or surgery, when necessary, will help decrease the orbital asymmetry and cosmetic deformities in these children.

Signs and Symptoms: A child born with anophthalmia has a small orbit and small eyelids.

Treatment: An oculoplastic surgeon can evaluate and determine the best treatment option, which may include surgery or placing a conformer to stimulate tissue growth. Eyelid or orbit implant surgeries are sometimes necessary.

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Basal Cell Carcinoma
Basal cell carcinoma is the most common form of skin cancer. Basal cell carcinoma (BCC) is rarely life threatening, but can be disfiguring and cause damage to adjacent structures – including the eyeball. It occurs mainly on the face and neck and is characterized by pimples that don’t heal, unyielding red bumps and red, scaly areas. Basal cell carcinoma has an extremely low rate of spreading to other parts of the body but commonly damages the surrounding tissues, including the eye.

Signs and Symptoms: Pimples that don’t heal, pink or red bumps, or red, scaly areas. Eyelash loss, notching of the eyelid or spontaneous bleeding are other signs.

Treatment: Complete surgical removal and oculoplastic reconstruction of the area.

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Blepharospasm
Blepharospasm is an episodic, involuntary spasm or contraction of the orbicularis oculi muscle (the circular muscle around the eye), resulting in uncontrolled blinking and squeezing of the eyelids. It occurs in both eyes and is sometimes accompanied with head and neck movements. Blepharospasm usually begins gradually and as the condition progresses the spasms may intensify and occur more frequently. In many cases, it can cause visual problems due to the closure of the eyelids.

Signs and Symptoms: Uncontrolled blinking, twitching or closure of eyelids; decreased vision in severe cases.

Treatment: Botulinum Toxin (Botox) injection by an oculoplastic surgeon. Lifting the eyelids or surgical excision of the orbicularis muscle is sometimes necessary in severe cases.

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Blepharoptosis
Blepharoptosis (ptosis for short) is the medical term for drooping of an upper eyelid, a condition that may affect one or both upper eyelids. When the level of the upper lid margin falls, it can interfere with the upper field of vision. Symptoms include a decreased ability to keep the eyes open, eyestrain, and eyebrow fatigue from the increased effort needed to raise the eyelids.

Signs and Symptoms: Drooping eyelid, loss of upper peripheral vision.

Treatment: Blepharoptosis repair.

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Blocked Tear Duct
Tears keep the exposed surface of the eye moist. Excessive tearing (epiphora) is common when a person is upset or the eye is irritated. It can also result from disorders to the external surface of the eye, blockage of the tear drainage system or flaccid lower eyelids. When the lacrimal system works well, the eyelids distribute tears over the surface of the eye each time a person blinks and pump the excess into a duct that drains into the nose. If a tear duct is blocked, tears back up and the excess spills over the eyelid and run down the face.

Signs and Symptoms: Blurred vision, tears running down the side of the face, possible infection from stagnant tears.

Treatment: Surgery to eliminate the obstruction of the tear duct or to create a new tear duct.

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Canaliculitis
Canaliculitis is an inflammation of the tear drainage passageways within the eyelids. It may cause tearing, discharge, red eye, and mild tenderness. Redness and tenderness are most prominent at the side of the eye near the nose.

Signs and Symptoms: Tearing, discharge, red eye, tenderness.

Treatment: Irrigation of the infected duct or surgical removal of the infected material, warm compresses, and/or antibiotic eye drops.

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Chalazion (or stye)
A chalazion is an inflammatory nodule on the eyelid and is akin to facial acne.

Signs and Symptoms include: Tenderness, redness, and an unsightly eyelid nodule.

Treatment: Warm compresses and eyelid hygiene at first. Some require further management with antibiotics, steroids, or surgical drainage.

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Dacryocystitis
Dacryocystitis is aninfection of the lacrimal sac, a small chamber into which tears drain. The usual cause of dacryocystitis is a blockage of the nasolacrimal duct, which leads from the lacrimal sac into the nose. Dacryocystitis may occur suddenly (acute) or be longstanding (chronic). In acute infection, the area around the lacrimal sac is painful, red, and swollen. The eye may become red and watery and may ooze pus. Slight pressure applied to the lacrimal sac may push pus through the lacrimal punctum, the opening at the inner corner of the eye, near the nose.

Often the infection is mild. Sometimes, the infection is severe and can cause fever or an abscess may form, which can rupture through the skin, creating a passage for drainage.

Signs and Symptoms: Red, watery eye, occasional pus, infection, fever.

Treatment: Antibiotics, warm compresses, surgery (dacryocystorhinostomy or DCR) to bypass the blocked nasolacrimal duct.

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Dermatochalasis
Dermatochalasis is an excess of skin in the upper or lower eyelid. The weakening of the connective tissues of the eyelid frequently contributes to this lax and redundant eyelid tissue. It is most commonly seen in the upper eyelids; however it can occur in lower eyelids. If dermatochalasis is more than minimal, it may block superior peripheral vision. Sometimes the problem is due to or worsened by droopy eyebrows.

Signs and Symptoms: Excess of skin. Reduced peripheral vision.

Treatment: Blepharoplasty and/or sometimes brow lifting.

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Ectropion
Ectropion is when the eyelids droop outward, away from the eye. It is most common in lower eyelids. Drooping is a result of reduced muscle tone in the muscles that control the eyelids. Sometimes it is due to scar tissue from previous surgery, sun damage or trauma. When ectropion occurs, the eyelids can no longer protect the eyes and the surface of the eye may become dry and irritated. In addition, drooping eyelids can prevent tears from draining normally, so tears may run down your cheeks.

Signs and Symptoms: Drooping eyelids, excessive tearing, infection, foreign body sensation, irritated eye, or red eye.

Treatment: Ectropion repair.

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Enophthalmos
Enophthalmos is the recession of the eyeball within the orbit. It is caused by degeneration and shrinking of the orbital fat, injury or sometimes cancer.

Signs and Symptoms: Sunken eye, droopy upper eyelid, asymmetric facial appearance.

Treatment: Depends on the underlying problem, but sometimes orbital volume augmentation and/or sometimes eyelid surgery.

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Entropion
Entropion is the eyelid turns inward forcing the lashes onto the eye, causing irritation and possible damage. In addition, drooping eyelids can prevent tears from draining normally, so tears may run down your cheeks. It is most common in lower eyelids. The eyelid turning may be due to reduced muscle tone in the eyelids or scar tissue.

Signs and Symptoms: Drooping eyelids, excessive tearing, infection, foreign body sensation, irritated eye or red eye.

Treatment: Entropion repair.

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Epiphora (Tearing)
Tears keep the exposed surface of the eye moist. Excessive tearing (epiphora) is common when a person is upset or the eye is irritated. However it can also result from disorders to the external surface of the eye, blockage of the tear drainage system or flaccid lower eyelids. When the lacrimal system works well, the eyelids distribute tears over the surface of the eye each time a person blinks and pump the excess into a duct that drains into the nose. If a tear duct is blocked, tears back up and the excess spills over the eyelid and run down the face.

Signs and Symptoms: Blurred vision, tears running down the side of the face, possible infection from stagnant tears.

Treatment: Depends on the underlying cause, but sometimes surgery to eliminate the obstruction of the tear duct or to create a new tear duct; sometimes surgery to tighten the tendon and pumping muscle of the lower eyelid.

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Eyelid “bags” and facial “wrinkles”
Aging may cause “bags,” dark circles, or excess skin.

Signs and Symptoms: These are sometimes medically significant, when affecting the upper eyelids (see dermatochalasis and blepharoptosis) but are often bothersome cosmetically. These features may cause a sad or tired appearance.

Treatment: Depends on the exact findings, but may include eyelid lifting, cheek lifting, laser resurfacing, or fat contouring.

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Exophthalmos
Exophthalmos is a protruding eyeball anteriorly out of the orbit (eye socket). Exophthalmos can be either bilateral (both eyes bulge out) or unilateral (just one eye bulges out). Doctors use an exophthalmometer to measure the degree of exophthalmos.

Signs and Symptoms: Bulging or protruding eyeballs, eye redness, eye irritation, sometimes intermittant tearing.

Treatment: Exophthalmos is not a condition, but rather a sign of a condition, usually related to thyroid disease, but sometimes due to tumors in the eye socket or inflammation. Depending on the cause, an oculoplastic surgeon can offer various treatments.

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Eyelid Retraction
Eyelid retraction is when the upper eyelid is too high or the lower eyelid is too low. It can cause the eye to be irritated, red or dry. It can be caused by scarring from previous surgery, thyroid eye disease or aging.

Signs and Symptoms: Irritated eye. Red or dry eye. Sometimes tearing

Treatment: Eyelid retraction repair

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Facial Nerve Palsy
Facial Nerve Palsy is a nervous system disorder in which a damaged nerve in the skull affects the movement of the muscles of the face. It can affect vision and closing one eye and can change the appearance of the face

Signs and Symptoms: The eye won’t close and then becomes irritated, dry or red. Sometimes tearing is a symptom. Other features include a change in the appearance of the face, difficulty making expressions or fine movement, drooping, paralysis, difficulty eating (items fall out of the weak corner of the mouth), face feels pulled to one side or stiff, headaches, impairment of taste, sensitivity to sound.

Treatment: Oculoplastic surgery including temporary or permanent fastening of the corner of the eye, sometimes implants to the eyelid to improve eyelid closure, and sometimes procedures to lift the facial droop. Eye drops, eye ointments or an eye patch are usually necessary to protect the surface of the eye.

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Graves' Disease/Thyroid Associated Ophthalmopathy
Graves' Ophthalmopathy is a thyroid-related disorder that causes inflammation of the eye muscles, which enlarge within the eye socket. As a result, the eyes bulge and/or stare; the eyelids retract and often cannot close; and the eye's surface dries and becomes uncomfortable. The swollen muscles can exert pressure on the optic nerve and threaten vision loss, the most serious consequence of Graves' disease. Graves' disease demands an oculofacial plastic surgery specialist. Sometimes doctors specializing in strabismus surgery, radiation, and endocrinology are also necessary.

Signs and Symptoms: Enlargement of the eyelid openings or “buggy” eyes, facial asymmetry, dry, scratchy eyes, poor or double vision.

Treatment
Mild cases: artificial tears and lubricating ophthalmic ointment to relieve dry eyes;

Severe cases: administration of corticosteroid medications, external beam radiation, or a combination of these to reduce pressure on the optic nerve.

Treatment: Depends on the severity, but may include steroids, orbital decompression surgery, eyelid surgery, and strabismus surgery.

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Hemifacial Spasm
Hemifacial spasm results in involuntary contraction of the facial muscles limited to one side of the face. The eyelids are involved, and upturning of the corner of the mouth is observed.

Signs and Symptoms: Facial twitching and involuntary closure of the eyelids.

Treatment: Imaging of the head and brainstem are sometimes necessary to rule out a vascular abnormality. Botulinum toxin (Botox) or oculoplastic surgery are also sometimes effective.

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Lagophthalmos
Lagophthalmos is when the eyelid will not completely close. When the eye does not close completely or blink, the eyes don’t get the thin layer of tear fluid. This fluid helps promote a moist area for the eye. In addition, tears flush out the eyes. Lagophthalmos can lead to abrasions, infections, corneal drying and ulceration.

Signs and Symptoms: Inability to completely close eyelids.

Treatment: Tear drops. Eyelid repair.

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Orbital Fracture
A break in one of the bones that make up the orbit. It can be a serious fracture and can threaten sight. The orbit is made up of parts of six bones: the frontal, ethmoidal, lacrimal and sphenoid bones and the maxilla and zygoma bones.

Signs and Symptoms: Pain, sometimes double vision or a sunken eyeball.

Treatment: Orbital repair.

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Orbital Trauma
Orbital trauma encompasses injuries to the eye including the soft tissues, lacrimal system and the bony orbit. The injury to the eye may not be obvious or may appear minor. Even minor injuries can lead to more complicated problems if not addressed early. If a patient feels that there has been trauma to their eyes, they should consult a physician immediately.

Signs and Symptoms: Discomfort or trauma to the eye.

Treatment: Physician will determine treatment based on diagnosis.

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Orbital Tumor
An orbital tumor occurs within the orbit of the eye. The orbit is a complex structure that houses the globe, extraocular muscles and fat, as well as and vascular, nerve, glandular, and connective tissues. It is a relatively small area, therefore even a small tumor takes much needed space.

Signs and Symptoms: Diagnosed during eye exam, in some cases the eye will bulge.

Treatment: Sometimes tumor excision. Some types of tumors may need radiation or chemotherapy. Other tumors can just be monitored.

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Pseudotumor Cerebri
Pseudotumor Cerebri is a process affecting the brain that appears to be, but is not, a tumor. It is often reversible. It is more common in premenopausal, obese women. It is important to monitor vision, as there is potential for visual loss. Follow-up MRI or CT scans may be done to rule out hidden cancer.

Signs and Symptoms: Increased pressure within the skull (increased intracranial pressure), headache, buzzing sound in ear, dizziness, nausea, double vision, partial or permanent loss of vision, blurred vision; symptoms may get worse during physical activity, especially when tightening the stomach muscles.

Treatment:
Mild: Fluid or salt restrictions. Medications such as corticosteroids, glycerol, acetazolamide, and furosemide.

Moderate or severe: Surgery to relieve pressure on the optic nerve. These may include lumbar puncture to optic nerve sheath decompression, or shunt procedures. Weight loss may be one of the most important long-term factors leading to improvement.

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Squamous Cell Carcinoma
Squamous cell carcinoma is the second most common form of skin cancer. Squamous cell cancer may appear as a firm red bump, an abnormal patch of skin or a sore that bleeds and does not heal. On the eyelids, eyelash loss or eyelid notching may be evident. It is highly treatable but it can metastasize. The most common places affected are sun-exposed areas such as the back of the hand, scalp, lip and upper portion of the ear.

Signs and Symptoms: Firm red bump or unusual patch of skin, sore that bleeds and doesn’t heal.

Treatment: Complete surgical removal and oculoplastic reconstruction of the area.

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Temporal Arteritis
Temporal arteritis is an inflammation and damage to blood vessels that supply the head area, particularly the large or medium arteries that branch from the neck. It is most common in the head, however it can affect medium to large arteries throughout the entire body. In some cases, paralysis of eye muscles can occur.

Signs and Symptoms: There are numerous symptoms, including blurred, double or reduced vision; excessive sweating, fever, feeling ill, jaw pain, loss of appetite, muscle aches, throbbing headache on one side of the head or the back of the head, scalp sensitivity, weakness, tiredness and more than 5 percent body weight loss

Treatment: Corticosteroids. Temporal artery biopsy is usually necessary to help with the diagnosis.

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Trichiasis (Misdirected Eye Lashes)
Trichiasis is a medical term for misdirected eyelashes that grow toward the eye, sometimes touching the cornea or conjunctiva. Severe cases may cause scarring of the cornea and lead to vision loss if untreated. Mild cases may not require treatment.

Signs and Symptoms: Abnormally directed eyelashes.

Treatment: Removal or destruction of the affected eyelashes. Removal with forceps, however with this method, the lashes grow back.

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For ophthalmology appointments, please call:

UC Irvine Medical Center
714-456-7183

Gavin Herbert Eye Institute Building
949-824-2020

Laser Refractive Surgery
949-824-9970

 

CATARACT SURGERY
Anand Bhatt, M.D.
Marjan Farid, M.D.
Sumit (Sam) Garg, M.D.
Sanjay Kedhar, M.D.
Sameh Mosaed, M.D.
Roger Steinert, M.D.
Matthew Wade, M.D.

COMPREHENSIVE
Timothy Scott Liegler, O.D.

CORNEA SURGERY
Marjan Farid, M.D.
Sumit (Sam) Garg, M.D.
Sanjay Kedhar
Roger Steinert, M.D.
Matthew Wade, M.D.

GLAUCOMA
Anand Bhatt, M.D.
Sameh Mosaed, M.D.

LASIK REFRACTIVE SURGERY
Marjan Farid, M.D.
Sumit (Sam) Garg, M.D.
Robert Lingua, M.D.
Roger Steinert, M.D.
Matthew Wade, M.D.

NEURO-OPHTHALMOLOGY
Chantal Boisvert, M.D.
R. Wade Crow, M.D.

OPHTHALMIC PATHOLOGY
Donald S. Minckler M.D.

OPHTHALMIC PLASTIC & RECONSTRUCTIVE SURGERY/
OCULOFACIAL COSMETIC SURGERY

Jeremiah Tao, M.D.

OPTOMETRIC SERVICES
Jennifer Che, O.D.
Scott Liegler, O.D.
Kailey Marshall, O.D.

PEDIATRIC OPHTHALMOLOGY
Chantal Boisvert, M.D.
Robert Lingua, M.D.
Jennifer Simpson, M.D.

RESEARCH
Lbachir BenMohamed, Ph.D.
James Jester, Ph.D.
Tibor Juhasz, Ph.D.

M. Cristina Kenney, M.D., Ph.D.
Henry Klassen, M.D., Ph.D.
Anthony Nesburn, M.D.
Eric Pearlman, Ph.D.
Jing Yang M.D.

RETINA/VITREOUS
Baruch Kuppermann, M.D., Ph.D.
Stephanie Lu, M.D.
Mitul Mehta M.D.

UVEITIS
Sanjay Kedhar, M.D.

For ophthalmology
appointments, please call:

Gavin Herbert Eye Institute
949-824-2020

Laser Refractive Surgery
949-824-9970

UC Irvine Medical Center
714-456-7183

Optical Shop
949-824-7690 Phone
949-824-8850 Fax


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