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
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Physicians
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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.
View Video
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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.
View Video
View Video
View Video
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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.
View Video
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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.
View Video
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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.
View Video
View Video
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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
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