Ophthalmic Plastic and Reconstructive 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 Anophthalmos 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. Basal Cell Carcinoma 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. Blepharospasm 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. Blepharoptosis Signs and Symptoms: Drooping eyelid, loss of upper peripheral vision. Treatment: Blepharoptosis repair.
Blocked Tear Duct 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. Canaliculitis 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. Chalazion (or stye) 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.
Dacryocystitis 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. Dermatochalasis Signs and Symptoms: Excess of skin. Reduced peripheral vision. Treatment: Blepharoplasty and/or sometimes brow lifting. Ectropion Signs and Symptoms: Drooping eyelids, excessive tearing, infection, foreign body sensation, irritated eye, or red eye. Treatment: Ectropion repair.
Enophthalmos 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. Entropion Signs and Symptoms: Drooping eyelids, excessive tearing, infection, foreign body sensation, irritated eye or red eye. Treatment: Entropion repair.
Epiphora (Tearing) 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. Eyelid “bags” and facial “wrinkles” 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.
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. Eyelid Retraction Signs and Symptoms: Irritated eye. Red or dry eye. Sometimes tearing Treatment: Eyelid retraction repair Facial Nerve Palsy 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. Graves' Disease/Thyroid Associated Ophthalmopathy Signs and Symptoms: Enlargement of the eyelid openings or “buggy” eyes, facial asymmetry, dry, scratchy eyes, poor or double vision. Treatment 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. Hemifacial Spasm 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. Lagophthalmos Signs and Symptoms: Inability to completely close eyelids. Treatment: Tear drops. Eyelid repair. Orbital Fracture Signs and Symptoms: Pain, sometimes double vision or a sunken eyeball. Treatment: Orbital repair. Orbital Trauma Signs and Symptoms: Discomfort or trauma to the eye. Treatment: Physician will determine treatment based on diagnosis. Orbital Tumor 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. Pseudotumor Cerebri 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: 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. Squamous Cell Carcinoma 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. Temporal Arteritis 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. Trichiasis (Misdirected Eye Lashes) 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. For ophthalmology appointments, please call: UC Irvine Medical Center Gavin Herbert Eye Institute Building Laser Refractive Surgery
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