Oculoplastics

Eyelid, Lacrimal and Orbital Disease

Oculoplastic surgery is a specialized surgical field that involves disease and conditions affecting the tissues around the eye, the eyelids, tear ducts, eye socket and orbit. Within Oculoplastics, Orbital disease is another complex area that includes neoplastic, inflammatory, vascular and structural disorders. Thyroid Eye Disease is the most common Orbital Inflammatory Disorder but many other specific and non-specific (or Idiopathic) Inflammatory Disorders can affect the Orbit. Thyroid Eye Disease is an autoimmune disorder affecting the eyelids, extraocular muscles and orbital tissues that can lead to Visual threat, Inflammation, Double vision and protrusion of the eyes (proptosis) and Lid retraction. This can lead to significant appearance issues and psychosocial disability. The Orbital surgeon’s role is to coordinate with the patient, endocrinologist and family doctor to help the patient on what is usually a long journey with this chronic disease. Orbital oncology includes both benign and malignant process, the most common of which is Lymphoma. A very broad range of tumours can be found in the orbit, usually primary but occasionally they can be secondary from tumours elsewhere. Structural disorders may follow trauma with fractures to the orbit leading to double vision or a recessed sunken eye (enophthalmos). The lacrimal system both produces tears and drains them away from the eye into the nasal cavity. Lacrimal disorders usually manifest as a watering eye, or epiphora. This can be due to overproduction of tears or reduced drainage of tears. Most commonly this is due to primary nasolacrimal duct narrowing or obstruction. Eyelid malpositions can also interfere with tear drainage. There are surgical procedures to improve both eyelid malposition and tear drainage. Rarely tumours may affect the lacrimal system and require specialised management. Many infants will have a congenital nasolacrimal duct obstruction, which may resolve spontaneously but occasionally will need intervention with probing or other procedures. A range of disorders can affect the eyelids. Unfortunately, Australia has one of the highest incidences of skin cancer in the world and skin tumours such as BCC, SCC, sebaceous carcinoma and melanoma can involve both upper and lower eyelids. Management usually involves excision with clear margins and complex repair to restore the best cosmetic and functional outcome. Eyelid malpositions are common. Ptosis, or drooping eyelids can be present from birth or acquired later in life, as an aging process or as part of a more generalised muscle disorder. Not all patients require surgery and the type of surgery discussed will depend on the underlying cause and severity of the ptosis. Where the eyelid muscle function is good, the levator muscle or attachments are advanced directly, whereas if the eyelid muscle function is poor, a sling might need to be used. With age, the eyelid tissues become unstable and the lower eyelid can roll in (entropion) or out (ectropion). This can lead to symptoms of irritability and watering and may require surgery.