Eye reconstructive surgery is a specialized area of ophthalmology that focuses on the eyelids and the structures surrounding the eye, including problems of the lacrimal (tear) system and the orbit, the region surrounding the eyeball. Ophthalmic Plastic and Reconstructive surgeons – such as Dr. R. Jeffrey Hofmann – are the most qualified physicians to treat these conditions. They have had extensive training in surgery of the eye and even more training in reconstructive surgery with particular attention to the eyelids and face. Dr. Hofmann has been a fellow of the American Society of Ophthalmic Plastic and Reconstructive Surgery for over twenty years (see www.asoprs.org).
Most reconstructive procedures are performed to improve the function of the eye following trauma, removal of a tumor, or eyelid malposition. But care is taken to improve aesthetic appearance as well.
Following an injury or upon consultation, the doctor will perform a complete eye exam and facial exam to determine the best course of treatment.
Depending on the diagnosis, the doctor may recommend reconstructive surgery or medical treatment for any of these conditions:
- Injury to the Eyelids. The eyelids are vital to good eye health and sight. They protect the eye and keep it lubricated. Most eyelid injuries and abnormalities are treated surgically to repair any damage and preserve vision.
- Eyelid and Skin Cancer. Skin cancers often occur on the eyelids or adjacent face. Usually they appear as painless elevations or nodules, most commonly on the lower eyelids or at the corner of the lids near the nose. In all cases of eyelid cancer, it is important that diagnosis and treatment be instituted as early as possible. Once the cancer is removed, the eyelid is reconstructed as necessary.
- Eyelid malpositions (ptosis, ectropion, entropion). Eyelid abnormalities can threaten the health of the eye or interfere with vision. Drooping eyelids (ptosis) can decrease peripheral vision. Lower eyelids that hang away from the eye (ectropion) can result in dryness and ulcers. Eyelids that turn in toward the eye (entropion) rub on the eye and irritate it. These conditions are all treated with various surgical procedures to reposition the eyelid.
- The Lacrimal System. In order for the eye to remain healthy, it must remain moist. The lacrimal gland is a specialized gland located under the outer one-third of the upper eyelid that produces tears. Each time you blink, the eyelid spreads the tears over the surface of the eye and pumps excess tears into the tear ducts that drain the tears into the nose.
- Dry Eyes. If the lacrimal gland fails to produce enough tears to properly wet the eye, the surface of the eye begins to dry out. An eye that is too dry, may burn, sting, or feel like there is sand in it. Dry eye is most often treated with lubricating drops and ointments that help to control the drying and irritation. Sometimes plugs need to be placed in the drainage ducts to increase lubrication.
- Wet Eyes. If the duct that drains the tears from the eye into the nose gets blocked, the tears will back up and spill over the eyelid and run down the face. This condition can lead to infection in the inner corner of the eyelids. Normally surgery is recommended to remove the obstruction and eliminate the tearing and infection. During the procedure, a new tear duct is created from the eye to the nose.
- Thyroid Eye Disease. This is a medical problem that causes the muscles that move the eye to become enlarged and open the eyelids too wide. The result is bulging eyes (proptosis) that move poorly, and swelling in the socket that can become so severe that the blood flow to the optic nerve is strangled, resulting in a slow loss of vision. Treatment may include steroids, radiation, or surgery to correct any eyelid abnormalities or proptosis. Occasionally emergency surgery is required to decrease vision-threatening pressure on the optic nerve.
- Orbital Tumors. The orbit is the bony socket that surrounds the eye. It contains the eye, muscles that move the eyes, arteries, and optic nerves. Numerous medical and surgical problems can affect the orbit. Anything that causes swelling and enlarging of the orbital structures behind the eye will push the eye forward (proptosis) and may restrict its movement. Double vision results from an eye that does not move properly. Fortunately, most orbital tumors are not malignant and can be effectively removed with surgery.
- Orbital Injuries and Fractures. Any trauma to the orbit may cause fractures in the bones surrounding the orbit. The two most common fractures are the cheekbone (tripod zygomatic) or the orbital floor (blow-out fracture). Such fractures are repaired with surgery.
- Loss of an Eye. At times, it becomes necessary to surgically remove an eye that has become severely damaged by disease or injury. Many times, the eye is removed because it is blind and painful. When an eye is removed, surgical socket reconstruction with a porous implant is performed so as to allow optimal fitting of an artificial eye with the best motility possible.