EYELID ENTROPION

Entropion of either lower or upper eyelid is quite common in our clinical practice. The keratinized skin of the eyelid margin and eyelashes rub against the cornea and conjunctiva, causing irritation. Unlike with ectropion, the irritation is troublesome enough so that most patients seek medical treatment early. Upper eyelid entropion is potentially blinding. Distichiasis and Trichiasis also common conditions and often accompany the entropion. One must be able to evaluate all the above-mentioned conditions to choose the most appropriate surgical technique.

EYELID TRAUMA

Many ophthalmologists, regardless of the type of practice they have, may be called upon to assist in the management of patients who have sustained acute eyelid trauma. So basic knowledge of eyelid anatomy and principles of repair must be known to an ophthalmologist. This is especially true for the upper eyelid and lacrimal canalicular trauma as they are very important protective and functional components of the eye.

BOTULINUM TOXIN: FUNCTIONAL USES IN OCULOPLASTY

Clostridium botulinum bacteria produce eight serotypes of botulinum toxin proteins (A, B, Ca, Cb, D, E, F, and G). Botulinum toxin serotype A is the most potent and is used for functional and cosmetic indications all over the body. There are some specific functional indications for Btx A injections in oculoplasty. Understanding those indications will help the general ophthalmologist to counsel their outdoor patients. Giving Btx A injections require knowledge of facial anatomy. Oculoplasty surgeons are trained to give Btx A injections.

ORBIT FRACTURES

Orbital fractures are a common midfacial trauma. Orbital fractures account for 40 % of all fractures of the facial skeleton. Isolated orbital fractures are observed in ~35–40 % of cases, while 30–33 % of injured patients have two walls damaged. In children, orbital fractures account for 23 % of all facial traumas. Trapdoor- type fractures constitute 25–70 % of all orbital fractures in the pediatric population. 70 % of all orbital fractures are combined with certain injuries of the globe, other facial bones, and head trauma.

The orbital fracture can cause functional impairment and cosmetic disfigurement as well. A timely repair will give very good results. Oculoplasty surgeons know the periocular functional anatomy very well and so can deal with orbital fractures alone or in association with plastic or maxillofacial surgeons. The transconjunctival route is the most aesthetic approach to repair the orbital floor and medial wall fractures.

THYROID ASSOCIATED OPHTHALMOPATHY

Thyroid-Associated Ophthalmopathy is associated with dysthyroid or euthyroid status. It is an autoimmune disease. It is also known as Grave's Orbitopathy or Thyroid Eye Disease or Thyroid Related Orbitopathy. The clinical presentation varies from mild to most severe, sight-threatening, disease. It can cause functional deficits, cosmetic disfigurement and compromised quality of life. A timely interventional approach by an oculoplastic and an endocrinologist can make a huge difference in the final outcome of the disease.

COSMETIC ARTIFICIAL EYE

Loss of vision indeed causes profound mental trauma. If the vision loss is accompanied by disfigurement of the eye it further adds to the trauma and decreases patient's self-confidence. The disfigurement can be very well corrected by an appropriate surgery as advised by an oculoplastic surgeon and a custom-made ocular prosthesis. The results are very satisfying in a typical case.

WATERY EYE IN CHILDREN

Watery eye in children is commonly due to a membranous obstruction at the opening of the nasolacrimal duct in the nose. This is known as congenital nasolacrimal duct obstruction. The management is usually conservative with massage (after every feed) and antibiotic eye drops if there is an infection. Surgical intervention can be postponed till the age of 10- 12 months.  It does not harm a child’s eyesight ever. Surgery is a very minor procedure under general anesthesia & takes 20 to 25 minutes without any scar. It must be done under endonasal endoscopic guidance to get the best results.  An oculoplastic surgeon is trained for the procedure.