ORBIT AND OCULOPLASTY

  • The department includes a wide variety of surgical procedures to treat anomalies of lids, lacrimal system, extra ocular muscles, fractures and  facial trauma, unsightly eyes,  lid tumors and other masses.
  • A distinct speciality whose services at RJN are being provided with continual improvement in its clinical approach with an experienced & skilled team of ophthalmologists and paramedics.
  • The Department is equipped to handle all kinds of Orbit and Oculoplasty cases specially Fractures and facial trauma, lid tumors and other masses and unsightly eyes.
  • The department envisions adding a cosmetic clinic and a chemotherapy unit for ocular & orbital malignancies to its array of services.

Diagnostic Procedures

  • Diagnosis and medical treatment of eyelid, orbit and lacrimal diseases.
  • Botox injection for abnormal facial movements (hemi facial spasm, essential blepharospasm etc)
  • Treatment of inflammatory conditions like thyroid eye diseases, pseudotumour, sarcoidosis etc.
  • Treatment of eye exposure after facial palsy (both medical and surgical)
  • Treatment of infective orbital conditions like orbital cellulitis, necrosting fasciitis
  • Diagnosis of malignancies of orbit and adnexa.

Surgical Procedures

  • Ptosis (congenital and acquired)
  • Entropion, ectropion, trichiasis, distichiasis
  • Enucleation and evisceration
  • Management of Congenital nasolacrimal duct obstruction (probing, Balloon dacryoplasty, paediatric DCR)
  • Dacryocystorhinostomy, conjunctival dacryocystorhinosto my with jones’ tube, punctoplasty
  • Lid reconstruction, Skin graft for lid contractures, cosmetic & aesthetic surgeries
  • Socket reconstruction(fornix formation, primary/secondary allogenic  implants & dermis fat grafts) followed by fitting with custom-made artificial eyes
  • Amniotic membrane grafts for symblepharon release
  • Fracture repair
  • Orbitotomies for orbital mass excision

Team – Orbit & Oculoplasty Department

  • Dr. Kamalpreet Likhari – Director & Sr. Consultant
  • Dr. Abhijit Suresh Rasal – Consultant

Ptosis


Ptosis is the term used for drooping of the upper eyelids. There are two types: congenital ptosis, which is more common, and acquired ptosis. Ptosis may involve one or both eyes and ranges from mild to severe. In cases of mild ptosis, the eye has an undesirable appearance but is functionally normal. In severe ptosis the drooping upper lid covers the pupil and visual axis of the eye, so the patient must lift his or her chin to see properly.

Congenital Ptosis


Congenital ptosis is present at birth and results from the poor development of the levator palpebrae superioris muscle, which lifts the eyelid. A child may have ptosis alone or may have other associated eye abnormalities such as eye movement disorders, refractive disorders and neurological disorders.

Acquired Ptosis


Acquired ptosis may occur at any time after birth, but is more common in old age. The etiology of this form of ptosis is normally ascribed to the weakening of the levator palpebrae superioris muscle due to such factors as old age, injury, surgery, muscular disease and neurological disease.

Symptoms

  • Drooping of the upper eyelid of both eyes; it may be mild or severe enough to cover the cornea.
  • Tired appearance of the eyes
  • Undesirable facial appearance due to drooping of the upper eyelid
  • Elevated chin, in cases of severe ptosis
  • Poor vision due to associated refractive errors
  • Stiff neck due to constant chin elevation
  • Decreased vision when the droop is severe and covers the pupil.

Treatment


Ptosis results in an undesirable facial appearance. Normal vision is affected in severe ptosis, thus hindering the daily activities of the person. Treatment is necessary even in cases of mild ptosis in order that the patient has the opportunity to lead life as a normal person. A child suffering from ptosis has a psychological handicap when compared to other normal children. Hence, severe cases should be treated as early as possible; otherwise, ptosis may lead to abnormal head positions or decreased vision. Treatment provides a desirable facial appearance as well as normal vision.

Surgery


The treatment is surgery. It usually involves one of the two procedures: strengthening the levator palpebrae superioris muscle or lifting the eyelid mechanically with the help of a thread-like material called a sling. Levator surgery is done in cases of mild or moderate ptosis, while sling surgery is performed in cases of severe ptosis. The levator muscle is strengthened by surgery so as to allow it to lift the eyelid normally.

Postoperative period


During the initial period after surgery, the patient may not be able to close his or her eyes fully, even during sleep. This malfunction results in a frightening appearance, but is usually corrected within a few weeks. Furthermore, when the patient looks down, the white of the eye may be visible. The patient is trained to move his or her head to look down rather than to move only the eyes.

Prognosis


The surgery for ptosis is quite safe and effective.

Risks of ptosis surgery


Generally, the surgery is safe. However, complications such as infection, bleeding, reduced vision, reduced eye movement, and corneal ulcer, may occur. The aim of the surgery is to have equal lid height in both the eyes. Under-correction or over-correction may occur, but either mistake can be rectified.