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Oculoplasty And Squint

Written and reviewed by
MBBS Bachelor of Medicine and Bachelor of Surgery, MS - Ophthalmology, DNB Ophtalmology
Ophthalmologist, Navi Mumbai  •  19 years experience
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Good morning friends.


I am Dr. Harshvardhan Ghorpade. Today I am going to speak to you about a very special type of disorder or disorders of the eyes which comes under the heading of oculoplastic and squint. Now what is oculoplasty? oculoplasty is plastic surgery or plastic disorders of the eye which means cosmetic disorders. These could be congenital which means they come during birth, acquired that come later on because of injuries or any other problem or weakness in the muscles or neurological or neuro-ophthalmic, which means because of disorders in the brain.

Now what are the different types of disorders that come under this heading, it could be droopy eyes, the eyelid droops down, it could be squinted eyes, the eyelids eyes go either out or in, it could be protruding eyes the eyes come out, it could be small eyes, large eyes, changes in the lids, the lids can go out, in, scar or can affect the inner layers or the outer layers of the eye by rubbing against them. So all these disorders ultimately can affect your vision, as well as the cosmetic problem, is always there, so how do we look at it?

First, we assess the patient, any patient who has any abnormality or difference between the two eyes. for example, if one eye is droopy, another eye is normal or both eyes are droopy or we need to assess. There are various causes of these disorders so we cannot just straight away go and treat the problem, first of all we should know what is the cause for example in myasthenia gravis which is a condition where there is weakness of the muscles because of a neurological problem, the eyes droop more in the evening and less in the morning this is because of tiredness of muscles this requires a totally different kind of approach we may even treat it without surgery, we can even just give medicines and control this disorder.

However if it's a congenital problem that is a problem since birth where the muscle of the eyelids are weak then of course we need to do a surgery and sometimes we need to do different types of surgeries, for example, a sling surgery or a levator resection, these are technical terms but they simply mean stranding of the eye muscles to get the lid back to its place.

There are other disorders like squinting. Now squinting is a problem which is very common, it's a taboo for children who go to school, people call them by various names so any child who is about to go to school has a cosmetic problem we need to correct them. There are various ways of correcting squinting. First of all, we need to know the cause. is it because of glass power or any retinal problem or a cornea problem or just the eye muscle problem? If eye muscle problem is there then we should consider the change of glasses initially or giving prism glasses which are special glasses which deviate the light; however, in larger squints, we may need to do a surgery. Sometimes even exercises are given to control the movement of the eye muscles which in turn strengthen the muscles and can lead to improvement of squint.

Surgeries are basically stranding surgeries where the muscles are positioned at different places. There are around six muscles which operate around the eyes which help you to move the eye in various directions, any weakness in these muscles can lead to squint so we need to assess which muscles are weak. There are various tests that we do first to find out what is the muscle involved and then after that we go and correct that muscle strength. Then we come to other problems like orbital, where orbit is basically the bony structure behind the eye, any problem in that can lead to protrusion of the eye, the eye comes out that can be because of thyroid and thyroid disorders are the most common cause of protrusion, hyperthyroidism per se and these can be corrected by medical therapy; however, sometimes we need to do radiotherapy or surgical correction to correct the protrusion.

Most important thing is to know the cause whether there is a tumor growing behind the eye or whether there is a blood vessel problem or muscle hypertrophy, so all this can be done by MRI scan and then after diagnosis is done by doing a few tests, we do the correction. Correction basically involves orbital reconstruction or orbital decompression, then there are other lid problems like eyelid going out or in because of scarring or old age all these need corrections because they can lead to tearing, watering, scarring of the cornea that is the black part of the eye and many other things can happen. These require cosmetic correction in such a way that we don't lead to any bad appearance of the patient at the end of the surgery,

Finally, there are problems of the nasolacrimal duct which is the duct which connects the eye to the nose. If there is an occlusion of that duct then it can lead to constant watering, in children is called congenital nasolacrimal duct obstruction and it's a very common surgery where we do what is known as DCR, where we connect the duct to the nose directly and bypass the occlusion; however, nowadays we do endonasal DCR, where endoscopy is used and we enter the nose and do the surgery in a reverse way which in turn leads to no scarring on the skin and cosmetically the patient is very good, the surgery is faster and bleeding is very less.

So all these various endoscopic surgeries and correcting surgery requires a very specific and very experienced eye plastic surgeon, basically oculoplastic surgeon and a squint surgeon both of them we have and we coordinate together all of us and finally give the best possible appearance to the patient, correcting his problem, going to the root of the problem and then getting him the happy face that he wants. At the same time, it also can affect vision so vision rehabilitation is also important at the end of surgery. amblyopia treatment that is lazy eye treatment and many other treatments video-based, software-based or surgical based can be done ultimately to give the best possible correction and happiness to the patient.

So I hope you all liked my video about oculoplastic and squint problems in children and adults and if you want to know more about it you can contact me on lybrate.com.

Thank you
 

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