Ophthalmoplegia: Treatment, Procedure, Cost and Side Effects

Ophthalmoplegia is a condition associated with the weakness or paralysis of the muscles of the eye. It can affect either one or more than six muscles which control the movement of the eye and holds it in place. Ophthalmoplegia is usually of two types, internal ophthalmoplegia and chronic progressive external ophthalmoplegia. Internal or internuclear ophthalmoplegia occurs when there is damage to the nerve fibers which controls lateral eye movement. This can lead to double vision. Whereas, chronic progressive external ophthalmoplegia develops with drooping eyelids and leads to problem controlling the eye muscles which coordinates eye movement.

The treatment for ophthalmoplegia generally depends upon the underlying causes, symptoms and type. Many times, drooping eyelids can be the main cause of ophthalmoplegia, in such cases, the doctor can suggest a procedure known as a silicone sling. This procedure helps to elevate a drooping eyelid. Silicone sling procedure can also help cure an eye condition known as ptosis. Lid crutches or adhesive tape can also be used when the symptoms of drooping eyelid is not too advanced.

In silicone sling procedure, a Seiff silicone suspension has to be used. The silicone is guided in the muscle through a stab incision. This procedure is highly popular and efficient because it includes early recovery, edema (minimum post operative scars), no multiple incisions and less surgical time. This procedure is ideal for patients with poor levator functions due to ophthalmoplegia. It provides more advantages as compared to standard sling procedures.

In children this procedure has to be performed under general anesthesia. The upper eyelid is coated with lidocaine and the area is cleaned and draped. A suprabrow stab incision is made of around 2.5 mm to 3 mm about 5 mm from the eyebrow. Then, a sterile Seiff silicone suspension is inserted. Precision and care has to be maintained so that the eye surgeon maintains the muscle plane through the entire procedure. When the incision mark is reached the needle is exteriorized after being pierced through the skin. The ends of the silicone rods are usually passed through the sleeve and knotted, the margin of the lid is adjusted according to the amount of correction required. In the end, a silk suture has to be tied in between the knots and is then buried below the subperiosteal pocket. The suprabrow incision is later closed with fibrin glue or a silk suture.

Complications are rare but can occur in certain cases. Some side effects include late recurrence of ptosis, bilateral chronic eyelid edema, the sling can be exposed in the forehead through the incision, suture granuloma, undercorrection, lagophthalmos and significant eyelid drooping. Silicone is extremely safe for frontalis suspension in patients with ophthalmoplegia, chronic inflammation, sling exposure, granuloma formation and recurrence of drooping eyelids is still possible if the surgery is not performed properly.

A lot of people in the beauty and fashion industry also get this procedure done if they have asymmetric eyelids. Many people can have an eyelid which is slightly droopy than the other, in such cases, silicone sling procedure is performed to give their face a more symmetric look. It does not take a lot of time to recover, this procedure can either be performed as an outpatient service or with 1 to 2 days hospital stay.

The price of silicone sling procedure in India can be anywhere between Rs.95,000 to Rs. 1,25,000.

The results of silicone sling procedure are usually permanent. This is a sure shot treatment to cure drooping eyelids which is the major cause of disorders like ophthalmoplegia. In this surgery, the eyelid incisions are placed around 6 mm above the lash line, for children, this spot lies at the lid crease line. If the ptosis is unilateral, a higher skin incision is made. This reduces the need for reoperation if there is crease formation in later years of the child’s life. Placing the sling material within the tissues of the eyelid also reduces surgery induced bulkiness. Sometimes, surgeons have to form the eyelid crease in a totally separate procedure months after the silicone sling procedure. This however requires more cost and more time for hospitalization. To avoid further hassles, silicone sling procedure should be performed by well experienced surgeons.