When it comes to eye problems, we often tend to think of areas like the lens, cornea and retina.

But some common eye complaints are caused by issues outside the eyeball – conditions such as droopy eyelids, in-turning or out-turning eyelids, eyelid lumps and tumours, problems with tear ducts and issues involving the eye socket. This is where oculoplastics can help. Oculoplastic surgeons are specialised ophthalmologists (eye doctors) who perform a range of eyelid and facial plastic operations to treat and improve conditions around the eyes.

Oculoplastics is a specialist form of eye care that deals with all the structures around the eye, including the eyelids, the lacrimal (or tear) system and orbit (the bone cavity around the eye). Various problems can affect these structures, and to some extent they are becoming more common; many more people are having eyelid surgery, for example, as the general population ages. Oculoplastic surgeons (also known as ophthalmic plastic and reconstructive surgeons, or oculo-facial surgeons) are eye doctors who have been specially trained to treat these important structures around the eye. The procedures they use range from simple eyelid malpositions to more complex reconstructions involving the eyelids and the surrounding forehead, temporal and cheek areas. Oculoplastic surgeons are experts at understanding the delicate anatomy and function of the eyelids and their surrounding structures. The goal of oculoplastic surgery is to correct either functional or cosmetic problems, and in some cases both.

An epiretinal membrane behaves like scar tissue. As the tissue contracts, it “puckers” the underlying macula. This can cause distortion and visual loss.

Oculoplastic surgery provides treatment for a number of different problems. The most common ones include:

Eyelid ptosis (drooping upper eyelids)

This is a condition where one or both of the upper eyelids hangs lower over the eye than it should do. Sometimes this is a minor cosmetic issue; if it progresses, however, it can affect a patient’s visual field, and may also cause a brow ache. There are many reasons why it might happen, and an oculoplastic surgeon will be able to assess the exact cause and recommend the appropriate treatment during a consultation. In some cases this will mean surgery, which is often performed as a day case under local anaesthetic. During the operation, the surgeon makes a small incision in the skin of the upper lid. The eyelid tissues are then adjusted to lift the lid back to its natural height.

Ectropion / Entropion (in-turning or out-turning eyelids)

Ectropion and Entropion are conditions where the lower (or sometimes upper) eyelid turns outwards (ectropion) or in towards the eyeball (entropion). It commonly happens to patients as they get older, due to age-related stretching of the tissues that support the lid; but there are other possible causes, and an oculoplastic surgeon will be able to assess these and provide an appropriate management plan. Though surgery is often required for ectropion and entropion, it can be done as a day case under local anaesthetic. During the operation, the surgeon makes incisions either to the skin of the lower lid just below the eyelashes, or inside the eyelid. Through these incisions, the structures of the eyelid are repositioned so the eyelid returns to its natural position.

Blepharoplasty (cosmetic surgery for eyelids)

Blepharoplasty is the medical term for plastic surgery that corrects problems with the eyelids. It can be used to reduce excess skin and sometimes fat from the upper or lower eyelids either for aesthetic reasons, or if the excess skin is having an effect on your peripheral vision (visual field). An oculoplastic surgeon should be the first choice for anyone considering cosmetic surgery to the eyelids, as they are best placed to make a full assessment of the eyelids and eyes to advise the correct treatment. They are able to properly assess the surface health of the eyes, and the function of the eyelids, prior to plastic surgery.

Watery eyes

Watery eyes can be due to either an excessive production of tears or a problem with tear drainage, and they can cause quite a lot of distress. An oculoplastic surgeon will be able to assess the reason for the watering and provide an appropriate management plan to treat the problem. Though simple treatments can make a big difference to patients with a watery eye, occasional surgery may be helpful. On assessment, your oculoplastic surgeon will be able to advise when and what type of surgery would be suitable.

Eyelid lumps and tumours

Many types of benign lumps can affect the eyelids, as well as some types of cancer. If you’re worried about a lump and want to have it properly looked at, the oculoplastic surgeon will be able to assess the situation, offer a diagnosis and then provide treatment if necessary. Removal of benign eyelid lumps is often not possible on the NHS, but it can be done privately. It is often a quick, office-based procedure, carried out under local anaesthetic.

Facial palsy

Facial palsy is a condition where the nerve that supplies the muscles on one side of the face is damaged. An oculoplastic surgeon is often involved because it affects the ability of the eyelids to close, which puts the eye at risk of exposure. The oculoplastic surgeon will be able to assess the extent of the damage to eyelid function and advise on appropriate management. This may involve simple conservative measures such as lubricant eyes drops, though it could also require surgery.

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