Oculoplastic and orbital surgery is plastic surgery focused on the structures surrounding the eye, including the eyelids, orbit (bones of the eye socket), lacrimal system (tear duct system), forehead, and midface area. Because surgery in these areas can affect vision, ophthalmic plastic surgeons are best qualified to perform this delicate surgery. The Oculoplastic and orbital surgeon at Jai Eye Centre treat conditions and injuries affecting the eyes, eyelids, and surrounding structures and also offers cosmetic surgical and nonsurgical procedures to enhance the appearance.

Conditions We Treat

• Dry eye, obstructed tear duct, and other problems with tear production
• Ectropion: Eyelids that turn out, exposing the inner surface
• Entropion: Eyelids that turn inward, causing the lashes to rub the eye
• Exophthalmos: Eyes that protrude abnormally, sometimes referred to as "bulging eyes." Some eyes naturally sit more forward, but it can also be associated with a condition such as thyroid eye disease, orbital cyst or growth, or sinus issues.
• Eyelid cancer: Skin cancer cells or tumors that develop on or in the eyelid
• Injury or illness that affects the eye, eyelid, orbit, or other nearby structures
• Ptosis: Drooping upper eyelid
• Phthisis bulbi and Contracted Socket: Enucleation/Evisceration and orbital implants for disfigured non seeing eyes

Ptosis is a condition characterized by the eyelid drooping over the eye. For some people, the drooping is barely noticeable. However, for other people, the drooping can obstruct their vision.

There are two primary ptosis surgery techniques doctors use. ^{(Learn More)} The type of ptosis a person has and the degree of drooping play a role in deciding which technique is the best option.

The general technique involves tightening the levator muscle. ^{(Learn More)} The sling technique involves using the frontalis muscle to lift the eyelid. ^{(Learn More)}

With the general technique, there are two approaches the surgeon may use, including an external approach and an internal approach.

The external approach is also referred to as levator advancement. When the person has a high upper eyelid crease and normal levator function, this is the most commonly used technique.

The procedure happens as follows:

• The surgeon cuts into the eyelid skin.
• They take the levator muscle attachment and reposition it so it is attached to the tarsus.
• Sutures are used to keep the new position of the levator muscle.

This helps to raise the eyelid, so the drooping is not as apparent. People are not put to sleep for this procedure, but they do get sedation to ensure comfort.

The internal approach is another technique the doctor might consider when a person has strong levator function. With this technique, the eyelid is turned inside out. The surgeon then shortens the eyelid muscles. This may include shortening either the Mueller’s muscle or the levator muscle, depending on which one is contributing to the drooping.

The surgeon usually focuses on the levator muscle when the person needs more of a lift for their eyelid. The Mueller’s muscle is targeted when only a subtle lift of the eyelid is necessary. For this procedure, the doctor will administer either sedation or general anesthesia.

Sling Technique

The sling technique is also called frontalis sling fixation. This procedure may be considered when someone has poor muscle function and ptosis. This is typically seen with neurogenic ptosis, congenital ptosis, or myogenic ptosis.

For this surgery, the frontalis muscle and the upper eyelid are attached to each other. The point of attachment is just above the eyebrows. A small silicone rod is usually used to attach the two structures together. It goes below the skin and is passed through the eyelid

Ectropion

What is ectropion?

Ectropion is a term used for describing the turning out of the lower eyelid and lashes. Why does it occur? The majority of ectropion are due to laxity of the tissues of the eyelid as a result of the ageing process, and some are due to eyelid skin disease and shortage.

Symptoms The eyeball is exposed and can become uncomfortable and sore. The lower lid is turning outwards, the tears produced in the eye will not drain correctly; therefore watering of the eye will occur. There is also a chance of damage to the surface of the eye.

Treatment Ectropion will need to be repaired surgically to relieve the symptoms. Eye lubrication with artificial teardrops might be necessary. The surgery to repair ectropion can be performed under local anaesthetic. This will involve tightening of the lower lid, which will correct the lid laxity. This is not a small procedure and will take 45 minutes. If the tear ducts are damaged as well, there is a chance that patient may have persistent watery eyes for which they may require a second operation to resolve it. 

Surgery

The type of surgery you have depends on the condition of the tissue surrounding your eyelid and on the cause of your ectropion:

• Ectropion caused by muscle and ligament relaxation due to aging. Your surgeon will likely remove a small part of your lower eyelid at the outer edge. When the lid is stitched back together, the tendons and muscles of the lid will be tightened, causing the lid to rest properly on the eye. This procedure is generally relatively simple.
• Ectropion caused by scar tissue from injury or previous surgery. Your surgeon might need to use a skin graft, taken from your upper eyelid or behind your ear, to help support the lower lid. If you have facial paralysis or significant scarring, you might need a second procedure to completely correct your ectropion.
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• Entropion
• What is Entropion? Entropion is a term used for describing the turning in of the lower eyelid. Why does it occur? The main cause of Entropion is due to the ageing process in which loose skin, weak muscles and lower lid laxity occurs. Symptoms Some patients with Entropion will find this condition extremely uncomfortable. When the eyelid turns inwards the lashes can rub against the surface of the eye, causing pain and watering. The affected eye may be red in appearance and in some cases can cause a drop in vision. Treatment Entropion will need to be repaired surgically, before the rubbing of the eyelashes causes damage to the surface of the eye. Whilst waiting for surgery you may be advised to use some skin friendly tape to hold the lower lid down, consequently relieving the symptoms. Sometimes, Botulinum toxin can be injected to the eyelid to prevent the eyelid turning in. This is effective usually for 2-3 months. The surgery to repair Entropion is usually performed under local anaesthetic. This will involve tightening of the muscles to correct the turning of the eyelid. This is not a small procedure and will take approximately 45 minutes. There is a small chance of recurrence in some patient