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The Oculoplastics Service at Children's Hospital Boston offers comprehensive evaluation and correction of the eyelids, orbit and lacrimal system in babies, children, and adults of all ages. Our highly experienced pediatric ophthalmologists are known locally and nationally for handling the most difficult cases. Alexandra Elliott, MD is a pediatric ophthalmologist and oculoplastic surgeon at Children's Hospital Boston and Instructor in Ophthalmology at Harvard Medical School. Children's Hospital interviewed Dr. Elliott to learn more about the specialty of oculoplastic surgery.
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Dr. Elliott: Oculoplastics, or oculoplastic surgery, is literally plastic surgery of the eyelids. It is a specialty of ophthalmology that focuses on three areas - the orbit, the eyelids, and the lacrimal system.
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Dr. Elliott: That is just the branch of plastic surgery that you hear about on television. Plastic surgeons are trained to perform procedures to correct deformities and injuries, and oculoplastic surgeons specialize on conditions that affect the areas around the eye specifically.
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Dr. Elliott: The orbit is the bony socket in your skull that contains the eye and all the associated structures that support the function of the eye like muscles, nerves and blood vessels. The orbit also contains fat ? but don?t worry, its not fat that you can see, it is specialized fat that acts as cushion to protect the eye as we run around, or if we inadvertently get hit in the eye.
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Dr. Elliott: Unfortunately, there are a variety of problems that can occur in the orbit or eye socket that effect the function of the eye. These processes range from inflammatory disease like thyroid associated orbitopathy as seen in patients with Graves? disease to tumors, infections, and trauma. When these problems occur, patients might develop prominent eyes, or a sunken appearance to the eyes. Patients might also get double vision, loss of vision, pain and swelling.
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Dr. Elliott: Drooping upper eyelids (ptosis) may interfere with vision, and if that happens, it is considered a medical condition, such that correcting the problem is usually covered by medical insurance. The eyelids can also turn inward (entropion), which is a painful condition where the eyelashes rub against the eye, or they can turn outward (ectropion), which causes the eyes to either dry out or tear excessively.
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Dr. Elliott: Some people are born with ptosis due to abnormal eyelid muscle or nerve function. Tumors, injuries, and some medical conditions can also cause ptosis. Older adults simply lose the function of their eyelids over time.
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Dr. Elliott: It almost always is in children. In older adults, it is sometimes a matter of appearance, even if function is okay. The skin can also lose its elasticity, resulting in sagging, baggy eyelids. Sometimes the orbital fat can start to pooch out, which causes more severe bagginess. Surgery on the upper and lower eyelids can help rejuvenate the appearance in adults, and when that happens, the correction is considered a cosmetic surgical procedure.
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Dr. Elliott: Yes. The tear film on the surface of the eye is a critical component of maintaining vision. Tears nourish and lubricate the surface of the eye as well as wash away debris. A smooth, balanced tear film (consisting of water, oil and mucus) also allows light to enter the eye in an optimal fashion. If there is a disturbance of the tear film, patients will often experience tearing, burning, irritation and most importantly blurred vision.
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Dr. Elliott: If the eyelids have an abnormal contour, or do not appose the eye properly, then the tear film can be disturbed. Excessive tearing is another common problem. There are two basic problems that can lead to excess tearing: Too much tear production, or not enough tear drainage. Either can cause the tears to overflow, but both conditions are usually amenable to treatment.
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Dr. Elliott: Probably the two most common are congenital ptosis and congenital tear duct obstruction. As I mentioned, congenital ptosis is not usually a cosmetic problem in children, it can actually cause vision loss if the eye is completely blocked by a drooping eyelid. Tear duct obstruction is even more common - probably 5% of all infants have an immature tear drainage apparatus and experience tearing soon after birth. While this will often improve spontaneously, we often have to perform a procedure to open up the tear duct.
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Dr. Elliott: Trauma can cause all sorts of trouble - lacerated eyelids, broken bones in the orbit, and various types of tumors or bumps that show up on or around the eyelid such as dermoid cysts. I will sometimes team up with some of the other specialists at Children's Hospital to treat tumors or congenital deformities that affect the entire face.
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For more information about oculoplastic surgery, go to the web site of the American Society of Ophthalmic Plastic and Reconstructive Surgeons at http://www.asoprs.org/home.cfm. For more about the Department of Ophthalmology at Children's Hospital, go to www.childrenshospital.org/eyes.
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