Oculoplastic Surgery - FAQ

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No parent wants her child to have to undergo surgery. It might help you to know that the caregivers in Boston Children’s Hospital's Pediatric Oculoplastic Program have a long and distinguished history of surgically repairing problems that affect children’s eyelids, lacrimal (tear) system and orbit.

Our doctors can help, first by identifying the severity of the problem—some don’t even require treatment—and then by working with you and your family to design an individualized plan of care.

Here’s some information about oculoplastic surgery and what makes Children’s different.

What are some of the more common conditions requiring oculoplastic surgery?

  • Congenital ptosis — Drooping upper eyelids (ptosis) are caused by a problem with your child’s eyelid muscles, usually the levator muscle.
    • Surgery is often necessary if the condition interferes with your child’s vision.
  • Tear duct obstruction —About 5 percent of all infants have an immature tear drainage apparatus.
    • While this condition usually improves spontaneously during the first year of life, we sometimes have to perform a surgical procedure to open up the tear duct.
  • Orbital dermoids — Some children experience this overgrowth of normal, non-cancerous tissue in the orbital region of the eye.
    • If the dermoid grows large, it can be at risk of rupturing, which can make removal more difficult and cause significant inflammation. If it is allowed to continued growing it could affect the ability of the eyeball to move well.
  • Infantile hemangioma — This benign vascular tumor can grow rapidly and put pressure on the eye or cause the eyelid to droop over the pupil.
    • If the hemangioma expands and threatens the eye, it may need to be removed or treated with medication.
  • Trauma — Children can sometimes injure their lacrimal system or orbit during an accident or while playing sports.


Questions to ask your doctor

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s treatment team and that you understand your provider’s recommendations.

If your child is scheduled for oculoplastic surgery and you’ve set up an appointment, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need.

Here are some questions you might want to ask:

  • How did you reach the decision that my child should have surgery at this time?
  • When should we have the surgery performed?
  • Is there anything we need to do to prepare for surgery?
  • Is it safe to use general anesthesia?
  • What will the recovery period be like?
  • How should I care for my child after surgery?

We’ve also put together some general information about how to prepare for surgery and what to expect. To read more, click here.

FAQ

Q: What is oculoplastic surgery?

A: Oculoplastics, or oculoplastic surgery, is literally plastic surgery of the eyelids. It’s a specialty of ophthalmology that focuses on three areas — the orbit, the eyelids, and the lacrimal (tear) system.

Q: What is the surgical process like?

A: We’ve put together some general information about how to prepare for surgeryand what to expect.

Q: What is the long-term outlook for my child?

A: Every child is unique, and your child’s long-term vision depends upon your child’s exact condition. But generally speaking, most of these surgical procedures have high success rates.

Ptosis — Children who have surgery to correct congenital ptosis sometimes need to have another procedure when they are older.

  • This may be due to the fact that the surgery relies upon the formation of scar tissue to hold the stitch in place. Sometimes this loosens with time. Other times the lid crease or symmetry between the two eyes can be improved.

Your doctor will discuss this possibility with you in more detail.

Tear duct obstruction — For 80 percent of the children who have the surgery, one probe into tear duct is sufficient to remove the obstruction. For the other 20 percent, more complicated surgery may be necessary.

Orbital dermoids — Once they are removed, they don’t grow back.

Infantile hemangioma — Once the hemangioma is removed or stops growing (usually when your baby is around one year old) it rarely recurs.

Q: Are there any other resources about oculoplastic surgery out there?

A:The American Society of Ophthalmic and Plastic and Reconstructive Surgery has an informative page.

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

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