Ophthalmic plastic surgery or Oculoplasty is a specialized branch of ophthalmology dealing with the diagnosis and treatment of cosmetic and functional deformities as well as tumors in and around the eyes. Our team of doctors at Dr Shroff’s Charity Eye Hospital comprises of highly skilled specialists trained from best centres in the country and abroad. The department is well equipped and gets referrals from across North India for treatment of various cosmetic and reconstructive surgeries around the eye. The centre also has dedicated Ocular Oncology Service managed by a multidisciplinary team of ocular oncologist, pediatric oncologist, Oculoplasty surgeon, pediatric ophthalmologist, ocular pathologist, ocularist and trained ocular oncology nurses to treat various ocular malignancies like retinoblastoma, melanoma, conjunctival carcinoma as well as various orbital tumors. .
Orbit and Oculoplasty disorders.
The various disorders which are treated at the department include:
Eyelid malpositions- Entropion and ectropion:
Entropion and ectropion refers to inturning or outturning of the eyelid margin and can involve both upper and lower eyelid. This is usually caused due to laxity of the eyelid tissues or scarring of the tissues of the eyelid and can manifest as persistent redness, irritation and watery eyes. If untreated, long standing cases can damage the cornea and thus cause decreased vision.
Most cases of entropion and ectropion can be corrected by simple surgical procedures done as an outpatient procedure under local anesthesia. Stitches are usually removed at 5-7 days. Surgery is done through hidden incisions and usually donot leave behind any visible scarring. Severe cases might require additional procedures like skin or mucous membrane grafting etc. Entropion and ectropion surgery are usually covered under health insurance.
Ptosis or droopy eyelids can present by birth in children or can happen in adults due to the weakness of the muscle which opens the eyelid. If left uncorrected, ptosis in small children can cause lazy eye and decrease in vision. Most cases of ptosis can be corrected by a simple surgery.
Watering from the eyes is usually due to an obstruction in the tear duct commonly because of trauma and infections. Sometimes the tear duct obstruction can be congenital and in those children the watering usually starts within first few months of life. Tear duct obstruction can be relieved by a surgery called dacryosytorhinostomy(DCR). The surgery can be done either through a small skin incision near the inner corner of eye or from inside the nose(Endonasal). In children with congenital tear duct obstruction, a simple out patient procedure called probing done under endoscopic guiding will open the blockage in most cases. Few children however might require DCR at a later age.
Thyroid eye disease
Thyroid eye disease causes the eye to bulge out and look prominent and can cause difference in the size of the eye aperture. It can also cause swelling, redness, watering, double vision or decreased vision. The initial phases of the disease is treated with steroid and other medications while persistent bulging of the eyes, difference in the eye size or persistent double vision might need surgery. Decompression surgery is done to put the eyeball back into the bony socket and improve the appearance of prominent eye or reduce the compression on the optic nerve. Eyelid surgery and squint surgery are also required to correct malposition of the eyelid or any squinting of the eyes.
Eyelid trauma and Orbital fracture following injury
Trauma to the eye can cause damage to the eyeball as well as to the surrounding structures like the eyelids, the tear duct or the surrounding bones(fractures). Careful examination of the patient is done to treat any injury which can affect the vision or impair the normal functioning of the eye. Damage to the tear duct of the eye due to injury can cause blockage of the duct and persistent watering if not treated immediately and appropriately. The repair of the delicate tear duct is done using silicone stents. Any injury to the eyelids also needs to be repaired carefully to retain the normal function and appearance. Orbital bone injury( fractures) can cause the eyeball to sink inside the eye socket causing it to appear smaller in size or can cause double vision due to injury to the eye muscles. The correction of the orbital fractures is done by a trained oculoplasty surgeon or along with a team of maxillofacial surgeons when injury involve other bones of the face also. The surgery is usually done via hidden incisions and does not leave any visible scar.
Ocular Prosthesis Services ( Artificial eyes)
Artificial eyes are used to restore near normal facial appearance when the eye is lost following trauma or has to be removed to treat eye cancer. The prosthetic eyes are made of medical grade polymers, are customized to match in color and size with the other eye, giving a natural look. The movements of the eyeball and eyelids are retained to the extent required with the artificial eyes. The artificial eye fits snugly within the eyelids and needs to be taken out at few weeks interval for cleaning which can be easily done by the patient at home. It usually takes about 2 days time to make a customized artificial eye. Occasionally, if the space within the eyelids is inadequate to fit the prosthesis(following severe trauma, infection or radiation therapy for cancers etc) a surgery is required to create adequate space for the same. In children where the eyeball is severely deformed by birth, near normal facial appearance can be restored by starting the process of expanding the eye socket and fitting an artificial eye early in life.
Dr Sima Das
Dr Gaurav Shah
Dr Namita Kumari
Cancers of the eye and the surrounding structures (Ocular Oncology) can affect all age groups, starting from young children to elderly individual. The treatment of the eye cancer requires a specialized team of doctors, nurses, low vision and rehabilitation facilities as well facilities for ocular pathology services, genetic counselling and prosthetic rehabilitation. The Integrated Eye Cancer Treatment centre at Dr Shroff’s Charity Eye Hospital is the first of its kind in North India with dedicated facilities for treatment of various eye cancers under one roof. In tune with the hospital’s mission and vision of providing quality care to patients from all sections of the society, the centre has tied up with likeminded NGOs and philanthropists to provide highly subsidized treatment to the patients from underprivileged section of the society. The centre currently treats about 400 patients with various eye cancers annually referred from across the country as well as identified through the primary and secondary care network of the hospital.
What are the signs of eye cancer? When should one suspect
Bulging or outward protrusion of one eye
A pigmented patch which is growing in size
A lump or mass on the lids which has started increasing in size
Blurring of vision, shadows or flashes, wavy lines in the vision
Loss of vision ( partial or total)
Localized congestion or redness in the eyes
The various types of eye cancers treated at the centre include:
Retinoblastoma: Retinoblastoma is the most common intraocular malignant tumor in children. This tumor is most commonly seen in children less than 5 years of age where it is seen as a white reflex (also called cats eye reflex) either involving one or both eyes. These tumor develop from retina and either grows inside the eye (endophytic) or grows outside the eye (exophytic). While timely detection and prompt treatment can save not only the eye and vision, delayed diagnosis and treatment can make this cancer spread to the brain and other parts of the body and can be fatal. Retinoblastoma can be treated by various modalities like intravenous chemotherapy, laser and cryotherapy, enucleation surgery, radiotherapy and the newer treatment modalities like intravitreal chemotherapy and intra-arterial chemotherapy(IAC).
Melanoma: Melanoma arise from pigmented cells of the eye called melanocytes and can arise from either iris (coloured part of the eye), choroid (pigmented nourishing layer of eye that nourishes retina) or ciliary body (contains muscles which help in changing focus of lens for distance and near object). It can also involve conjunctive where it is seen as a dark pigmented patch over the surface of eye. Melanoma are usually aggressive malignant tumors, usually affecting the elderly and if not detected and treated on time can spread to the other parts of the body and can be fatal. Melanoma can be detected by a detailed examination of the eye by an eye surgeon with special training in diagnosis and treatment of eye cancer (ocular oncologist).
Lymphoma: Lymphoma is another malignant tumor which can involve the eye. Most commonly it’s the Non Hogdkins lymphoma originating from white blood cells of lymphatic system which involves the eyeball. They can develop from retina (light sensitive tissue of eye), vitreous (jelly like fluid inside the eye) or from optic nerve at the back of the eye.
Eyelid tumor : There are various forms of the cancers seen involving eyelid like sebaceous gland carcinoma, squamous cell carcinoma or basal cell carcinoma which presents as a mass in the eyelid and progressive increase in size. Complete removal by surgery under frozen section margin control is the commonest treatment modality of choice.
Orbital tumor: Orbital tumors can be benign or malignant, or they can be primary or metastatic. The most common benign tumor involving orbit is cavernous hemangioma affecting young or middle aged adults. Other types of orbital tumors are meningiomas, schwannomas, lacrimal gland tumors ,optic gliomas or sarcomas. Orbital tumors present as progressive bulging and/or displacement of the eyeball with or without a palpable or visible lump around the eyeball. Most orbital tumors are treated by surgical removal and additional treatment like chemotherapy and radiotherapy might be required in selected aggressive malignant tumors.
Conjunctival carcinoma: Carcinoma of the conjunctiva and cornea (visible outer layer of the eyeball) also know as OSSN (ocular surface squamous neoplasia) is a common tumor of the eye. This tumor is usually visible as a reddish/pinkish lump. Treatment is usually by a simple surgery or with topical chemotherapy medications
Secondary tumors(metastasis): These are malignant tumor cells from other parts of the body which involves eye, Most commonly they involve choroidal layer of the eye since it is the most vascular structure of the eye. The common eye metastasis is from breast cancer (in females) and lung cancer (in males).
Eye cancer treatment facilities at Dr. Shroff’s Charity Eye Hospital:
The Integrated Eye Cancer Treatment Centre at Dr Shroff’s Charity Eye Hospital treats more than 400 patients with eye tumour every year and has the following facilities for treatment:
Trained Ocular Oncologist
Radiation Oncologist(In collaboration)
Trained Oculoplasty surgeons
Ocular Onco-pathology Services in house
In house chemotherapy facilities
Plaque brachytherapy facility in house
Paediatric anaesthesia services and facilities for same day paediatric examination under anaesthesia (EUA)
Trained oncology nurses
Investigation modalities for diagnosis and monitoring of eye cancers like
Ultrasound B scan
Ultrasound bio microscopy
Anterior segment and Retinal OCT
Fluorescein angiography and OCT angiography
Imaging modalities like CT/MRI (in collaboration) etc.
Trans pupillary thermotherapy (TTT) and laser therapy facilities
Facilities for specialized ocular surgeries like paediatric retinal, cataract, glaucoma and corneal surgeries
Intravitreal chemotherapy facilities
Intra-arterial chemotherapy for retinoblastoma (In Collaboration)
In house genetic counsellor and genetic testing for ocular tumours
Customized ocular prosthesis services in house for prosthetic rehabilitation after treatment of eye tumors