Opthalmic
Ophthamlic plastic surgery (ocular plastics) is part of an increasing number of subspecialties within ophthalmology. This is in recognition of improved results in the management of periocular, adnexal, orbital and lacrimal surgery in the hands of those solely committed to this speciality.
Ophthalmic plastic surgery encompasses the following categories of work:
Adnexal
The largest referral base to an ocular plastics service is for adnexal work. This includes malposition of the eyelids, entropian and ectropian of the upper and lower lids, and ptosis of the upper lids. Brow ptosis and mid-face ptosis secondary to paresis, palsy or involutional change is also frequently treated by this service. Tumours account for a significant portion of the workload, as 10% of skin malignancies occur withi the periorbital region. As over 95% of periocular tumours are basal cell carcinomas in most series the technique of Moh's micrographic surgical removal is predominantly used for tumour excision. Moh's technique reduces the recurrance rate of these tumours to less than 1% in five years, compared with up to 15% recurrance rate for a random excision of tumours in this area. Moh's technique also allows for maximum tissue preservation in this sensitive region.
Orbital
Orbital disease from thyroid dysfunction or malignancies accounts for a small but significant portion of the work. We perform orbital rehabilitation with orbital implants following enucleation and evisceration and we also provide management of artificial eyes.
Lacrimal
Lacrimal surgery for a blocked nasolacrimal system, resulting in epiphora (watery eyes), through an external or endoscopic approach will also be provided by this service.
Aesthetic/Cosmetic
Ophthalmic plastic surgeons undertake aesthetic surgery in the periorbita but usually confine this to the eyelids - blepharoplasty, external or transconjunctival brow ptosis - suprabrow or endoscopic surgery, or ptosis and mid-faced droop (soof lifts).
Ophthalmic plastic surgeons work alongside a large number of other specialties for crossover work, including craniofacial plastcis for facial periocular diseases, and ENT surgeons for endoscopic dacrocystorhinostomies and orbital decompressions. Larger facial cases may involve a multi-disciplinary approach, including faciomaxillary, craniofacial, plastics and numerous surgical services.