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Bascom Palmer Eye Institute

Diseases and Disorders that Involve Plastic Surgery

What ophthalmic diseases and disorders involve plastic and reconstructive surgery?

Graves’ Ophthalmopathy is a thyroid-related disorder that causes inflammation of the eye muscles, which enlarge within the eye socket. As a result, the eyes bulge and/or stare; the eyelids retract and often cannot close; and the eye’s surface dries and becomes uncomfortable. The swollen muscles can exert pressure on the optic nerve and threaten vision loss, the most serious consequence of Graves’ disease.

Graves’ disease demands a multispecialty approach, often involving strabismus, oculoplastic and reconstruction expertise, as well as the skills of a neuro-ophthalmologist, a radiation expert, and an endocrinologist.

When other medical therapies fail to reduce muscle swelling, special procedures can:

  • relieve pressure on the optic nerve by removing the part of the bony wall and floor of the eye’s socket, creating additional space for swollen muscles
  • reconstruct the eyelids to protect the cornea and cosmetically improve the patient’s appearance. This involves dropping the upper eyelids and raising the lower eyelids (by adding tissue taken from the roof of the mouth —- a hard palate graft), and placing them at a cosmetically appropriate level. Bascom Palmer physicians also help preserve vision by assisting neuro-ophthalmologists diagnose and treat patients who are losing vision in both eyes due to increased intracranial pressure. In such cases, they perform an optic nerve sheath “fenestration,” creating a “window” in the lining of the nerve, which releases built-up pressure.

Plastic and reconstructive surgery offers other important therapies for specialists treating patients with complicated glaucoma. Filtering surgery, for example, reduces pressure within the eye, but usually creates a “bleb” (blister) on the eye’s surface. If this bleb is exposed, the eye is at risk of serious infection. If the bleb is large, it can affect the eyelid’s function. In either case, surgical adjustment of the eyelid allows it to function well and protects the bleb —- without affecting the pressure control benefit of filtering surgery itself.

In cases of end-stage glaucoma, or old trauma, there can be complete loss of sight and excessive pain. To relieve the pain, oculoplastic surgeons often remove the eye (enucleation) and place an orbital implant. Approximately five weeks later, a custom-made ocular prosthesis is made by an ocularist. This artificial eye will restore a more normal appearance and relieve discomfort.

Some patients requiring ophthalmic plastic and reconstructive surgery have problems related to the lacrimal drainage system and the outflow of tears – problems which may be secondary to congenital anomalies, infections, tumors, long-term glaucoma therapy, nose injuries, sinus problems, and natural aging. Yet others have orbital (eye socket) problems caused by sinus infections or tumors extending into the orbit, Graves’ disease, and fractures due to accidents or physical violence.