Although rare, these are cases that involve many doctors of various fields to help in the care of the patient that suffer severe orbital injury: from neurosurgeons, maxillofacial surgeons, otolaryngologists, plastic surgeons to oculoplastic surgeons. I saw similar cases, although not inolving shears, during my residency and fellowship training. I had the opportunity to work at two very busy county hospitals: Santa Clara Valley Hospital during my training at Stanford University and at Bellevue County Hospital during my fellowship training at NYU. We had cases of gun shots, pencils, forks, and even knives piercing the orbit and luckily leaving the eyeball free from injury. However, there were also those cases where the eye was severely injured and had to be removed and replaced with an orbital implant and a prosthetic. Read this CNN article below for more about this latest case from Arizona.
Tuesday, September 6, 2011
Revisional eyelid surgery: A case of upper lid ptosis and lower lid retraction
A common reason patients see me is for abnormal eyelid positions. The term revisional eyelid surgery refers to the correction of the eyelid position (either upper or lower lid) after having undergone prior eyelid surgery. A few of the more common reasons for eyelid malpositions are from prior blepharoplasty or eyelid reconstruction from trauma or removal of an eyelid skin cancer.
The eyelid is a series of aesthetic units that all together makes it an extremely challenging area to operate on. It is difficult to tell which patient is at risk for having an eyelid malposition prior to any surgery but in many cases, we as surgeons do our best in preventing such circumstances.
My goal in revisional eyelid surgery is to customize the management to each patient. Conservative therapy can often help in some symptoms, but ultimately, most patients will end up requiring some form of revisional eyelid surgery. There are various components to performing revisional eyelid surgery and it depends on each patient's clinical findings.
I recently saw a patient that had undergone prior upper and lower blepharoplasty in the past (see below photograph). He complained of a droopy appearance to his upper lids (termed ptosis) and irritation in both eyes due to the retraction in his lower lids. Retraction of the lower lids is a result of a downward displacement of the lower lids either from prior surgery (cosmetic or trauma), thyroid related problem, or just as a result of aging changes. The retraction can be a direct result of the laxity (or looseness) of the lower lids, or secondary to the scarring changes that may occur after surgery, or a combination of both factors. He also had ptosis in his upper lids which may have worsened with time. He wished to have his eyelids appear more natural appearing, see better, and improve his irritation.
Preoperative Diagnosis: Bilateral upper lid ptosis and lower lid retraction
The goal of my surgery was to help him see better by lifting his eyelids and also to correct the laxity and retraction he had in his lower lids. The retraction in his lower lids prevents him from closing his eyes at well so he has problems with excessive exposure to the eyes. This results in his irritation and redness to the eyes. As a result, he underwent bilateral upper lid ptosis surgery with no additional removal of eyelid skin though. He also underwent retraction repair to help lift up his lower lids to a more normal position by a canthoplasty. A canthoplasty is a type of a lower lid resuspension technique.
Postoperative Photograph, four weeks after underging bilateral upper lid ptosis surgery and lower lid retraction repair through a canthoplasty lid resuspension technique.
Surgeon: Christopher Zoumalan, MD. Oculoplastic Surgeon.
Location: Beverly Hills, California