Oculoplastic and reconstructive surgery (also known as oculofacial surgery) is a highly specialized practice of ophthalmology and plastic surgery that manages and treats deformities and abnormalities of the eyelids, lacrimal (tear) system, the orbit (bony cavity surrounding the eye) and the adjacent facial structures.
An oculofacial plastic surgeon is a board certified ophthalmologist and plastic surgeon who has completed specialized training in plastic surgery of the eyelid area and surrounding structures. Based on this advanced surgical training, the oculofacial surgeon is ideally suited to treat the eyelid and adjacent structures as they relate to the eyes and face.
In addition to focusing on disorders of the eye, the oculofacial surgeon focuses on conditions that affect the bony structures around the eye and immediate facial area, including eyelids and eyebrows. An oculofacial surgeon diagnoses and treats blocked tear ducts, eyelid and orbital trauma, congenital abnormalities, orbital tumors and cancer of the eye tissue, thyroid eye disease, dermatochalasis, and ptosis (droopy eyelids).
Oculofacial surgeons also specialize in cosmetic surgery to improve vision as well as the appearance of eyelids and eyebrows in order for patients to look and feel their best.
The oculofacial surgeons at the Wheaton eye clinic are members of the prestigious American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). To become a member of this society, one must complete an approved fellowship training program that has fewer than 30 positions in the world each year.
Blepharospasm is a condition that describes the involuntary clenching of eyelid and facial muscles. In severe cases, the clenching of the eyelids affects the daily function of the individual and can be debilitating.
Since 1989, injection of these muscles with botulinum toxin (Botox) has helped eliminate their involuntary contraction. In fact, Botox injections have become the first line of treatment for this condition. In general, the efficacy of Botox lasts 3 to 4 months. Injections can be performed in the office and are often covered by insurance. Injections are performed in the office by Dr. Pak and Dr. Patel.
Chalazions, or styes, present as bumps along the eyelid, particularly around the eyelash region. They often disappear spontaneously and are usually not infectious, but sometimes require treatment.
Apply warm compresses for 10 minutes several times a day to the area. Chalazions may take several weeks to resolve completely. Steroid creams or eyelid injections may be applied to improve the chances of eliminating the bumps.
Our oculofacial surgeons at the Wheaton eye clinic also are specialists in cosmetic procedures and surgery. Our surgeons perform non-surgical cosmetic procedures such as Botox as fillers and are also specialists in surgical procedures such as brow lifts, and upper and lower eyelid blepharoplasty to help with excess skin and puffiness of the upper and lower eyelids.
Dermatochalasis is the medical term for “drooping or puffy eyelids” or excess skin of the eyelid.
Eyelids provide a vital part of a person’s overall facial appearance. Aging leads to changes in both the amount of excess skin and quality of the skin. This causes drooping of the eyelids that can affect the cosmetic appearance of a patient, and at times can impact vision as well.
Apart from age, heredity and sun exposure can alter the skin of the eyelids.
A blepharoplasty is a surgical procedure that removes the excess skin of the eyelids. This procedure can be performed for medical necessity when it affects one’s peripheral vision. In order to define medical necessity, a full consultation with an oculoplastic surgeon is necessary. This procedure also can be performed for cosmetic purposes to attain a more rejuvenated appearance of the eyelids. Cosmetic blepharoplasty is the third most common plastic surgery procedure performed in this country.
For the upper eyelids, excess skin and puffiness can be eliminated by a surgical procedure that “hides” the incision line by placing it in an area where the skin naturally creases. It is an outpatient procedure requiring local anesthetic and mild sedation. It normally takes 20 minutes for each eyelid. This procedure can be performed for medical or cosmetic purposes and is one of the most common procedures performed in the world.
The puffiness and sagging skin of the lower eyelids can be eliminated by a surgical procedure that involves no external incision, called a transconjunctival blepharoplasty. It can also be performed externally through the skin where the incision is hidden by the lower eyelid lashes. Both procedures are an excellent approach to rejuvenating the appearance of the lower eyelids. This procedure is not covered by medical insurance as it is a purely cosmetic procedure. Similar to the upper blepharoplasty, this procedure is performed on an outpatient basis.
Lower blepharoplasty and upper blepharoplasty are commonly performed in the same surgical setting.
During the initial consultation with Dr. Pak or Dr. Patel, a visual field test and photography will be performed. These are vital elements to the examination and help facilitate the appropriate approach for your care.
Entropion is a common condition observed on the lower eyelid, in which the lower eyelid rotates inward toward the eye.
As a result of the eyelid skin and lashes rolling inward toward the eye, individuals commonly experience tearing, photosensitivity, and red eyes. If entropion exists, it is important to have a doctor repair the condition before permanent damage to the eye occurs.
Entropion is caused by a weakening of several muscles of the lower eyelid that stabilize its position. It can occur as a result of advancing age, trauma, scarring or previous surgeries to the lower eyelid.
There are several procedures that are performed to correct this common eyelid condition. These procedures require minimal incisions of the lower eyelid and involve strengthening muscles and eyelid tissues to impart a perfect balance of the eyelid. All entropion procedures are performed under mild anesthesia on an outpatient basis.
When the lower eyelid pulls away from the eye, a condition called ectropion exists.
This condition can result in tearing and irritation of the eye. If ectropion is not treated, it can lead to chronic tearing, eye irritation, redness, pain, a gritty sensation, crusting of the eyelid, mucous discharge and breakdown of the cornea due to exposure.
Similar to entropion, the causes of ectropion can be related to age, trauma, previous lower eyelid surgery, or nerve dysfunction.
The surgical treatment of ectropion of the lower lid involves tightening of the eyelid at the corner, called the lateral canthus. The incisions are hidden within the eyelid creases. This treatment of ectropion is a minor outpatient surgical procedure.
There is an eyelid condition that describes the inward direction of skin and eyelashes that is commonly found in young individuals of Hispanic and Asian descent. This medical condition is called epiblepharon.
Due to the eyelashes rubbing on the cornea, constant irritation of the eyes, tearing and light sensitivity are common.
In order to correct this disorder, surgery is performed to realign the eyelid tissue. This is performed as an outpatient procedure.
Growths and skin changes are commonly identified by your ophthalmologist or dermatologist. At the Wheaton Eye Clinic, Dr. Pak and Dr. Patel serve as a referral center for many individuals with eyelid lesions.
A “bump” or lesion on the eyelid that demonstrates growth, bleeding or crusting should be evaluated by an oculoplastic surgeon.
Skin lesions can develop due to aging and sun damage. These lesions require medical evaluation. At times, exposure to sun and the aging process can influence the development of skin cancers. There are several types of skin cancers that can develop on the eyelids:
A common type of eyelid skin cancer is basal cell carcinoma. This type of cancer has various appearances but typically grows at a relatively slow rate. Basal cell carcinoma can occur anywhere on the eyelid and 70% develop on the lower eyelid. In general, the lesions are solitary, elevated lesions that can bleed intermittently.
The eyelid can develop other non-basal cell carcinomas such as melanoma, sebaceous cell carcinoma and squamous cell carcinoma. Collectively, these occur less frequently compared to basal cell carcinoma, however, they have a greater ability to metastasize and spread. Due to the aggressiveness of these tumors, it is important to seek medical attention for eyelid “bumps” or lesions.
During the initial evaluation, Dr. Pak and Dr. Patel will examine the lesion on the eyelid and determine the ensuing appropriate steps. Typically, this involves measuring and photographing the lesions. If necessary, a biopsy of the lesion will be performed on a subsequent office visit. If a biopsy is performed, the lesion is sent to a pathologist, a physician trained at evaluating microscopic tissue, and the results will be available in several days. Our office will contact you once the result of the biopsy has been completed by the pathologist.
Skin cancer needs to be removed surgically by a skilled surgeon who can not only remove the tumor, but reconstruct the eyelid or periorbital (surrounding eye region) area to regain excellent aesthetic and functional qualities. Generally, Dr. Pak and Dr. Patel team up with an expert dermatologist specializing in skin cancer and Mohs surgery to treat skin cancer. An oculofacial surgeon is an optimal professional to repair defects of the delicate eyelid caused by cancer.
Enucleation is the surgical procedure for removal of an eyeball. This procedure is done only when the vision in the eye cannot be saved, and the eye is blind and painful, infected, or secondary to severe trauma. This surgery can often help relieve pain for a patient. It is done with general anesthesia.
The loss of an eye from injury or other cause is unpleasant and upsetting. However it need not remain so. A prosthetic eye can look very natural, and movement is capable in some cases. Many people wear artificial eyes with great success for many years.
At times, there can be some side effects of long term use of a prosthetic eye that requires surgical attention. Side effects include sagging eyelids caused by the weight of the prosthetic or a sunken appearance of the eye area. Another condition is shrinkage or loss of shape of the eye socket. Some patients also experience migration of the socket implant, which may require replacement. These issues can often be fixed with a surgical procedure.
Ptosis refers to the drooping of the upper eyelid(s). This condition can develop in all age groups and can sometimes be observed at birth.
Ptosis is a common condition that may cause a reduction in the field of vision. A drooping eyelid can develop suddenly or gradually over a period of time. Commonly, individuals with ptosis describe difficulties keeping their eyelids open which results in problems with reading and visualizing objects in the periphery. To compensate, they will often arch their eyebrows in an effort to raise the drooping eyelids.
The treatment for a drooping eyelid generally requires surgery. There are several surgical procedures that can correct a drooping eyelid and typically involve strengthening the eyelid muscles that lift the eyelid. One approach is a minimally invasive procedure called an internal ptosis procedure or mullerectomy. This procedure is performed underneath the lid without creating an incision on the skin.
An evaluation of the drooping lid will determine the most appropriate surgical procedure. The goal is to elevate the eyelid to improve the peripheral field of vision and to achieve symmetry with the opposite upper eyelid. The surgery is typically performed at an outpatient surgical facility.
It is important to evaluate tearing to determine if there is a problem with tear production or tear drainage.
Tearing can be due to several factors and a complete tearing evaluation can identify the causes. There are several tear-producing structures within the eyelid. Under certain conditions, the cornea and eye do not contain sufficient lubrication and subsequently, the glands are triggered to produce more tears. As a result of the increased tears, the drainage system might not be able to accommodate the increased amount of tears and symptoms of tearing result.
A major cause of tearing is insufficient drainage of the tears. Drainage of tears relies on several anatomical structures: eyelid, lacrimal punctum and nasolacrimal duct. These structures must work together in order to maintain proper drainage. A dysfunction in any of these structures can result in tearing.
During the evaluation, a procedure called probing and irrigation of the lacrimal duct may be performed. This painless procedure helps determine the location and presence of a blockage within the tear drainage system.
Sometimes tearing is the result of the nasolacrimal duct or tear duct being partially or completely blocked. In cases where the symptoms are bothersome, a surgical procedure can be performed that creates a bypass away from the blocked tear duct. This procedure is called a dacryocystorhinostomy (DCR). A DCR is performed by creating a new passageway from the lacrimal sac to the nasal infrastructure, bypassing the obstruction.
There are two ways to create this opening: external and internal. The internal procedure is performed with an otolaryngologist and this process can be discussed during the evaluation.
The DCR surgery is performed as an outpatient procedure It requires general anesthesia. A DCR should be performed by a surgeon specializing in the care and treatment of the lacrimal system. As ASOPRS oculofacial surgeons, Dr. Pak and Dr. Patel both have advanced training in the evaluation, care and treatment of the lacrimal system.
Many individuals seek non-surgical treatment for wrinkles on the face. Botox injections into these areas can help reduce and, in some cases, eliminate lines generated by muscle activity.
We perform cosmetic Botox injections at all six Wheaton Eye Clinic locations. Treatment takes a short amount of time and is done through a series of tiny injections; an anesthetic is not needed. Results appear within days and the appearance of the area may continue to improve for up to 14 days. Typically, the effects of Botox last for about 3-4 months.
As skin ages, it loses a naturally occurring substance, called hyaluronic acid, which provides skin fullness and elasticity. With this decrease, skin loses volume, increasing the chances for wrinkles and folds to appear. There are many different types of fillers that can be injected into the skin and deeper tissues to help with these folds. Some of them are made of a substance called hyaluronic acid that is well-tolerated, non-surgical, and long-lasting. In general, fillers last 6-9 months and can provide a good non-surgical alternative for some patients!
Wheaton Eye Clinic’s unparalleled commitment to excellence is evident in our continued growth. Today we provide world-class medical and surgical care to patients in six suburban locations—Wheaton, Naperville, Hinsdale, Plainfield, St. Charles, and Bartlett.
(630) 668-8250 (800) 637-1054
