This is a distinct subspecialty of Ophthalmology which deals with the Eyelids, the Lacrimal drainage system of tears and the bony Orbit [the bony cage housing of the Eyeball and its surrounding structures]. It also deals with the aesthetic aspect of the eyes, eyelids and the eyebrows as they are the most significant aspect of the beauty of the entire face. At the MM Eyetech Institute we have highly trained specialists in this field.
A brief description of each with the relevant ailments which fall under this branch of ophthalmology are highlighted below:
Consisting of the Upper and Lower eyelids in each eye, their functions include providing protection to the superficial layers of the eye, viz the Cornea and Conjunctiva, producing the protective oily secretion from the Meibomian glands [also called Tarsal glands] and evenly spreading out tears over the eye with each blink, while also providing the aesthetic appearance to the whole face.
Common Ailments affecting the eyelids are: Drooping eyelids / hard swellings of lid glands (Chalazion) ,infections of the glands (Styes or Hordeolums), congenital malformations, Entropion or in-turning of eyelids, Ectropion or out-ward turning of eyelids, Abnormally directed lashes (Trichiasis / metaplastic lashes), Coloboma or defect in the continuity of eyelids, Injuries to the eyelid, eyebrow and the surrounding facial structures including the bone or facial skeleton and eyelid Tumors. Cosmetic changes such as puffy eyelids and swellings may develop as one grows older.
Consisting of the Lacrimal Gland (the main tear secretor) and the Lacrimal Drainage system (consisting of the Puncta, The Canaliculi and the Naso-Lacrimal Duct, which together act as the drain pipes for the tear fluids to be drained into the nose)
The Lacrimal gland lies in the upper and outer area of the upper eyelid and together with the accessory tear glands in the upper eyelid conjunctiva, acts to provide the necessary wetness and protection to the eyeball. Common conditions involving the lacrimal gland are: inflammations (swelling),infections, (medically called Dacryoadenitis) which may have a variety of causes, and Tumors which may be benign or malignant. Therefore, an acquired swelling in the upper or outer region of the upper eyelid should not be overlooked. Dry Eye is a common problem, sometimes due to under secretion from the gland.
The Drainage system consists of the puncta (the openings to the drainpipes), the canaliculi (one each in the upper and the lower eyelid ), the lacrimal sac and the naso-lacrimal duct (NLD) on the inner aspect of the eye, draining into the nose. Blockage of each of these gives excessive watering, a condition called epiphora, which causes tearing of eyes and resultant discomfort and excoriation of eyelid and cheek skin. Deeper blocks may also lead to infection resulting in pain, redness and swelling due to collection of pus in the lacrimal sac near the nasal side of the eyelids (medically called Dacrocystitis). Hard swelling in this area might also be a tumor inside the nasolacrimal duct (which may cause bloody discharge) or a cyst (mucocoele).
Consisting of the bony cage made up of seven bones of the skull, it is the cavity in the skull which house the eyeball and its attached and surrounding structures like the fat, extra ocular muscles (six in number), nerves, blood vessels and the Optic Nerve. Apart from providing the strategic space and support for the eyeball, the bony cage also provides significant protection from injuries and accidents. However, each of these structures can give rise to specific or non specific diseases. The common ones being:
PROPTOSIS / EXOPHTHALMOS (PROTRUSION OF THE EYEBALL)
Resulting from increased size of the various structures inside the orbit eg: tumors involving the lacrimal gland, swelling in the fat or excess fat, muscles nerves etc or enlargement of muscles as seen in thyroid eye disease or inflammation of muscles (myositis). The orbit being a bony cage, is essentially a limited space, hence any enlargement of tissues can cause it to push the eyeball outwards and put pressure on the soft contents of the orbit.
ENOPHTHALMOS (SUNKEN EYEBALL)
occurs due to either shrinkage of tissues surrounding the eyeball or a defect in the bone caused by a blowout fracture. This is a condition where injury to the orbital bones from outside causes the fractured bones to bend out of the orbit into the surrounding sinus cavities thereby enlarging the orbital space. The eyeball and other orbital contents then tend to fall backwards. These disorders can cause symptoms like pain, diplopia (double vision), enlarged eyeball or sunken eyeball, nerve palsies (paralysis) or entrapped muscle causing restricted movement of eye in a particular direction, etc.
specific diagnosis and therapy of each of these conditions requires the help of various techniques of radio imaging and/or surgical biopsy.
Consists of the space between the eyelid margin of the upper and lower eyelids and the attached conjunctiva, which is the mucous layer covering the white portion of the eyeball. Various conditions, either primary or acquired, can give rise to problems like dry eyes, symblepharon, keratinization or ankyloblepharon ( sticking of eyelids together and/or with the conjunctiva), Contracted socket (shrinking of the conjunctiva due to chronic irritation of an improperly fitted artificial eye , surgery or radiation).
Each of the above problems can be successfully managed if a proper diagnosis is made.