Eyes don’t see what the mind doesn’t know!

It is not often that an eye surgeon is able to awe a room full of medical students and residents in a busy Ophthalmology clinic. So I’ll take this opportunity to write the story about this this extra-ordinary accomplishment. 

A Lot to cry about…… but finally tears of happiness!

Once the incision wound had completely healed, it was like he never had a surgery. Even the patient himself couldn’t locate the scar. The is the benefit of a  minimally invasive surgery and aesthetically planned surgery. Even though the entire orbital lobe of the lacrimal gland was excised, there was no dry eye in the patient. This is because most of the regular lacrimation is by minor lacrimal glands spread out throughout the conjunctiva (transparent layer on the eyeball).

Cancer Cancer go away! Don’t come another day!

Ocular Surface Squamous Neoplasia (OSSN) is a spectrum of pre-cancerous and cancerous lesions of the conjunctival epithelium (transparent coat covering the surface of the eye).

Growing out of a Crack!

Dermoid cyst (also known as choristoma) is a benign tumor growing out of a embryonic suture line. The tumour consists of normal cells occurring in an abnormal location. It is usually diagnosed in children when it is first visible but it is not uncommon to have adults coming to the clinic to know if it can be removed.

Hugging the Optic Nerve!

The MRI scan showed a large intraconal well defined mass sitting right next to the optic nerve causing mass effect which in turn was causing diminution of vision. My working differentials going into surgery- based on location and imaging was Cavernous Hemangioma, Fibrous Histiocytoma, Dermoid cyst, Schwannoma among others.

A Bridge between Eye & Brain

Nothing beats the feeling of being able to remove a skull base tumour through a small incision in the upper eyelid crease. This here is after the tumour has been completely excised. This picture shows the amount of exposure we can achieve by just the orbital route and also that’s me admiring the orbital anatomy for a few seconds before closing up.

The Dumbbell on the Eyelid

Epidermal Inclusion Cyst (also known as Epidermoid cyst or Sebaceous cyst) is a benign encapsulated, sub-epidermal nodule filled with keratin material. This is one of the commonest masses seen in the eyelid.

The rodent that dug into the eyelid! Basal Cell Carcinoma

BCC is one of the commonest eyelid malignancies in India. While in the west, BCC accounts for nearly 90% of the eyelid malignancies, in the Indian subcontinent, BCC cedes it’s top position to Sebaceous cell carcinoma in India. BCC is a non-melanocytic cancer of the skin arising from basal cells of the epidermis. It is mostly seen on sun exposed areas, particularly in the head and neck region. BCC is caused by skin damage caused by prolonged exposure to ultraviolet light thus explaining the preponderance of this cancer in Caucasian skin which does not have the protective effect of melanin.

Tumour Behind the eye! Intra-conal Orbital Cavernous Hemangioma

In an earlier era, these tumours would be removed via a craniotomy (brain surgery) by neurosurgeons or a disfiguring open surgery sometimes causing the loss of vision in the involved eye by other surgeons- that’s way too much morbidity for a benign tumour. But with the advent of modern day techniques and skilled oculoplastic surgeons performing orbitotomy today to remove such tumours, this surgery’s risks and complications is very low with the added advantage of a scarless as well as without even having to remove bone. This surgery is followed by a mostly uneventful recovery period.

OSSN- Cancer of the surface of the eye!

Ocular Surface Squamous Neoplasia (OSSN) is a spectrum of pre-cancerous and cancerous lesions of the conjunctival epithelium (transparent coat covering the surface of the eye). The good news is that, this type of cancer can be completely cured by surgery and/or chemotherapy eye drops if diagnosed before it becomes an invasive Squamous Cell Carcinoma.