A 48 year old patient had a painfully blind right eye for which he wanted resolution with best aesthetic outcome.
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.
Blepharophimosis syndrome is also knows as BPES (Blepharophimosis, Ptosis, Epicanthus Inversus Syndrome). It is an autosomal dominant condition usually inherited from parents but not always.
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.
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.
While going home that evening, I reflected on how much technology had advanced that surgeons like me get to perform apparent everyday miracles like this while confidently knowing what it is that we are going after. Couldn’t help but remember Arthur C Clark’s third law:
“Any sufficiently advanced piece of technology is indistinguishable from magic.”
The COVID-19 lockdown was a period when we had stopped elective surgery and were prioritising semi-urgent surgeries and emergencies. But some surgeries can’t wait even if not life threatening. Like this girl who fell down the stairs to have an orbital (eye socket) fracture. The walls of the bony socket holding the eye were broken entrapping the eye muscles- which causes double vision and also making the eye sunken (enophthalmos). This needed early intervention- hence a semi-urgent surgery.
The outbreak of COVID-19 pandemic is changing the infection, transmission and safety practices of medical establishments globally. From evidence that is available presently, the risk of transmission of this virus is high amongst medical personnel involved in procedures and surgeries around the head and neck region- Ophthalmology, Otorhinolaryngology, Craniomaxillofacial surgery, Head and Neck Oncology, Neurosurgery including Anesthesiology. The field of Oculoplastic Surgery has risk factors common to both ophthalmology and all of the above craniofacial subspecialties. While clear directives and strategies to handle elective, urgent and emergency surgeries in SARS-Cov2 positive patients is constantly evolving, we herewith attempt to consolidate various guidelines from various relevant professional global medical societies which will be beneficial to the orbit, oculoplastic and ophthalmic trauma surgeon and also their hospital administrators.
There have been many incredible moments during my career as a surgeon but this story has to be the closest to my heart and will be for a long time to come.
I wasn’t a natural at being a doctor and struggled a little bit in medical school. Medical school was sometimes confusing and intimidating. I picked up empathy along the way and learnt to be compassionate to other people. I found out that I loved the difference that I bought to others and got better at doing my job. A lot of what I love about my job today, I discovered while being a doctor. If I hadn’t taken up medicine I would have never found out how much I would enjoy it.