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.

Eyebags of Worry- Trans-conjunctival Lower lid Blepharoplasty

Blepharoplasty is the removal and repositioning of the skin, muscle and fat of the upper and/or lower eyelid. In the lower eyelid the incision is made along the skin just beneath the eyelashes or in the moist surface of the eyelid known as conjunctiva. This involves repositioning of prolapsed orbital fat on both sides by draping the fat to the orbital rim area- which gives an aesthetically better appearance. This technique is done with an incision on the inside of the eyelid without a skin incision making the surgery “scarless”.

An Eye for an Eye- Customised Ocular Prosthesis

A 48 year old patient had a painfully blind right eye for which he wanted resolution with best aesthetic outcome.

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.

The Dog and the Eyebrow! Eyebrow Reconstruction

The Eyebrow is a unique facial aesthetic unit and it’s importance to the face is apparent only when it is disfigured with loss of the hair bearing skin like in this case. Likewise, reconstruction of the eyebrow is challenging because the thickness and direction of the eyebrow hair which is unique and not easy to replicate with hair transplants from other hair bearing areas.

Opening the eyes! Blepharophimosis

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.

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.

Radiology Saves the Eye

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.”

Orbital Fracture repair during COVID-19 lockdown

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.

Guidelines for the Oculoplastic and Ophthalmic Trauma Surgeon during the COVID-19 era – An APOTS & APSOPRS Document

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.