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OCULOPLASTIC SURGERY

Mr Edmunds has gained extensive training from national centres of excellence in the assessment and non-surgical and surgical management of the full range of  oculoplastic (eyelid), lacrimal (tear system) and orbit (eye socket) conditions.

He is a member of the British Oculoplastic Surgery Society (BOPSS) and the European Society of Ophthalmic Plastic & Reconstructive Surgery (ESOPRS).

What is an oculoplastic surgeon?

Common oculoplastic problems and procedures include: 

- Upper lid blepharoplasty

- Lower lid ectropion

- Lower lid entropion

- Upper lid ptosis

- Brow ptosis

- Botulinum toxin (Botox) injection

- Eyelid lumps, cysts and skin tags

- Watery eyes and blocked tear systems

- Painful or unsightly blind eyes

Excellent patient information for a wide range of oculoplastic surgical procedures can also be found at the British Oculoplastics Surgical Society (BOPSS) website here.

UPPER LID BLEPHAROPLASTY

An upper lid blepharoplasty is an operation to remove some of the excess skin from your above your eye (the medical term for this is upper lid 'dermatochalasis').

Excess skin on the eyelid is often due to ageing, sun damage or occasionally an underlying medical condition such as thyroid problems. Sometimes it may be an effect of the eyebrow itself drooping.


The excess skin creates folds in the upper lids which can overhang and affect vision. It may affect one or both sides to a greater or lesser extent.

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LOWER EYELID ECTROPION SURGERY

Ectropion is the medical term used to describe the lower eyelid turning outwards and drooping away from the eye.


The commonest cause of ectropion is laxity of the eyelid tissues due to ageing. Other causes do exist and you will be thoroughly examined for these.


One or both eyelids may be affected at the same time.

The type of treatment offered will depend on what caused the condition.


The commonest treatment is with an operation to tighten the lower lid, sometimes combined with other techniques. The aim is to reposition the lid so that it sits in a more normal position.

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LOWER LID ENTROPION SURGERY

Entropion is the medical term used to describe the lower eyelid turning inwards. This may result in the eyelashes touching the front of the eye. 


The commonest cause of entropion is laxity of the eyelid tissues due to ageing. Other causes do exist and you will be thoroughly examined for these.


One or both eyelids may be affected at the same time.

The type of treatment offered will depend on what caused the condition.


The commonest treatment is with an operation to tighten the lower lid, sometimes combined with other techniques. The aim is to reposition the lid so that it sits in a more normal position.

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UPPER LID PTOSIS SURGERY

Ptosis of the upper eyelid means that the upper lid is drooping low, on one or both sides. It may be associated with contact lens wear, allergic conjunctivitis, injury, and certain medical conditions affecting muscles or nerves. It is also possible to be born with ptosis. However, in most patients the only apparent cause is increasing age.

If the upper lid comes down over the pupil there may be loss of vision, especially in the upper part of the field of vision. For most patients with visual problems due to ptosis, surgery is the best treatment.

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BROW PTOSIS SURGERY

‘Brow Ptosis’ means that the eyebrow area is drooping low, usually with age. A low brow position may lead to excess skin causing a ‘hooded’ effect over the eye so that the upper part of the field of vision may be lost. We often use a 'brow lift’ operation to try to restore a more normal appearance and relieve any restriction of the upper part of the vision.

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REMOVAL OF EYELID CYSTS, LUMPS, SKIN TAGS AND FATTY DEPOSITS

Many benign cysts, lumps and lesions can arise on and around the eyelids. If these are unsightly, cause irritation or affect the vision they may benefit from removal. The adjacent image depicts a typical 'meibomian cyst' or 'chalazion'.

Occasionally skin cancers (such as 'basal cell carcinoma') can arise on the eyelids and may require more complex assessment, management and follow-up.

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WATERY EYES AND BLOCKED TEAR SYSTEMS

There are many reasons why one may have a watery eye.

Common reasons include eyelid margin problems (e.g. blepharitis) or laxity of the lower eyelids.

In other situations there may be a blockage or partial blockage of the normal tear drainage system.

This may be as simple as a narrowing of the tear holes ('puncta') of the eyelids but may represent blockage of the internal tear drainage system (lacrimal sac or nasolacrimal duct).

In the latter of these situations there may be benefit to performing DCR (dacryocystorhinostomy) surgery to bypass the tear system blockage.


DCR involves opening up your existing tear sac and connecting it directly into the nose to form a new tear drainage pathway. This requires removal of the small amount of bone that lies between your nose and your tear sac.

DCR surgery may be performed through an incision on the side of the nose (external DCR) or from the inside of the nose (endonasal DCR), typically using a thin camera (endoscope).

If DCR is unsuccessful a Lester-Jones tube may be considered.

The reasons for watery eyes may be multiple and complex and management can sometimes be particularly challenging.

 
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MANAGEMENT OF PAINFUL OR UNSIGHTLY BLIND EYES

An unsightly eye may result from previous injury or due to a pre-existing ocular condition. Sometimes the appearance can be improved by a cosmetic shell or contact lens, but if the eye becomes painful it may be beneficial to remove it.

An eye is most commonly removed by either enucleation or evisceration. Enucleation is the surgical removal of the eyeball. Evisceration is removal of the contents of the eyeball, leaving the white part of the eye and the eye muscles intact.

In the place of the eye a permanent solid spherical orbital implant (or ‘ball’, typically made of silicone, rubber or plastic) is placed deep within the eye socket to compensate for the loss of volume, and the muscles which move the eye are reattached to this implant. 

Once the socket has healed (around 6-8 weeks) you will be seen by an ocular prosthetist. They will fit you with a temporary artificial eye (prosthesis) that you will use until your custom prosthesis is produced.  


The prosthetist will take an impression of the socket in order to create a bespoke artificial eye (which matches the colour of the other eye), and this is fitted 3-4 months after the surgery when the wound is secure and all the swelling has subsided. This is worn like a shell within the eye socket and is held in place by the eyelids. The front surface of the artificial eye is custom painted to match the other eye. The back surface is moulded to fit the socket for maximum comfort and movement.