Conditions We Treat
The specialists of the New York Eye and Ear Infirmary (NYEE) Oculoplastic, Orbital, and Reconstructive Surgery Service are skilled in treating a wide range of conditions, including the following:
Patients born with normal eyelids may, over time, experience a change in the position of their eyelids that affects their appearance or function and even causes vision problems. For example, the eyelid can turn inwards and cause the eyelashes to rub against the eye, a condition called entropion. The eyelid can also turn outwards and cause the eye to be irritated or tear excessively, a condition known as ectropion.
One of the most common eyelid malpositions occurs when the eyelids become droopy or heavy. This can be due to excess eyelid skin (dermatochalasis), sagging eyebrows (brow ptosis), or weak eyelid muscles (blepharo-ptosis, also known as ptosis, pronounced TOE-sis). This condition occurs when muscles that open the eyelid become weak or stretched, causing the upper eyelid to sag. It can affect one or both eyes. While some people are born with ptosis, others develop ptosis with age, after injury, or as a result of neurological or muscular disorders. People with ptosis may develop headaches from straining to keep their eyes open, and in more serious cases, find that their vision is blocked.
How are Droopy Eyelids Treated?
The first step to correcting droopy eyelids is a thorough evaluation to determine the factor(s) causing droopy eyelids, including dermatochalasis, brow ptosis, and blepharoptosis. A patient can have one or multiple conditions, which contribute to droopy eyelids. While each condition requires a different surgical treatment, the oculoplastic surgeons at NYEE may treat multiple conditions at the same time.
A blepharoplasty (surgical removal of excess eyelid skin and fat) is the name for the surgery to treat dermatochalasis. In contrast, ptosis cannot be corrected simply by plastic surgery that removes excess eyelid skin; the eyelid muscles must be re-connected during surgery to raise the eyelids. Similarly, a browlift may be necessary when brow ptosis is the main factor causing eyelid heaviness. Only oculoplastic surgeons have the extensive training required to recognize and surgically correct all of the various causes of a “droopy lid.”
Cosmetic Surgery Services
For many individuals, facial rejuvenation is a way to present a different image to the world, boosting their self-confidence in the process. Our oculoplastic specialists have extensive experience helping patients achieve a more youthful appearance by reducing excess skin of the upper eyelids or “bags” under the lower eyelids and making the face look more symmetric.
Botulinum toxin (Botox-R) or injectable fillers can also be used to achieve a more youthful bright-eyed appearance without surgery. As a major national and international referral center, our surgeons also treat many patients for revisional surgery to improve previous eyelid (cosmetic) surgery.
Eyelid Lesions and Eye Tumors
Eyelid lesions are abnormal growths of tissue that can be either benign (for example cysts and styes) or malignant (skin cancers such as basal cell carcinoma, squamous cell carcinoma, and melanoma). Tumors can grow in the eye socket, or orbit, the space around and behind the eyeball. Orbital tumors can displace the eye or push it forward to create a bulging effect known as proptosis. If left untreated, tumors can become painful, lead to loss of vision, invade surrounding tissues, or even spread to other parts of the body.
How are Eye Lesions and Eye Tumors Treated?
The first step in treatment of a lesion or a tumor of the eye is an accurate diagnosis. This is obtained by performing a biopsy of the lesion to determine if it is benign, pre-cancerous, or cancerous. The Ophthalmic Pathology Service at NYEE offers onsite pathology services, allowing our surgeons to closely collaborate with pathologists to obtain a correct diagnosis as quickly as possible. Once the diagnosis is known, your surgeon, working with other doctors in the health care team, will guide you through the various cutting-edge treatment regimens based on the most current research.
Malignant cancers of the eyelid are most often removed through surgery, and oculoplastic surgeons repair and restore the eyelid’s appearance and function through highly specialized plastic (reconstructive) surgery. Orbital tumors are treated through a combination of surgery, radiation, and chemotherapy. Your oculoplastic surgeon will work with a multispecialty team of experts from the Mount Sinai Health System to develop and implement a customized treatment plan.
Malignant cancers can also grow on the surface of the eye. The NYEE Ocular Oncology Service specializes in eye surface or intraocular tumors and may work with the oculoplastic surgery specialists on difficult cases requiring reconstruction of the eye socket and eyelid. Most of these lesions can be removed through surgery, though some require additional cryotherapy (a freezing technique) or radiation therapy after surgery. In the case of tumors affecting the iris, our specialists use high frequency ultrasound to diagnose and monitor for evidence of growth before treatment is considered.
Tear Duct Obstruction
The lacrimal system in your eye is responsible for keeping your eye properly lubricated by producing and draining tears. When the lacrimal gland produces tears, they exit the surface of the eye through a system of canals beginning in each eyelid and ultimately ending in the nose (nasolacrimal duct). When this duct becomes obstructed, it can cause excessive tearing, redness of the eye, and infections.
Not all excessive tearing is the result of tear duct obstruction. Sometimes the eyes tear because of irritation or even, paradoxically, as a response to being too dry. Your oculoplastic surgeon can evaluate the many causes of tearing to arrive at the best treatment option.
How is Tear Duct Obstruction Treated?
Nasolacrimal duct obstructions in newborn babies generally resolve on their own within the first year of birth. If there is no improvement by age one, a relatively simple procedure (probing and intubation) to open up the tear drain blockage may be required and is usually very successful.
Tear duct obstruction in adults can be corrected through surgery to create a new tear drain opening that bypasses the obstruction in the nasolacrimal duct. This surgery is called a dacryocystorhinostomy (DCR) and is performed as an ambulatory surgery. A soft silicone tube is often placed in the newly-created passageway to keep it open and is removed several weeks after surgery in the doctor’s office. Though every patient’s particular situation is different, in general, most patients experience a significant improvement in tearing after surgery.
Reconstruction of the eyelids and eye socket (the cavity of the skull that holds the eye in place) may be required following facial trauma due to falls, car accidents, burns, or objects that hit the eye. Certain diseases, including invasive cancers, may also require socket reconstruction or even surgery to enhance the ability to wear an eye prosthesis.
The NYEE oculoplastic, orbital, and reconstructive surgery team is among the most experienced in the Northeast in treating and managing eye trauma. We not only use the latest reconstructive techniques and technology, but draw upon ENT, oncology, and diagnostic imaging specialists from the Mount Sinai Health System to handle complicated cases that require multiple areas of expertise. The goal of this multidisciplinary team is to expertly repair the damaged bone and tissue around the eyes, and preserve your vision.
How is Eye Trauma Treated?
Eyelid trauma is best repaired by meticulously restoring natural anatomy at the time of the trauma. However, even years after the initial trauma, our surgeons can often dramatically improve the appearance and function of the face around the eyes. For cases involving possible orbital fracture, our ocuplastic and orbital specialists start with a thorough eye and facial exam including a CT scan to determine the extent of the damage and the treatment required. Often, they work together with multiple specialists who manage resulting conditions inside the eye, such as retinal detachment and corneal transplant. For the most serious fractures—ones that result in double-vision from impaired eye movement—surgery to reconstruct the eye socket is usually required.
Thyroid-Related Eye Disease
Graves’ Disease is a disorder in which abnormal chemicals produced primarily by the thyroid gland result in excessive growth of the fat and muscles around the eyeball. People with this disorder may experience bulging eyes (proptosis), a “stare” appearance from upper eyelids that are too high (retraction), double vision, and a sandy sensation to the eyes from severe dryness.
How is Thyroid Eye Disease Treated?
First, your endocrinologist must control the underlying thyroid disease with a regimen of medication, radiation, or surgery. The majority of eye changes from Graves’ disease can be improved with surgery, but unless the optic nerve is being compressed (which is very rare), patients should not undergo surgery until their exam and thyroid function are stable for 6-12 months. Operating too soon may even result in worse vision, appearance, and reactivation of the disease. Often the “waiting period” after diagnosis but before the disease is stable is a frustrating period for both patient and physician, and a number of non-surgical treatments can improve patient comfort during this period.
When severe proptosis is present, the first surgery that is done is orbital decompression, or partial removal of the bones of the eye socket. We routinely perform this as a multispecialty team, bringing together ophthalmic plastic surgeons, who remove some of the bone through a small incision, and Ear, Nose, and Throat (ENT) surgeons, who remove part of the bone endoscopically through the nose. If necessary, NYEE strabismus surgeons then perform eye muscle surgery to restore single vision in patients who experience double vision. Finally, oculoplastic surgeons can perform eyelid surgery to lower the upper lids and raise the lower eyelids to further improve the facial appearance.