The oculoplastic or eye-facial surgeon is a surgeon who after completing his specialisation in ophthalmology, faced abroad a selective “High degree” path in plastic, reconstructive and aesthetic surgery of eyelids, lacrimal ducts, orbit and face.

An ophthalmic plastic surgeon (also Known as oculoplastic surgeon) is therefore an expert with advanced training in treating, both aesthetic and functional, of the region of the eye and face

WHY CHOOSE THE OCULOPLASTIC SURGEON?

Over the decades we have lost the figure of the ” general surgeon “, to make room for more sectorialized and specialized figures: there are the heart surgeon and vascular surgeon, orthopedic surgeon and knee orthopedic surgeon or hand orthopedic surgeon, and so on.

What has emerged, with the huge advances in medicine, is the need for ultra-surgical specialties in which an experienced surgeon can focus his practice in a specific area, and become a point of reference and excellence, constantly updated and advanced in that field.

The field of cosmetic surgery has undergone a similar development. The continuous advancement of technologies and techniques require to acquire the knowledge, skills and experience necessary to operate effectively on highly selected areas of the body and of the face.

WHAT CHARACTERIZES THE OCULOPLASTIC SURGEON?

The oculoplastic surgeon has exclusive competence in the treatment of the gaze and the eye:

• It has a very thorough knowledge of the anatomy of the eye, of the eye’s components (eyelids, eyebrow, face average) and of the periorbital muscle from both an aesthetic and functional point of view.
• Perform only treatmentor surgery on the face.
• The vast experience and attention to the aesthetics of the gaze guarantees the uniqueness of the result: the intervention will be personalized to maintain a natural look, to reflect the patient’s personality and the individuality of its image and to meet the needs expressed during the preoperative interview.
• The skills acquired through experience and dedication to one area of the face guarantee optimal management of any possible operative complications.
• The continuous updating and comparison with colleagues during highly specialized conferences ensures the selection of cutting-edge techniques and the ability to combine multiple surgical practices to achieve the best aesthetic result (for example blepharoplasty associated with eyebrow lift).

Who turn to oculoplastic surgeon wants to find the freshness of his/her eyes and face, without adhering to standardized “artificial” and built canons of beauty

Each patient will be advised and directed to the most appropriate and cutting-edge techniques, according to the latest guidelines of the international professional associations

L'articolo Who is the Oculoplastic Surgeon? sembra essere il primo su Oculoplastica Dr. Carlo Graziani.

DEFINITION.

In the upper eyelid there are approximately 100 lashes while in the lower one 50. The eyelashes originate from the anterior portion of the lid margin, in front of the tarsal plate (anterior layer), and are on two or three rows. We can find some eyelashes at the level of the caruncle. From the embryological point of view eyelashes and the Meibomian glands differentiate during the second month of gestation, starting from the same germ epithelial cells (1).

Trichiasis: altered orientation of lashes that, even if they emerge physiologically at the level of the anterior layer, are in contact with the ocular surface. Eyelashes with abnormal direction can affect the total upper and/or lower eyelid, or a portion thereof.

Distichiasis: presence of a double row of eyelashes, the first one resulting from the anterior layer while the other one, metaplastic, from the posterior layer (orifices of the Meibomian glands).

Aberrant lashes: metaplastic lashes that originate from the orifices of the Meibomian glands, located in the back layer (Pictures 1).

PICTURES 1-4: by Dr. Carlo Graziani

All malpositions of the eyelashes can cause eye irritation, epiphora, abrasion and / or corneal ulcers with loss of corneal transparency and more or less serious reduction of vision

CLASSIFICATION.

The malposition of the eyelid margin and abnormal positions of the eyelashes often coexist: inflammatory causes (chronic blepharitis, Stevens-Johnson Syndrome; vernal keratoconjunctivitis), infectious reasons (trachoma: Picture 2; herpes zoster; parasitosis: dermodex folliculorum), autoimmune causes (ocular pemphigoid scar), or iatrogenic causes (resulting from surgeries: lower blepharoplasty, correction of fracture of the orbital floor, enucleation, ectropion correction; they are secondary to trauma by chemical or physical agents) (3) lead to inflammatory processes in the eyelid edge and the bulbs hair contained therein. The post inflammatory healing can induce changes in the normal anatomical structure of eyelid with consequent malposition of the eyelashes (trichiasis).

Distichiasis can be acquired or congenital (1). The acquired form is secondary to inflammatory, infectious, autoimmune or traumatic processes involving the eyelid margin.

The congenital form can be inherited with an autosomal dominant mechanism, but it can also be associated with ptosis, strabismus, congenital heart defects, mandibulofacial dysostosis or congenital lymphoedema (4). It may remain asymptomatic until the age of 4-6 years, when direct eyelashes against the eye surface become stronger, increasing their abrasive action.

The ìetiopathogenesis of aberrant eyelashes is related to the lack of differentiation in the Meibomian gland of epithelial germ cells, that become pilosebaceous units.

MEDICAL THERAPY.

The local medical treatment of malposition of the eyelashes, with lubricants in drops, with creams or through the application of therapeutic contact lens, has the only purpose of reducing the irritative symptoms, resulting from the rubbing of the eyelashes against the eye surface.

SURGICAL THERAPY.

Numerous surgical procedures have been described for the treatment of malposition of the eyelashes (5). Different techniques are used depending on the extent of such malpositions (Table 1) (6-13). The various procedures related to the two categories ‘destruction’ and/or ‘repositioning’ of eyelashes/follicles, can be used separately or in combination. The ‘repositioning’ techniques, generally used for the entropion correction can sometimes be useful in the treatment of malposition of the eyelashes because the malposition of the eyelid margin and trichiasis often coexist (table 2), while the ‘destruction’ techniques of eyelashes and follicles are used in a specific way for the treatment of malposition of the eyelashes.

IATROGENIC COMPLICATIONS.

Possible intra- and post-operative complications, that should be discussed with the patient, are: bleeding, infection, recurrence, re-intervention, scars and alteration of the normal palpebral profile.

All eyelid malposition, if untreated, can lead to abrasions, corneal leucomas, keratitis and blindness

BIBLIOGRAPHY.

1. Scheie HG, Albert DM. Distichiasis and trichiasis: origin and management. Am J Ophthalmol. 1966;61:718-20.
2. West ES, Munoz B, Imeru A. The association between epilation and corneal opacity among eyes with trachomatous trichiasis. Br J Ophthalmol. 2006;90:171-4.
3. Collin RJO. Entropion and trichiasis. In: A Manual of Systemic Eyelid Surgery. New York: Churchill-Livingstone;1989: 7-26.
4. Samlaska CP. Congenital lymphedema and distichiasis. Pediatr Dermatol. 2002 Mar-Apr;19(2):139-41

1. Bartley GB, Bullock JD, Olsen TG, Lutz PD. An experimental study to compare methods of eyelash ablation. Ophthalmology. 1987;94:1286-9.
2. Johnson RL, Collin JR. Treatment of trichiasis with a lid cryoprobe. Br J Ophthalmol. 1985;69:267-70.
3. Wojono TH. Lid splitting with lash resection for cicatricial entropion. Ophthalmic Plast Reconst Surg. 1992;8:287-289.
4. Wood JR, Anderson RL. Complications of cryosurgery. Arch Ophthalmol. 1981;99:460-3
5. West ES, Alemayehu W, Munoz B. Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial methodology. Ophthalmic Epidemiol. 2005;12:279-86.
6. Tirakunwichcha S, Tinnangwattana U, Hiranwiwatkul P. Folliculectomy: management in segmental trichiasis and distichiasis. J Med Assoc Thai. 2006;89:90-3.
7. Kersten RC, Kleiner FP, Kulwin DR. Tarsotomy for the treatment of cicatricial entropion with trichiasis. Arch Ophthalmol. 1992;110:714-7.
8. Jordan DR, Zafar A, Brownstein S. Cicatricial conjunctival inflammation with trichiasis as the presenting feature of Wegener granulomatosis. Ophthal Plast Reconstr Surg. Jan-2006;22:69-71.
9. Elder MJ, Collin R. Anterior lamellar repositioning and grey line split for upper lid entropion in ocular cicatricial pemphigoid. Eye. 1996;10:439-42.

L'articolo Trichiasis, distichiasis, aberrant lashes sembra essere il primo su Oculoplastica Dr. Carlo Graziani.