Eyelid, orbital, and optic nerve surgery

Abstract

Surgical techniques to manage eyelid, orbital, and optic nerve disease are rapidly advancing due to new technology such as lasers and endoscopy. New indications are developing for preexisting surgical techniques. Often, the new indications for surgical techniques are implied empirically rather than as an understanding of the pathophysiologic process. Indications for blowout fracture repair remain controversial. A discussion comparing the opposing views that all blowout fractures should be repaired with the opinion that no blowout fractures should be repaired is reviewed. A recent controversial area is that of optic nerve surgery. Optic canal decompression for traumatic optic neuropathy and optic nerve sheath decompression for pseudotumor cerebri or progressive nonarteritic anterior ischemic optic neuropathy are discussed. While the indications for optic nerve sheath decompression for vision loss owing to pseudotumor cerebri appear well established, the surgical indications for optic canal decompression for traumatic optic neuropathy and optic nerve sheath decompression for progressive nonarteritic anterior ischemic optic neuropathy remain controversial. Endoscopic sinus surgery has become a common surgical technique, and orbital complications are becoming more frequent. A description of the spectrum of orbital complications secondary to endoscopic sinus surgery are reviewed. Numerous new eyelid surgical techniques are developed each year. Frontalis suspension for ptosis and eyelid retraction surgery for Graves' ophthalmopathy are reviewed. Functional indications for blepharoplasty are suggested with the hope they will be accepted by health care insurance companies. Finally, lacrimal surgery is reviewed with an eye toward the pathophysiologic mechanism of canalicular lacerations.