Eye surgery, also known as ophthalmic or ocular surgery, is surgery performed on the
eye
Eyes are organs of the visual system. They provide living organisms with vision, the ability to receive and process visual detail, as well as enabling several photo response functions that are independent of vision. Eyes detect light and conv ...
ophthalmologist
Ophthalmology ( ) is a surgery, surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders.
An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Followin ...
or sometimes, an
optometrist
Optometry is a specialized health care profession that involves examining the eyes and related structures for defects or abnormalities. Optometrists are health care professionals who typically provide comprehensive primary eye care.
In the Un ...
. Eye surgery is synonymous with
ophthalmology
Ophthalmology ( ) is a surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders.
An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a med ...
. The eye is a very fragile organ, and requires extreme care before, during, and after a surgical procedure to minimize or prevent further damage. An expert eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as
1800 BC
The 18th century BC was the century that lasted from 1800 BC to 1701 BC.
Events
*1800 BC: Iron Age in India
*1800 BC: Beginning of the Nordic Bronze Age in the period system devised by Oscar Montelius.
* c. 1800 BC: Sedentary Maya civilizatio ...
, with cataract treatment starting in the fifth century BC. Today it continues to be a widely practiced type of surgery, with various techniques having been developed for treating eye problems.
Preparation and precautions
Since the eye is heavily supplied by nerves,
anesthesia
Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), a ...
is essential.
Local anesthesia
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. I ...
is most commonly used. Topical anesthesia using lidocaine topical gel is often used for quick procedures. Since topical anesthesia requires cooperation from the patient, general anesthesia is often used for children, traumatic eye injuries, or major orbitotomies, and for apprehensive patients. The physician administering anesthesia, or a nurse anesthetist or anesthetist assistant with expertise in anesthesia of the eye, monitors the patient's cardiovascular status. Sterile precautions are taken to prepare the area for surgery and lower the risk of infection. These precautions include the use of antiseptics, such as povidone-iodine, and sterile drapes, gowns, and gloves.
Laser eye surgery
Although the terms laser eye surgery and
refractive surgery
Refractive eye surgery is optional eye surgery used to improve the refractive state of the eye and decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea ( keratomil ...
are commonly used as if they were interchangeable, this is not the case. Lasers may be used to treat nonrefractive conditions (e.g. to seal a retinal tear). Laser eye surgery or laser corneal surgery is a medical procedure that uses a laser to reshape the surface of the eye to correct myopia (short-sightedness), hypermetropia (long-sightedness), and astigmatism (uneven curvature of the eye's surface). Importantly, refractive surgery is not compatible with everyone, and people may find on occasion that eyewear is still needed after surgery.
Recent developments also include procedures that can change eye color from brown to blue. Before proceeding with laser surgery, your eye specialist needs to certify that you are a suitable candidate for the surgery and there are several factors to be considered before doing laser surgery.
Cataract surgery
A
cataract
A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry or double vision, halos around light, trouble w ...
is an opacification or cloudiness of the eye's crystalline lens due to aging, disease, or trauma that typically prevents light from forming a clear image on the
retina
The retina (from la, rete "net") is the innermost, light-sensitive layer of tissue of the eye of most vertebrates and some molluscs. The optics of the eye create a focused two-dimensional image of the visual world on the retina, which then ...
. If
visual loss
Visual impairment, also known as vision impairment, is a medical definition primarily measured based on an individual's better eye visual acuity; in the absence of treatment such as correctable eyewear, assistive devices, and medical treatment ...
is significant, surgical removal of the lens may be warranted, with lost optical power usually replaced with a plastic
intraocular lens
Intraocular lens (IOL) is a lens (optics), lens implanted in the human eye, eye as part of a treatment for cataracts or myopia. If the natural lens is left in the eye, the IOL is known as Phakic intraocular lens, phakic, otherwise it is a pseudop ...
. Owing to the high prevalence of cataracts, cataract extraction is the most common eye surgery. Rest after surgery is recommended.
Glaucoma surgery
Glaucoma
Glaucoma is a group of eye diseases that result in damage to the optic nerve (or retina) and cause vision loss. The most common type is open-angle (wide angle, chronic simple) glaucoma, in which the drainage angle for fluid within the eye re ...
is a group of diseases affecting the
optic nerve
In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual information from the retina to the brain. In humans, the optic nerve is derived fro ...
that results in vision loss and is frequently characterized by raised intraocular pressure. Many types of glaucoma surgery exist, and variations or combinations of those types can facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower it by decreasing the production of aqueous humor.
Canaloplasty
Canaloplasty is an advanced, nonpenetrating procedure designed to enhance drainage through the eye's natural drainage system to provide sustained reduction of intraocular pressure. Canaloplasty uses microcatheter technology in a simple and minimally invasive procedure.
To perform a canaloplasty, an ophthalmologist creates a tiny incision to gain access to a canal in the eye. A microcatheter circumnavigates the canal around the iris, enlarging the main drainage channel and its smaller collector channels through the injection of a sterile, gel-like material called viscoelastic. The catheter is then removed and a suture is placed within the canal and tightened. By opening up the canal, the pressure inside the eye can be reduced.
Refractive surgery
Refractive surgery aims to correct errors of refraction in the eye, reducing or eliminating the need for corrective lenses.
*
Keratomilleusis
Keratomileusis, from Greek κέρας (kéras: horn) and σμίλευσις (smíleusis: carving),The word is derived from Greek κέρας - keras (root: kerat-) "horn, cornea" and σμίλευσις - smileusis "carving or corneal reshaping, is ...
is a method of reshaping the corneal surface to change its optical power. A disc of the cornea is shaved off, quickly frozen, lathe-ground, then returned to its original power.
* Automated lamellar keratoplasty
* Laser-assisted ''in situ'' keratomileusis ( LASIK)
* Laser assisted subepithelial keratomileusis (
LASEK
Photorefractive keratectomy (PRK) and laser-assisted sub-epithelial keratectomy (or laser epithelial keratomileusis) (LASEK) are laser eye surgery procedures intended to correct a person's vision, reducing dependency on glasses or contact lenses. ...
Astigmatic keratotomy
Astigmatism is a type of refractive error due to rotational asymmetry in the eye's refractive power. This results in distorted or blurred vision at any distance. Other symptoms can include eyestrain, headaches, and trouble driving at nig ...
, arcuate keratotomy, or transverse keratotomy
* Radial keratotomy
*
Hexagonal keratotomy
In geometry, a hexagon (from Greek , , meaning "six", and , , meaning "corner, angle") is a six-sided polygon. The total of the internal angles of any simple (non-self-intersecting) hexagon is 720°.
Regular hexagon
A ''regular hexagon'' h ...
* Epikeratophakia is the removal of the corneal epithelium and replacement with a lathe-cut
corneal button
A corneal button is a replacement cornea to be transplanted in the place of a damaged or diseased cornea normally approximately 8.5–9.0mm in diameter.Keratoconus Australia. (n.d.). ''Corneal transplantation''. Retrieved from https://www.keratocon ...
.
*
Intracorneal rings
An intrastromal corneal ring segment (ICRS) (also known as intrastromal corneal ring, corneal implant or corneal insert) is a small device implanted in the eye to correct vision. The procedure involves an ophthalmologist who makes a small incisio ...
or corneal ring segments
* Implantable contact lenses
* Presbyopia reversal
* Anterior ciliary sclerotomy
* Scleral reinforcement surgery for the mitigation of degenerative myopia
Corneal surgery
Corneal surgery
The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Along with the anterior chamber and lens, the cornea refracts light, accounting for approximately two-thirds of the eye's total optical ...
includes most refractive surgery, as well as:
* Corneal transplant surgery is used to remove a cloudy/diseased cornea and replace it with a clear donor cornea.
*
Penetrating keratoplasty
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating keratoplasty a ...
Corneal tattooing
Corneal tattooing (or keratopigmentation) is the practice of tattooing the cornea of the human eye. Reasons for this practice include improvement of cosmetic appearance and the improvement of sight. Many different methods and procedures exist tod ...
*
Osteo-odonto-keratoprosthesis
Osteo-odonto-keratoprosthesis (OOKP), also known as "tooth in eye" surgery, is a medical procedure to restore vision in the most severe cases of corneal and ocular surface patients. It includes removal of a tooth from the patient or a donor.
Af ...
is surgery in which support for an artificial cornea is created from a tooth and its surrounding jawbone. This is a still-experimental procedure used for patients with severely damaged eyes, generally from burns.
* Eye color-change surgery through an iris implant, known as Brightocular, or the stripping away the top layer of eye pigment, known as the stroma procedure
Vitreoretinal surgery
Vitreoretinal surgery includes:
* Vitrectomy
** Anterior vitrectomy is the removal of the front portion of vitreous tissue. It is used for preventing or treating vitreous loss during cataract or corneal surgery, or to remove misplaced vitreous in conditions such as aphakia pupillary block glaucoma.
** Pars plana vitrectomy or trans pars plana vitrectomy is a procedure to remove vitreous opacities and membranes through a pars plana incision. It is frequently combined with other intraocular procedures for the treatment of giant retinal tears, tractional retinal detachments, and posterior vitreous detachments.
* Pan retinal photocoagulation is a type of photocoagulation therapy used in the treatment of
diabetic retinopathy
Diabetic retinopathy (also known as diabetic eye disease), is a medical condition in which damage occurs to the retina due to diabetes mellitus. It is a leading cause of blindness in developed countries.
Diabetic retinopathy affects up to 80 perc ...
.
* Retinal detachment repair
** Ignipuncture is an obsolete procedure that involves cauterization of the retina with a very hot, pointed instrument.
** A scleral buckle is used in the repair of a retinal detachment to indent or "buckle" the sclera inward, usually by sewing a piece of preserved sclera or silicone rubber to its surface.
** Laser photocoagulation, or photocoagulation therapy, is the use of a laser to seal a retinal tear.
** Pneumatic retinopexy
** Retinal cryopexy, or retinal cryotherapy, is a procedure that uses intense cold to induce a chorioretinal scar and to destroy retinal or choroidal tissue.
* Macular hole repair
* Partial lamellar sclerouvectomy
* Partial lamellar sclerocyclochoroidectomy
* Partial lamellar sclerochoroidectomy
* Posterior sclerotomy is an opening made into the vitreous through the sclera, as for detached retina or the removal of a foreign body.
* Radial optic neurotomy
* Macular translocation surgery
** through 360° retinotomy
** through scleral imbrication technique
Eye muscle surgery
With about 1.2 million procedures each year, extraocular muscle surgery is the third-most common eye surgery in the United States
* Eye muscle surgery typically corrects
strabismus
Strabismus is a vision disorder in which the eyes do not properly align with each other when looking at an object. The eye that is focused on an object can alternate. The condition may be present occasionally or constantly. If present during a ...
and includes:
** Loosening or weakening procedures
*** Recession involves moving the insertion of a muscle posteriorly towards its origin.
*** Myectomy
*** Myotomy
*** Tenectomy
*** Tenotomy
** Tightening or strengthening procedures
*** Resection
*** Tucking
*** Advancement is the movement of an eye muscle from its original place of attachment on the eyeball to a more forward position.
** Transposition or repositioning procedures
** Adjustable suture surgery is a method of reattaching an extraocular muscle by means of a stitch that can be shortened or lengthened within the first postoperative day, to obtain better ocular alignment.
Oculoplastic surgery
Oculoplastic surgery, or oculoplastics, is the subspecialty of
ophthalmology
Ophthalmology ( ) is a surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders.
An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a med ...
that deals with the reconstruction of the eye and associated structures. Oculoplastic surgeons perform procedures such as the repair of droopy eyelids (
blepharoplasty
Blepharoplasty ( Greek: ''blepharon'', "eyelid" + ''plassein'' "to form") is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face. Wit ...
), repair of tear duct obstructions, orbital fracture repairs, removal of tumors in and around the eyes, and facial rejuvenation procedures including laser skin resurfacing, eye lifts that are trending nowadays like the Fox eyes lift , brow lifts, and even facelifts. Common procedures are:
Eyelid surgery
*
Blepharoplasty
Blepharoplasty ( Greek: ''blepharon'', "eyelid" + ''plassein'' "to form") is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face. Wit ...
(eyelift) is
plastic surgery
Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes cranio ...
of the
eyelid
An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. The human eyel ...
s to remove excessive skin or subcutaneous fat. East Asian blepharoplasty, also known as double eyelid surgery, is used to create a double eyelid crease for patients who have a single crease (monolid).
*
Ptosis
Ptosis (from the Greek: πτῶσις 'falling', 'a fall', 'dropped') refers to droopiness or abnormal downward displacement of a body part or organ. Particular cases include:
* Ptosis (eyelid)
* Ptosis (chin)
* Ptosis (breasts)
* Visceroptosis, ...
repair for droopy eyelid
** Ectropion repair
* Entropion repair
* Canthal resection
** A canthectomy is the surgical removal of tissue at the junction of the upper and lower eyelids.Cline D; Hofstetter HW; Griffin JR. ''Dictionary of Visual Science''. 4th ed. Butterworth-Heinemann, Boston 1997.
** Cantholysis is the surgical division of the canthus.
** Canthopexy
** A canthoplasty is plastic surgery at the canthus.
** A canthorrhaphy is suturing of the outer canthus to shorten the palpebral fissure.
** A canthotomy is the surgical division of the canthus, usually the outer canthus.
*** A
lateral canthotomy
Lateral is a geometric term of location which may refer to:
Healthcare
*Lateral (anatomy), an anatomical direction
*Lateral cricoarytenoid muscle
*Lateral release (surgery), a surgical procedure on the side of a kneecap
Phonetics
*Lateral cons ...
eyelid
An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. The human eyel ...
s are partially sewn together to narrow the opening (i.e. palpebral fissure).
Orbital surgery
* Orbital reconstruction or ocular prosthetics (false eyes)
* Orbital decompression is used for Grave's disease, a condition (often associated with overactive thyroid problems) in which the eye muscles swell. Because the eye socket is bone, the swelling cannot be accommodated and as a result, the eye is pushed forward into a protruded position. In some patients, this is very pronounced. Orbitial decompression involves removing some bone from the eye socket to open up one or more sinuses and so make space for the swollen tissue and allowing the eye to move back into normal position.
microdermabrasion
Dermabrasion is a type of surgical skin planing, generally with the goal of removing acne, scarring and other skin or tissue irregularities, typically performed in a professional medical setting by a dermatologist or plastic surgeon trained spe ...
tear duct
The nasolacrimal duct (also called the tear duct) carries tears from the lacrimal sac of the eye into the nasal cavity. The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. The ...
in which the closed segment is excised and the open end is joined to the
lacrimal sac
The lacrimal sac or lachrymal sac is the upper dilated end of the nasolacrimal duct, and is lodged in a deep groove formed by the lacrimal bone and frontal process of the maxilla. It connects the lacrimal canaliculi, which drain tears from th ...
lacrimal punctum
The lacrimal punctum (plural ''puncta'') or lacrimal point, is a minute opening on the summits of the lacrimal papillae, seen on the margins of the eyelids at the lateral extremity of the lacrimal lake. There are two lacrimal puncta in the media ...
and canaliculus for the relief of epiphora
* A dacryoadenectomy is the surgical removal of a lacrimal gland.
* A dacryocystectomy is the surgical removal of a part of the lacrimal sac.
* A dacryocystostomy is an incision into the lacrimal sac, usually to promote drainage.
* A dacryocystotomy is an incision into the lacrimal sac.
Eye removal
* An enucleation is the removal of the eye leaving the eye muscles and remaining orbital contents intact.
* An
evisceration
Evisceration (pronunciation: /ɪvɪsəˈreɪʃən/) is disembowelment, i.e., the removal of viscera (internal organs, especially those in the abdominal cavity). The term may also refer to:
* Evisceration (autotomy), ejection of viscera as a defen ...
is the removal of the eye's contents, leaving the scleral shell intact. Usually performed to reduce pain in a blind eye.Cassin, B. and Solomon, S. ''Dictionary of Eye Terminology''. Gainesville, Florida: Triad Publishing Company, 1990.
* An
exenteration
Eye surgery, also known as ophthalmic or ocular surgery, is surgery performed on the eye or its adnexa, by an ophthalmologist or sometimes, an optometrist. Eye surgery is synonymous with ophthalmology. The eye is a very fragile organ, and requ ...
is the removal of the entire orbital contents, including the eye, extraocular muscles, fat, and connective tissues; usually for malignant orbital tumors.
Other surgery
Many of these described procedures are historical and are not recommended due to a risk of complications. Particularly, these include operations done on ciliary body in an attempt to control glaucoma, since highly safer surgeries for glaucoma, including lasers, nonpenetrating surgery, guarded filtration surgery, and seton valve implants have been invented.
* A ciliarotomy is a surgical division of the ciliary zone in the treatment of glaucoma.
* A ciliectomy is the surgical removal of part of the ciliary body or the surgical removal of part of a margin of an eyelid containing the roots of the eyelashes.
* A ciliotomy is a surgical section of the ciliary nerves.
* A conjunctivoanstrostomy is an opening made from the inferior conjunctival cul-de-sac into the maxillary sinus for the treatment of epiphora.
* Conjuctivoplasty is plastic surgery of the conjunctiva.
* A conjunctivorhinostomy is a surgical correction of the total obstruction of a lacrimal canaliculus by which the conjunctiva is anastomosed with the nasal cavity to improve tear flow.
* A corectomedialysis, or coretomedialysis, is an excision of a small portion of the iris at its junction with the ciliary body to form an artificial pupil.
* A
corectomy
An iridectomy, also known as a surgical iridectomy or corectomy, is the surgical removal of part of the iris.Cline D; Hofstetter HW; Griffin JR. ''Dictionary of Visual Science''. 4th ed. Butterworth-Heinemann, Boston 1997. coretomy, is any surgical cutting operation on the iris at the pupil.
* A corelysis is a surgical detachment of adhesions of the iris to the capsule of the crystalline lens or cornea.
* A coremorphosis is the surgical formation of an artificial pupil.
* A coreplasty, or coreoplasty, is plastic surgery of the iris, usually for the formation of an artificial pupil.
* A coreoplasy, or
laser pupillomydriasis
A laser is a device that emits light through a process of optical amplification based on the stimulated emission of electromagnetic radiation. The word "laser" is an acronym for "light amplification by stimulated emission of radiation". The firs ...
, is any procedure that changes the size or shape of the pupil.
* A cyclectomy is an excision of portion of the ciliary body.
* A cyclotomy, or cyclicotomy, is a surgical incision of the ciliary body, usually for the relief of glaucoma.
* A cycloanemization is a surgical obliteration of the long ciliary arteries in the treatment of glaucoma.
* An iridectomesodialysis is the formation of an artificial pupil by detaching and excising a portion of the iris at its periphery.
* An iridodialysis, sometimes known as a
coredialysis
Iridodialysis is a localized separation or tearing away of the iris from its attachment to the ciliary body.Cline D; Hofstetter HW; Griffin JR. ''Dictionary of Visual Science''. 4th ed. Butterworth-Heinemann, Boston 1997. Cassin, B. and Solomon, ...
, is a localized separation or tearing away of the iris from its attachment to the ciliary body.
* An iridencleisis, or corenclisis, is a surgical procedure for glaucoma in which a portion of the iris is incised and incarcerated in a limbal incision. (Subdivided into
basal iridencleisis
Basal or basilar is a term meaning ''base'', ''bottom'', or ''minimum''.
Science
* Basal (anatomy), an anatomical term of location for features associated with the base of an organism or structure
* Basal (medicine), a minimal level that is nece ...
and
total iridencleisis
Total may refer to:
Mathematics
* Total, the summation of a set of numbers
* Total order, a partial order without incomparable pairs
* Total relation, which may also mean
** connected relation (a binary relation in which any two elements are comp ...
.)
* An iridesis is a surgical procedure in which a portion of the iris is brought through and incarcerated in a corneal incision in order to reposition the pupil.http://www.merckmedicus.com/pp/us/hcp/thcp_dorlands_content.jsp?pg=/ppdocs/us/common/dorlands/dorland/dmd_i_12.htm
* An iridocorneosclerectomy is the surgical removal of a portion of the iris, the cornea, and the sclera.
* An iridocyclectomy is the surgical removal of the iris and the ciliary body.
* An iridocystectomy is the surgical removal of a portion of the iris to form an artificial pupil.
* An iridosclerectomy is the surgical removal of a portion of the sclera and a portion of the iris in the region of the limbus for the treatment of glaucoma.
* An iridosclerotomy is the surgical puncture of the sclera and the margin of the iris for the treatment of glaucoma.
* A rhinommectomy is the surgical removal of a portion of the internal canthus.
* A
trepanotrabeculectomy
Trabeculectomy is a surgical procedure used in the treatment of glaucoma to relieve intraocular pressure by removing part of the eye's trabecular meshwork and adjacent structures. It is the most common glaucoma surgery performed and allows draina ...
is used in the treatment of chronic open- and chronic closed-angle glaucoma.