Eye surgery, also known as ophthalmic surgery or ocular surgery, is

surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

performed on the

eye An eye is a sensory organ that allows an organism to perceive visual information. It detects light and converts it into electro-chemical impulses in neurons (neurones). It is part of an organism's visual system. In higher organisms, the ey ...

or its adnexa. Eye surgery is part of

ophthalmology Ophthalmology (, ) is the branch of medicine that deals with the diagnosis, treatment, and surgery of eye diseases and disorders. An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a ...

and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An 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, with cataract treatment starting in the fifth century BC. It continues to be a widely practiced class 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 (American English) or anaesthesia (British English) 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 prev ...

is essential.

Local anesthesia Local anesthesia is any technique to induce the absence of sense, sensation in a specific part of the body, generally for the aim of inducing local analgesia, i.e. local insensitivity to pain, although other local senses may be affected as well. ...

is most commonly used.

Topical anesthesia A topical anesthetic is a local anesthetic that is used to numb the surface of a body part. They can be used to numb any area of the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital area. ...

using

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia and ventricular fibrillation. When used for local anae ...

topical gel is often used for quick procedures. Since topical anesthesia requires cooperation from the patient,

general anesthesia General anaesthesia (UK) or general anesthesia (US) is medically induced loss of consciousness that renders a patient unarousable even by painful stimuli. It is achieved through medications, which can be injected or inhaled, often with an analgesi ...

is often used for children, traumatic eye injuries, or major orbitotomies, and for apprehensive patients. The physician administering anesthesia, or a

nurse anesthetist A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. They are involved in the administration of anesthesia in a majority of countries, with varying levels of autonomy. Nurse anesth ...

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

antiseptic An antiseptic ( and ) is an antimicrobial substance or compound that is applied to living tissue to reduce the possibility of sepsis, infection, or putrefaction. Antiseptics are generally distinguished from ''antibiotics'' by the latter's abil ...

s, such as povidone-iodine, and sterile drapes, gowns, and gloves.

Laser eye surgery

Although the terms laser eye surgery and

refractive surgery Refractive surgery is an 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 ( keratomi ...

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 Myopia, also known as near-sightedness and short-sightedness, is an eye condition where light from distant objects focuses in front of, instead of on, the retina. As a result, distant objects appear blurry, while close objects appear normal. ...

(short-sightedness),

hypermetropia Far-sightedness, also known as long-sightedness, hypermetropia, and hyperopia, is a condition of the eye where distant objects are seen clearly but near objects appear blurred. This blur is due to incoming light being focused behind, instead o ...

(long-sightedness), and

astigmatism Astigmatism is a type of refractive error due to rotational asymmetry in the eye's refractive power. The lens and cornea of an eye without astigmatism are nearly spherical, with only a single radius of curvature, and any refractive errors ...

(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, the eye specialist needs to certify that the patient is a suitable candidate for the surgery and there are several factors to be considered before doing laser surgery.

Cataract surgery

cataract A cataract is a cloudy area in the lens (anatomy), lens of the eye that leads to a visual impairment, decrease in vision of the eye. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colours, blurry or ...

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 (; or retinas) is the innermost, photosensitivity, light-sensitive layer of tissue (biology), tissue of the eye of most vertebrates and some Mollusca, molluscs. The optics of the eye create a focus (optics), focused two-dimensional ...

. If

visual loss Visual or vision impairment (VI or VIP) is the partial or total inability of visual perception. In the absence of treatment such as corrective eyewear, assistive devices, and medical treatment, visual impairment may cause the individual difficul ...

is significant, surgical removal of the lens may be warranted, with lost

optical power In optics, optical power (also referred to as dioptric power, refractive power, focal power, focusing power, or convergence power) is the degree to which a lens, mirror, or other optical system converges or diverges light. It is equal to the ...

usually replaced with a plastic

intraocular lens An intraocular lens (IOL) is a lens (optics), lens implanted in the human eye, eye usually as part of a treatment for cataracts or for correcting other vision problems such as myopia, near-sightedness (myopia) and farsightedness, far-sightednes ...

. 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 can lead to damage of the optic nerve. The optic nerve transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of ...

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 system, visual information from the retina to the brain. In humans, the optic nerve i ...

that results in

vision loss Visual or vision impairment (VI or VIP) is the partial or total inability of visual perception. In the absence of treatment such as corrective eyewear, assistive devices, and medical treatment, visual impairment may cause the individual difficul ...

and is frequently characterized by raised

intraocular pressure Intraocular pressure (IOP) is the fluid pressure inside the eye. Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk of glaucoma. Most tonometers are calibrated t ...

. 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. *

Keratomileusis Keratomileusis, from Greek κέρας (kéras: horn) and σμίλευσις (smíleusis: carving), or corneal reshaping, is the improvement of the refractive state of the cornea by surgically reshaping it. It is the most common form of refractive ...

is a method of reshaping the corneal surface to change its

. 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 LASIK or Lasik (; "laser-assisted in situ keratomileusis"), commonly referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and astigmatism. LASIK surgery is p ...

) * Laser assisted subepithelial keratomileusis ( LASEK), Epi-LASIK *

Photorefractive keratectomy 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. ...

* Laser thermal keratoplasty * Conductive keratoplasty uses radio-frequency waves to shrink corneal collagen. It is used to treat mild to moderate hyperopia. *

Limbal relaxing incisions Limbal relaxing incisions (LRI) are a refractive surgical procedure to correct minor astigmatism in the eye. Incisions part way through the cornea are made at one side or at opposite edges of the cornea, following the curve of the iris, causing ...

can correct minor astigmatism * Astigmatic keratotomy, arcuate keratotomy, or transverse keratotomy *

Radial keratotomy Radial keratotomy (RK) is a refractive surgery, refractive surgical procedure to correct myopia (nearsightedness). It was developed in 1974 by Svyatoslav Fyodorov, a Russian Ophthalmology, ophthalmologist. It has been largely supplanted by newer, ...

* Hexagonal keratotomy * Epikeratophakia is the removal of the corneal epithelium and replacement with a lathe-cut corneal button. * Intracorneal rings or corneal ring segments * Implantable contact lenses * Presbyopia reversal * Anterior ciliary sclerotomy * Scleral reinforcement surgery for the mitigation of degenerative myopia * Small incision lenticule extraction

Corneal surgery

Corneal surgery 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 * Keratoprosthesis * Phototherapeutic keratectomy * Pterygium excision * Corneal tattooing * Osteo-odonto-keratoprosthesis 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 Vitrectomy is a surgery to remove some or all of the vitreous humor from the Human eye, eye. Anterior vitrectomy entails removing small portions of the vitreous humor from the front structures of the eye—often because these are tangled in an i ...

** 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. It is a leading cause of blindness in developed countries and one of the lead causes of sight loss in the wor ...

. *

Retinal detachment Retinal detachment is a condition where the retina pulls away from the tissue underneath it. It may start in a small area, but without quick treatment, it can spread across the entire retina, leading to serious vision loss and possibly blindness. ...

repair **

Ignipuncture Ignipuncture (Latin: ''Ignis'' (fire) + ''puncture'') is the procedure of closing a retinal separation by transfixation of the break via cauterization Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a ...

is an obsolete procedure that involves

cauterization Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, o ...

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 an eye disorder in which the eyes do not properly align with each other when looking at an object. The eye that is pointed at 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

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. With ...

), 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, 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. With ...

(eyelift) is plastic surgery 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. "Palpebral ...

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 repair for droopy eyelid **

Ectropion Ectropion is a medical condition in which the lower eyelid turns outwards. It is one of the notable aspects of newborns exhibiting congenital harlequin-type ichthyosis, but ectropion can occur due to any weakening of tissue of the lower eyelid ...

repair *

Entropion Entropion is a medical condition in which the eyelid (usually the lower lid) folds inward. It is very uncomfortable, as the eyelashes continuously rub against the cornea causing irritation. Entropion is usually caused by Genetics, genetic factors. ...

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 The palpebral fissure is the elliptic space between the medial and lateral canthi of the two open eyelids. In simple terms, it is the opening between the eyelids. In adult humans, this measures about 10 mm vertically and 30 mm horizontally. Va ...

. ** A canthotomy is the surgical division of the canthus, usually the outer canthus. *** A lateral canthotomy is the surgical division of the outer canthus. * Epicanthoplasty * Tarsorrhaphy is a procedure in which the

s are partially sewn together to narrow the opening (i.e.

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 Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity. The maxillary sinuses are located under the eyes; the frontal sinuses are above the eyes; the ethmoidal sinuses are between the eyes and the sphenoi ...

and so make space for the swollen tissue and allowing the eye to move back into normal position.

Other oculoplastic surgery

Botox Botulinum toxin, or botulinum neurotoxin (commonly called botox), is a neurotoxic protein produced by the bacterium ''Clostridium botulinum'' and related species. It prevents the release of the neurotransmitter acetylcholine from axon endi ...

injections * Ultrapeel microdermabrasion * Endoscopic forehead and browlift * Face lift ( rhytidectomy) *

Liposuction Liposuction, or simply lipo, is a type of fat-removal procedure used in plastic surgery. Evidence does not support an effect on weight beyond a couple of months and does not appear to affect obesity-related problems. In the United States, lip ...

of the face and neck * Browplasty

Surgery involving the lacrimal apparatus

* A dacryocystorhinostomy or dacryocystorhinotomy is a procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function. * Canaliculodacryocystostomy is a surgical correction for a congenitally blocked tear duct 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 ...

. * Canaliculotomy involves slitting of the

lacrimal punctum The lacrimal punctum (: 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 medial (inside) ...

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'' 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'' 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, or 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, 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 (surgery), 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, 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 and total iridencleisis.) * 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. * 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 is used in the treatment of chronic open- and chronic closed-angle glaucoma.

References

{{Eye surgery Surgical specialties Ophthalmology