A woman has Horner’s Syndrome as a result of surgery. She wants to know the different ways to treat her sunken eye and drooping eyelid.
Dr. Amiya Prasad, a practicing oculofacial plastic surgeon in Manhattan and Long Island for over 20 years, explains that this woman’s situation requires a full examination before she will get a more comprehensive answer. He says that it depends on the type of surgery she had that led to the Horner’s Syndrome. If she had some intracranial or neurosurgical procedure that led the eye to be pushed, then it has to do with the bones around the eyes called the boney orbit. The reconstruction can be very complex and may require a team approach which includes an orbital oculoplastic surgeon and a neurosurgeon in order to achieve the restoration and the position of the eye. It may or may not be practical to do that.
Dr. Prasad adds that patients who have enophthalmos or eyes pushed inwards and exophthalmos where the eye is pushed out like patients with Graves' Disease or thyroid eye disease, he always has to think practically. His goal in every procedure is to always reduce risk. Eyelid surgery alone is reasonable compromise because trying to achieve ideal may involve more risk. For patients with thyroid eye disease that have eyes that are bulging out and one eyelid is particular high, he would offer the option of just bringing that eyelid down. That’s not a simple procedure but it is less invasive than doing an orbital decompression. After the procedure, patients are more satisfied because the eyes are more symmetric than before so a classical approach is necessary. His goal is to deal with individual situations and balance risk and benefit.
In this woman’s situation, Dr. Prasad thinks that more detail and examination are necessary. This should be brought to the attention of an oculoplastic or orbital surgeon. If she had neurosurgery as he described, then it is something that she should also discuss with her neurosurgeon on how to get a normal eye position. The challenge now is when the eye recedes back, a lot of scar tissue may form making it very difficult to place the eye in a normal position even with the correction of the structure around the eye. It may still be more practical to have ptosis surgery to get the eyelid in a more natural symmetric position.
Whenever an individual has a problem like this woman, patients always think that everyone’s looking at them and sees that asymmetry, but Dr. Prasad always explains to them that people look at a person globally. If she is able to create some balance even with one or two millimeters of correction, then everything else averages out and blends and gets camouflaged.
Dr. Prasad suggests that she meet with some doctors and the specialties he described so that she can get more information. She may need imaging studies. She also may need to figure out whether or not a more complex surgery in the orbit is necessary versus a more straightforward surgery that Dr. Prasad routinely does in his office. Whether or not it’s to lift the eyelid or bring the eyelid down, it’s considerably less risky. Once she has her information, she may move forward with whatever she’s comfortable with.
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