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Modern System of Ophthalmology

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• Disorders of Retina and Vitreous Published

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• Theory and Practice of Optics and Refraction, 4/e Published

• Profile and Management of Ocular Trauma Published

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• Disorders of Uvea and Sclera Published

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• Disorders of Cornea and Ocular Surface In Press

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Modern System of Ophthalmology MSOS e r i e s

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Editor-in-Chief

A K KhuranaChiefEditor-in-

A K Khurana

Modern System of Ophthalmology MSOS e r i e s

Disorders of Eyelids, Lacrimal System, Orbit and Oculoplastic Surgery

Interactive Surgical Videos Interactive Surgical Videos Disorders of Eyelids, Oculoplastic SurgeryLacrimal System, Orbit and

Santosh G HonavarAshok K GroverEditors

Bhawna P Khurana Aruj K Khurana

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Dedicated to Education

Modern System of Ophthalmology (MSO) is a series of multiple volumes, planned with a very specific aim to cater to the needs of residents in ophthalmology. Volume editors of this series make a team of like-minded and devoted teachers from different subspecialties.

Disorders of Eyelids, Lacrimal System, Orbit and Oculoplastic Surgery.This volume of the MSO series provides a comprehensive coverage on different aspects of various disorder of eyelids, lacrimal system, orbit and oculoplastic surgery in a concise manner. Text matter, complete and up-to-date with recent advances, has been organized in three sections:Section I: Disorders of Eyelids includes a total of twelve chapters with one chapter each, describing the

Basic Principles of Oculoplastic Surgery and Aesthetic Oculoplastic Surgery, respectively.Section II: Disorders of Lacrimal System includes six chapters with one chapter on lacrimal sac surgery.Section III: Disorders of Orbit includes nine chapters with two chapters devoted to orbital surgery.DVD Containing surgical videos a companion to this book, provides high quality videos for quick

understanding of the steps of common surgical procedures on eyelids, ocular surface, lacrimal apparatus and orbit.

AK Khurana,Chief Editor of MSO Series, is currently Senior Professor, and Head, Squint and Oculoplasty Unit, Regional Institute of Ophthalmology, PGIMS, Rohtak. In addition to this book, he has written many popular books which have been well received by the medical students. Dr Khurana has published more than 160 scientific papers in national and international journals of repute. He has also contributed several chapters for four postgraduate reference books published in India and abroad. He has also been Editor of Haryana Journal of Ophthalmology, North Zone Journal of Ophthalmology, and Indian Journal of Strabismus and Pediatric Ophthalmology (IJSPO). He is WHO Fellow from Moorfields Eye Hospital, London, and did Certificate course in Tropical Ophthalmology(CTO) from Institute of Ophthalmology, University of London, UK. He has been honored with Distinguished Author Award by the Federation of Educational Publishers of India, and Excellence Awards by HOS, NZOS, and SPOSI; Fellowship of All India Collegiums of Ophthalmologists (FAICO), and Gold Medal by Intraocular Implant and Refractive Society of India (IIRSI).

Ashok K Grover, recipient of Padma Shree award by President of India, is Chairman, Department of Ophthalmology, Sir Ganga Ram Hospital and Vision Eye Centres, New Delhi. He is President of the collegium of All India Ophthalmological Society (AIOS) and Chairman, Subspecialty Education Committee, ICO. Dr Grover is a past President of Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery (APSOPRS), AIOS, OPAI. He has been awarded honorary FRCS(Glasgow), FICO and FIMSA. He has also received the distinguished service award from the Asia Pacific Academy of Ophthalmology. He has edited 4 books, authored over 50 publications, 70 chapters and made over 1000 scientific presentations, nationally and internationally. He has won prestigious awards and orations, chaired sessions or conducted courses and live surgeries for many ophthalmic societies in the country and the world including the World Congress, AAO, APAO, APSOPRS and Afro Asian Congress.

Santosh G Honavar, is currently Head, Department of Oculoplasty and Ocular Oncology at the Centre for Sight, Hyderabad. Trained at Wills Eye Hospital, Philadelphia, USA, he is a Fellow of the American College of Surgeons. Formerly he was at LV Prasad Eye Institute, Hyderabad, an Adjunct Professor at the Case Western Reserve University, and Adjunct Associate Professor at the University of Rochester School of Medicine. He is Scientific Program Coordinator of Oculoplastic Association of India (OPAI), Secretary of International Society of ocular Oncology(ISOO), President of Asia Pacific Society of Ocular Oncology and Pathology(APSOOP) and Editor Indian Journal of Ophthalmology(IJO). He has over 230 publications in peer reviewed, journals and has written several book chapters. He has many awards to his credit, namely a few; senior Achievement Award by American Academy of Ophthalmology (AAO), Shanti Swarup Bhatnagar Award by Government of India (GOI), Dr Gullapalli Rao Oration by Indian Medical Association (IMA).

Aruj K Khurana Editor, a Gold Medalist, currently Vitreo-Retina consultant at Nirmal Eye Institute, Rishikesh and has been trained at Narayana Nethralaya, Bengaluru, Karnataka and Sankara Nethralaya, Chennai. He has special interest in Uvea and Vitreo-Retinal disorders. Formerly, he has worked at Department of Ophthalmology, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, Department of Ophthalmology, VMMC and Safdarjung Hospital, New Delhi and Regional Institute of Ophthalmology PGIMS, Rohtak. He has co-authored nine books of ophthalmology and has more than 30 publications to his credit.

Bhawna P Khurana Editor, has done her Long Term Fellowship in Orbit, Oculoplasty and Ocular Oncology from Narayana Nethralaya, Bengaluru. She has done her MS, followed by Senior Residency in Squint and Pediatric Ophthalmology unit from Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi. She has also worked at Department of Ophthalmology, AIIMS, Rishikesh, Nirmal Eye Institute, Rishikesh and RIO, PGIMS, Rohtak. She is a co author of 9 books of ophthalmology and has more than 35 publications and several presentations to her credit.

MSOS e r i e s

Modern System of Ophthalmology

Disorders of

Eyelids, Lacrimal System,Orbit and

Oculoplastic Surgery

CBS Publishers & Distributors Pvt LtdNew Delhi • Bengaluru • Chennai • Kochi • Kolkata • Mumbai

Hyderabad • Nagpur • Patna • Pune

Disorders of

Eyelids, Lacrimal System,Orbit and

Oculoplastic Surgery

AK Khurana MS, FAICO, CTO (London)Fellow, Moorfields Eye Hospital, London

Senior Professor and HeadSquint and Oculoplasty ServicesRegional Institute of OphthalmologyPostgraduate Institute of Medical SciencesRohtak, Haryana

Ashok K Grover MD, MNAMS, FRCS, FIMSA, FICO

Chairman, Department of OphthalmologySir Ganga Ram Hospital andVision Eye CentresNew Delhi

Aruj K Khurana DNB, FICO

Fellow Vitreo-RetinaNarayana Nethralaya, BengaluruConsultant, Vitreo-Retina ServicesNirmal Ashram Eye InstituteRishikesh

Santosh G Honavar MD (AIIMS), FACS

Director, Ophthalmic and Facial Plastic Surgeryand Ocular OncologyCentre for Sight Superspeciality Eye HospitalHyderabad, Andhra Pradesh

Bhawna P Khurana MS, DNB, FICO

Fellow, Orbit, Oculoplasty and Ocular OncologyNarayana NethralayaBengaluru, Karnataka

Editor-in-Chief

Editors

Disclaimer

Science and technology are constantly changing fields.New research and experience broaden the scope ofinformation and knowledge. The editors have tried theirbest in giving information available to them while preparingthe material for this book. Although, all efforts have beenmade to ensure optimum accuracy of the material, yet itis quite possible some errors might have been leftuncorrected. The publisher, the printer and the editors willnot be held responsible for any inadvertent errors, omissionsor inaccuracies.

ISBN: 978-93-86478-07-8

Copyright © AK Khurana

First Edition 2017

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means,electronic or mechanical, including photocopying, recording, or any information storage and retrieval systemwithout permission, in writing, from the editors and the publishers.

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tothe teachers and residents in ophthalmology for

their endeavour to dissipate and acquire knowledgeto our parents and teachers for their blessings

to our families for their understanding and encouragementto our patients for letting us learn

Preface

Modern System of Ophthalmology (MSO) series comprises separate volumes on differentsubspecialties of ophthalmology. Each volume is planned with a very specific aim to cater to theneeds of postgraduate students in ophthalmology.

Salient Features of MSO Series• Each volume is edited by different editors, yet the layout and organization has been kept identical.• Editors of different volumes are masters in their subspecialty with an uncanny knack of picking

up the right perspectives.• Text matter is designed to meet the needs of residents in ophthalmology with a comprehensive

coverage in a concise manner. Text is complete and up-to-date with recent advances incorporated.• Text is organized in such a way that the students can easily understand, retain and reproduce it.

Various levels of headings, subheadings, bold face and italics given in the text will be helpful fora quick revision of the subject.

• A brief list of chapter contents given in the beginning of each chapter provides a clear layout ofthe text.

• Text has been profusely illustrated with high quality coloured photographs and computer drawncolour diagrams which provide vivid details.

• Exposition of the text is such that an average postgraduate student will find it easy to gleanthrough and assimilate the facts for longer retention.

Disorders of Eyelids, Lacrimal System, Orbit and Oculoplastic Surgery. This volume of MSOseries presents the common disorders of the eyelids, lacrimal system and orbit in a comprehensiveyet concise manner. Over the years the demand of oculoplastic surgery is increasing day-by-day.Therefore, in addition to basic knowledge about common disorders of ocular adnexa and orbit asregards their clinical features, diagnosis, differential diagnosis and management, this volume alsoprovides a working knowledge on common oculoplastic procedures. Though primarily meant forpostgraduates in ophthalmology, it is hoped to be useful as a handbook to fellows in the subspecialityof orbit and oculoplastic surgery.

Text matter of this volume has been arranged in three sections:Section I: Disorders of Eyelids, includes a total of twelve chapters. First chapter is devoted to theanatomy and physiology of eyebrows and eyelids and the next nine chapters to the commondisorders of eyelids. Last two chapters of this section comprehensively present the basic principlesof oculoplastic surgery and aesthetic oculoplastic surgery, respectively.

Section II: Disorders of Lacrimal System, covers anatomy, physiology and common disorders of thelacrimal system including the lacrimal sac surgery in six chapters.

Section III: Disorders of Orbit, includes a chapter on anatomy of the skull, orbit and paranasalsinuses; six chapters on disorders of orbit and two chapters on orbital surgery.

Surgical videos of high quality, in the DVD accompanying the text, are an asset for this volume.These offer a quick and vivid understanding of the steps of common surgical procedures on eyelids,ocular surface, lacrimal apparatus and orbit.

viii Disorders of Eyelids, Lacrimal System, Orbit and Oculoplastic Surgery

Editorial team of this volume comprises ophthalmologists dedicated and specialized in oculoplasticsurgery. Dr AK Grover, Chairman, Dept of ophthalmology, Sir Ganga Ram Hospital and VisionEye Centres, New Delhi; and Dr Santosh Honavar, Director, Ophthalmic and Facial Plastic Surgeryand Ocular Oncology, Centre For Sight (CFS), Hyderabad, are established international faculty inthis field. Another editor Dr Bhawna P Khurana, an enthusiastic oculoplastic surgeon, is trained atGuru Nanak Eye Centre (GNEC), New Delhi and Fellow, orbit, oculoplastic surgery and ocularoncology, at Narayana Nethralaya, Bengaluru. Dr Aruj K Khurana, trained at Sankara Nethralaya,Chennai and Narayana Nethralaya, Bengaluru is consultant, vitreo-retina specialist. However,because of his interest in writing, he is deeply associated with each volume of MSO series.

Acknowledgement needs to be made to all those who have been instrumental in making thisvolume a reality. The generous help received from the faculty and residents of Regional Instituteof Ophthalmology, PGIMS, Rohtak is duly acknowledged. The co-operation received from Dr KetanBhardwaj, Dr Devanshu Shakya, Dr Kamal Garg is worth appreciating. My special thanks are dueto the editorial team and the selfless contributors of various chapters. Dr AK Grover and Dr SantoshHonavar deserve special thanks and appreciation for contributing high class surgical videos, whichare an added attraction to this volume. I want to express my gratitude to Prof OP Kalra, Vice-Chancellor, UHS, Rohtak; Prof RK Gupta, Director, PGIMS; and Prof CS Dhull, Head, RIO, PGIMS,Rohtak; for providing an atmosphere conducive to such academic activities.

I want to put on record the remarkable assistance rendered by Dr Aruj Kumar Khurana andDr Bhawna P Khurana in compiling the whole MSO series. The affection and moral support receivedfrom my daughter Dr Arushi and son-in-law Dr Gurukripa, Fellows, Virginia CommonwealthUniversity (VCU), USA and my wife Prof Indu Khurana, Dean-cum-Principal, World College ofMedical Sciences and Research, Gurawar, Jhajjar made my task untiring.

The enthusiastic co-operation received from Mr SK Jain, Managing Director; Mr YN Arjuna,Senior Vice President—Publishing, Editorial and Publicity, and Mrs Ritu Chawla, AGM, Production;CBS Publishers & Distributors, New Delhi, needs special acknowledgement. Mr Sanju andMr Neeraj, graphic artists and Mr Tarun, DTP operator need special mention because of theirefforts to provide considerable beauty to this volume.

In spite of the best efforts, a venture like this is unlikely to be error-free. Constructive criticismand suggestions from the readers are invited for further improvement in this volume.

AK KhuranaEditor-in-Chief

ixContents

Editor-in-Chief

Editors


Fellow Vitreo-RetinaNarayana Nethralaya, BengaluruConsultant, Vitreo-Retina ServicesNirmal Ashram Eye InstituteRishikesh


Fellow, Orbit, Oculoplasty andOcular OncologyNarayana NethralayaBengaluru, Karnataka

Editorial Board

AK Khurana MS, FAICO, CTO (London)Fellow, Moorfields Eye Hospital, London

Senior Professor and HeadSquint and Oculoplasty ServicesRegional Institute of OphthalmologyPostgraduate Institute of Medical SciencesRohtak, Haryana

Ashok K GroverMD, MNAMS, FRCS, FIMSA, FICO

Chairman, Department ofOphthalmologySir Ganga Ram Hospital andVision Eye CentresNew Delhi


Director, Ophthalmic and FacialPlastic Surgeryand Ocular OncologyCentre for Sight Superspeciality EyeHospitalHyderabad, Andhra Pradesh

List of Contributors

AK Khurana MS, FAICO, CTO (London)

Senior Professor and HeadSquint and Oculoplasty ServicesRegional Institute of OphthalmologyPGIMS, Rohtak, Haryana, India


Director, Ophthalmic and Facial Plastic Surgeryand Ocular OncologyCentre for Sight Superspeciality Eye HospitalHyderabad, Andhra Pradesh


Consultant, Vitreo-Retina ServicesNirmal Ashram Eye InstituteRishikesh

Nitin Trivedi MS

Professor of Ophthalmology, andIncharge Oculoplasty ClinicNagri Eye HospitalAhmedabad, Gujarat

Gangadhara Sundar DO, FRCSEd, FAMS

Head, Orbit and Oculofacial SurgeryNational University Hospital SystemSingapore

Sameera Irfan FRCS

Consultant, Oculoplastic and StrabismologistMughal Eye Trust HospitalLahore, Pakistan

Shubhra Goel DO, DNB

ConsultantDepartment of Oculoplasty and Facial AestheticApollo Hospital, Hyderabad

Kasturi Bhattacharjee MS, DNB, FRCS

Head, Ophthalmic Plastic and Reconstructive SurgeriesSri Sankaradeva NethralayaGuwahati, Assam

Swapna Parekh MS, DNB

Consultant, Orbit and OculoplastyJaslok Hospital and Research CentreMumbai, Maharashtra

Urmil Chawla MS, DNB

ProfessorRIO, PGIMS, Rohtak

Ashok K Grover MD, MNAMS, FRCS, FIMSA, FICO

Chairman, Department of OphthalmologySir Ganga Ram Hospital and Vision Eye CentresNew Delhi


Fellow, Orbit, Oculoplasty and OncologyNarayana NethralayaBengaluru, Karnataka

VP Gupta MD, DNB

Professor of Ophthalmology andPrincipalUCMS, New Delhi

Indu Khurana MD

Dean-cum-PrincipalWorld College of Medical Sciences and ResearchGurawar, Jhajjar

Shaloo Bageja DNB, MBBS

Senior ConsultantDepartment of OphthalmologySir Ganga Ram HospitalNew Delhi

Sima DasConsultantOculoplasty and Ocular Oncology ServicesDr Shroff’s Charity Eye HospitalDaryaganj, New Delhi

Raksha Rao MS

Orbit, Oculoplasty and Ocular Oncology ServicesChaitanya Eye Hospital and Research InstituteTrivandrum, Kerala

Shilpa Taneja DNB, MNAMS, FICO

Consultant, Ophthalmologist and Facial Plastic SurgeonHealing Touch Eye CenterNew Delhi

Sunandan Sood MS

Professor and HeadDepartment of OphthalmologyGMCH, Chandigarh

Mehul Shah MS, FMRF

Medical DirectorDrashti NetralayaDahod, Gujarat

xii Disorders of Eyelids, Lacrimal System, Orbit and Oculoplastic Surgery

Shreya Shah DOMS

Administrative DirectorDrashti NetralayaDahod, Gujarat

Reena GuptaAssociate ProfessorRIO, PGIMS, Rohtak

Nishita Beke MS, DNB, FPOS

ConsultantPaediatric Ophthalmologist and StrabismologistDr Beke’s Day Care Centre, Pune

Shweta Goel MS

FellowVenu Eye InstituteNew Delhi

Ketan Bhardwaj MS (st)

Jr ResidentRIO, PGIMS, Rohtak

Arati Diyali DO

Department of Ophthalmic Plastic andReconstructive SurgerySri Sankaradeva NethralayaGuwahati, Assam

Bindu Singla MS

Department of Ophthalmic Plastic andReconstructive SurgerySri Sankaradeva NethralayaGuwahati, Assam

Neebha AnandProfessor of Squint and Oculoplastic UnitRIO, PGIMSRohtak, Haryana

Panchmi Gupta MS

Sr Resident, Department of OphthalmologyNDMC Hospital, New Delhi

Ishita Anand DNB

Senior Resident, Department of OphthalmologySir Ganga Ram Hospital

New Delhi

Amrita Sawhney DNB

Senior Resident, Department of OphthalmologySir Ganga Ram HospitalNew Delhi

Harsh Rathod DNB (st)

Resident, Department of OphthalmologySir Ganga Ram HospitalNew Delhi

Devika Singh DNB (st)

Jr Resident, Department of OphthalmologySir Ganga Ram HospitalNew Delhi

xiiiContents

Preface vii

List of Contributors xi

Section I. Disorders of Eyelids

1. Anatomy and Physiology of Eyebrows and Eyelids 3AK Khurana, Indu Khurana, Bhawna P Khurana, Aruj K Khurana

2. Congenital Anomalies of Eyelids 27Urmil Chawala, AK Khurana

3. Inflammatory Disorders of Eyelids 45AK Khurana, Bhawna P Khurana, Aruj K Khurana

4. Trichiasis, Distichiasis and Entropion 57Ashok K Grover, AK Khurana, Shaloo Bageja, Bhawna P Khurana,Panchmi Gupta, Harsh Rathod

5. Ectropion and Facial Nerve Palsy 75AK Khurana, Gangadhara Sundar, Bhawna P Khurana, Aruj K Khurana

6. Symblepharon and Ankyloblepharon 108Kasturi Bhattacharjee, Bindu Singla

7. Blepharospasm and Related Disorders 118Shubhra Goel

8. Ptosis 127Ashok K Grover, AK Khurana, Shaloo Bageja, Bhawna P Khurana

9. Eyelid Trauma and Techniques of Eyelid Repair 163AK Khurana. Bhawna P Khurana, Shreya Shah, Nishita Beke, VP Gupta

10. Tumours of Eyelid 182Raksha Rao, Santosh Honavar

11. Basic Principles of Oculoplastic Surgery 198Ashok K Grover, Shaloo Bageja, Amrita Sawhney, Devika Singh,Swapna Parekh

12. Aesthetic Oculoplastic Surgery 212Ashok K Grover, Shaloo Bageja, Ishita Anand, Shilpa Taneja

Section II. Disorders of Lacrimal System

13. Anatomy and Physiology of Lacrimal Apparatus and Tear Film 233AK Khurana, Indu Khurana, Bhawna P Khurana, Aruj K Khurana

14. The Watering Eye 256Bhawna P Khurana, AK Khurana, Aruj K Khurana

Contents

xiv Disorders of Eyelids, Lacrimal System, Orbit and Oculoplastic Surgery

15. Dacryocystitis 264AK Khurana, Bhawana P Khurana

16. Lacrimal Passage Surgeries 273Nitin Trivedi

17. Dacryoadenitis 287Kasturi Bhattacharjee, Arati Diyali

18. Tumours of Lacrimal Gland 295AK Khurana, Ketan Bhardwaj, Shweta Goel

Section III. Disorders of Orbit

19. Anatomy of Skull, Orbit and Paranasal Sinuses 301AK Khurana, Bhawna P Khurana, Indu Khuarna, Aruj K Khurana

20. Developmental Anomalies of the Orbit 324Sima Das

21. Proptosis and Enophthalmos 337AK Khurana, Bhawna P Khurana, Aruj K Khurana

22. Orbital Infections and Inflammations 366AK Khurana, Bhawna P Khurana, Aruj K Khurana

23. Thyroid Ophthalmopathy 389AK Khurana, Urmil Chawla, Neebha Anand, Bhawna P Khurana,Reena Gupta

24. Tumours of the Orbit 399Raksha Rao, Santosh Honavar

25. Orbital Trauma 420AK Khurana, Shreya Shah, Mehul Shah, Sunandan Sood,Bhawna P Khurana, Nishita Beke

26. Enucleation and Evisceration 440Sameera Irfan

27. Orbital Surgery 457Ashok K Grover, Shaloo Bageja, Ishita Anand, Amrita Sawhney• Orbitotomy 458• Orbital Decompression 464• Socket Management 471• Exenteration 476

Index 481

xvContents

Contents of DVD

A. EYELID SURGERYI. Entropion Correction• Entropion correction—Fox technique: Santosh Honavar• Entropion correction—Jones procedure: Santosh Honavar• Entropion correction—Marginal rotation: Santosh Honavar• Entropion correction—Tarsal wedge resection: Santosh Honavar• Surgical management of entropion, trichiasis and distichiasis—wedge resection: Ashok K Grover,

Shaloo Bageja

II. Ectropion Correction• Cicatrical ectropion correction—Full thickness skin graft: Ashok K Grover, Shaloo Bageja• Lateral tarsal strip procedure: Ashok K Grover, Shaloo Bageja

III. Ptosis Correction• Ptosis correction—Fasanella-Servat procedure: Santosh Honavar• Ptosis correction—Levator plication: Santosh Honavar• Ptosis correction—Levator reinsertion: Santosh Honavar• Ptosis correction—Levator resection: Santosh Honavar• Ptosis correction—Tarsofrontal sling with ethibond suture: Santosh Honavar• Ptosis correction—Tarsofrontal sling with silicone: Santosh Honavar• Ptosis correction—Silastic sling: Ashok K Grover, Shaloo Bageja• Marcus Gunn jaw-winking ptosis—Bilateral levator excision with bilateral fascia lata sling surgery:

Ashok K Grover, Shaloo Bageja

IV. Blepharophimosis Syndrome• Blepharophimosis correction—Hornblas’ CU plasty with Verwey’s lateral canthoplasty: Santosh

Honavar• Blepharophimosis correction—Transnasal wiring with double Z-plasty: Ashok K Grover, Shaloo

Bageja

V. Eyelid Reconstruction• Direct closure: Santosh Honavar• Cutler-Beard technique: Santosh Honavar• Cutler-Beard technique: Ashok K Grover, Shaloo Bageja• Pedicle flap: Ashok K Grover, Shaloo Bageja• Spectrum of eyelid reconstruction techniques: Ashok K Grover, Shaloo Bageja

VI. Eyelid Retraction• Levator and lower eyelid retractor recession: Santosh Honavar• Techniques for lid retraction correction: Ashok K Grover, Shaloo Bageja, Rituraj Baruah

xvi Disorders of Eyelids, Lacrimal System, Orbit and Oculoplastic Surgery

VII. Eyelid TraumaSurgical management of eyelid trauma: Ashok K Grover, Shaloo Bageja• Eyelid margin repair• Lateral canthal repair• Medial canthal repair• Canalicular repair with Teflon intracanthal tube• Canalicular repair with Mini-Manoka tube• Post-traumatic cicatricial ectropion repair by V-Y and Z plasty

VIII. BlepharoplastyAshok K Grover, Shaloo Bageja

B. LACRIMAL SURGERY• External DCR: Santosh Honavar• External DCR: Ashok K Grover, Shaloo Bageja

C. SOCKET SURGERY• Enucleation with implant—Myoconjunctival technique: Santosh Honavar• Enucleation—Ashok K Grover, Shaloo Bageja• Evisceration—Ashok K Grover, Shaloo Bageja• Socket reconstruction—Mucous membrane graft: Santosh Honavar• Socket reconstruction—Dermis fat graft: Santosh Honavar

D. ORBITAL SURGERY• Orbitotomy—Anterior transconjunctival approach: Santosh Honavar• Orbitotomy—Lateral transcutaneous approach: Santosh Honavar• Lateral orbitotomy—Ashok K Grover, Shaloo Bageja• Orbital decompression—Lateral wall with fat decompression: Santosh Honavar• Orbital exenteration—Eyelid sparing technique: Santosh Honavar• Orbital fracture repair—Transconjunctival approach for orbital floor fracture: Santosh Honavar• Orbital floor fracture repair—Transconjunctival approach: Ashok K Grover, Shaloo Bageja

E. OCULAR SURFACE SURGERY• Ocular surface surgery—Dermolipoma excision: Santosh Honavar• Ocular surface surgery—OSSN excision: Santosh Honavar

orbit and eyelids, disorders of

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