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Ординатура / Офтальмология / Английские материалы / Fundamentals of Clinical Ophthalmology Plastic and Orbital Surgery_Collin, Rose_2001

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Fundamentals of Clinical

Ophthalmology

Plastic and Orbital

Surgery

Edited by Richard Collin and Geoffrey Rose

BMJ Books

Fundamentals of Clinical Ophthalmology

Plastic and Orbital Surgery

Fundamentals of Clinical Ophthalmology series

Glaucoma

Edited by Roger Hitchings

Neuro-ophthalmology

Edited by James Acheson and Paul Riordan-Eva

Paediatric Ophthalmology

Edited by Anthony Moore

Scleritis

Edited by Peter McCluskey

Uveitis

Edited by Susan Lightman and Hamish Towler

Forthcoming:

Cataract Surgery

Edited by David Garty

Cornea

Edited by Douglas Coster

Strabismus

Edited by Frank Billson

Fundamentals of Clinical Ophthalmology

Plastic and Orbital Surgery

Edited by

Richard Collin

Consultant Ophthalmic Surgeon,

Moorfields Eye Hospital,

London, UK

and

Geoffrey Rose

Consultant Ophthalmic Surgeon,

Moorfields Eye Hospital,

London, UK

Series Editor

Susan Lightman

Professor of Clinical Ophthalmology,

Institute of Ophthalmology/Moorfields Eye

Hospital, London, UK

© BMJ Books 2001

BMJ Books is an imprint of the BMJ Publishing Group

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission of the publishers.

First published in 2001

by BMJ Books, BMA House, Tavistock Square, London WC1H 9JR

www.bmjbooks.com

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN 0-7279-1475-8

Typeset by FiSH Books Printed in Malaysia by Times Offset

Contents

Contributors

vii

Preface to the Fundamentals of Clinical Ophthalmology series

viii

Preface

viii

1

Anatomy and general considerations

1

 

Fiona Robinson

 

2

Eyelid trauma and basic principles of reconstruction

7

 

John Pitts

 

3

Ectropion

15

 

Michèle Beaconsfield

 

4

Entropion

24

 

Ewan G Kemp

 

5

Ptosis

32

 

Ruth Manners

 

6

Tumour management and repair after tumour excision

44

 

Brian Leatherbarrow

 

7

Seventh nerve palsy and corneal exposure

67

 

Anthony G Tyers

 

8

Cosmetic surgery

78

 

Richard N Downes

 

9

Socket surgery

89

 

Carole A Jones

 

v

CONTENTS

10

Investigation of lacrimal and orbital disease

98

 

Timothy J Sullivan

 

11

Dysthyroid eye disease

112

 

Carol Lane

 

12

Benign orbital disease

123

 

Christopher J McLean

 

13

Malignant orbital disease

140

 

Michael J Wearne

 

14

Orbital trauma

150

 

Brett O’Donnell

 

15

Basic external lacrimal surgery

161

 

Cornelius René

 

16

Laser-assisted and endonasal lacrimal surgery

168

 

Jane M Olver

 

17

Specialist lacrimal surgery and trauma

174

 

Alan A McNab

 

Index

182

vi

Contributors

Michèle Beaconsfield

Consultant Ophthalmic Surgeon, Moorfields Eye Hospital, London, UK

Richard N Downes

Consultant Ophthalmic Surgeon, General Hospital, St Helier, Jersey, CI

Carole A Jones

Consultant Ophthalmic Surgeon, Kent County Ophthalmic and Aural Hospital, Maidstone, UK

Ewan G Kemp

Consultant Ophthalmologist, Gartnavel General Hospital, Glasgow, UK

Carol Lane

Consultant Ophthalmic Surgeon, University Hospital of Wales, Cardiff, UK

Brian Leatherbarrow

Consultant Ophthalmic, Oculoplastic and Orbital Surgeon, Manchester Royal Eye Hospital,

Manchester, UK

Christopher J McLean

Consultant Ophthalmic Surgeon, Royal Surrey County Hospital, Guildford, UK

Alan A McNab

Consultant Ophthalmic Surgeon, Royal Victorian Eye and Ear Hospital, The Royal Melbourne Hospital and the Royal Children’s Hospital, Melbourne, Australia

Ruth Manners

Consultant Ophthalmic Surgeon, Southampton General Hospital, Southampton, UK

Brett O’Donnell

Consultant Ophthalmic Surgeon, Royal North Shore Hospital and StVincent’s Hospital, Sydney,

Australia

Jane M Olver

Consultant Ophthalmic Surgeon, The Western Eye Hospital, London, UK

John Pitts

Consultant Ophthalmologist, Barts and the London NHS Trust, London, UK

Cornelius René

Consultant Ophthalmic Surgeon, Addenbrooke’s Hospital, Cambridge, UK

Fiona Robinson

Consultant Ophthalmologist, King’s College Hospital, London, UK

Timothy J Sullivan

Clinical Associate Professor and Head, Department of Ophthalmology, Royal Brisbane Hospital, Brisbane, Australia

Anthony G Tyers

Consultant Ophthalmologist, Salisbury District Hospital, Salisbury, UK

Michael J Wearne

Consultant Ophthalmic Surgeon, Eastbourne District Hospital, Eastbourne, UK

vii

Preface to the

Fundamentals of Clinical Ophthalmology series

This book is part of a series of ophthalmic monographs, written for ophthalmologists in training and general ophthalmologists wishing to update their knowledge in specialised areas. The emphasis of each is to combine clinical experience with the current knowledge of the underlying disease processes.

Each monograph provides an up to date, very clinical and practical approach to the subject so that the reader can readily use the information in everyday clinical practice. There are excellent illustrations throughout each text in order to make it easier to relate the subject matter to the patient.

The inspiration for the series came from the growth in communication and training opportunities for ophthalmologists all over the world and a desire to provide clinical books that we can all use. This aim is well reflected in the international panels of contributors who have so generously contributed their time and expertise.

Susan Lightman

Preface

This book covers the whole field of eyelid, lacrimal, orbital and socket surgery. As part of the series of ophthalmic monographs it is written for ophthalmologists in training and general ophthalmologists wishing to update their knowledge of oculoplastic surgery. It aims to provide a practical guide to the management of basic oculoplastic problems. It does not try to give didactic details of a systematic series of surgical procedures, but rather to present an outline of the different options which are available to the surgeon with their advantages and disadvantages.This is achieved by a team of contributors practising in different countries throughout the world who have all worked at Moorfields Eye Hospital with the editors, but who have adapted their practice to their current local circumstances. In this way we hope to have provided a surgical guide which will be of value throughout the world.

Richard Collin

Geoffrey Rose

viii

CHAPTER TITLE

1 Anatomy and general considerations

Fiona Robinson

A sound understanding of the basic anatomy of the eyelids, lacrimal system and orbits is essential in order to perform successful surgery.This chapter presents a basic overview together with general considerations relative to oculoplastic and orbital surgery.

 

Whitnalls ligament

 

Orbicularis

Pre-Aponeurotic

fat

 

 

pad

 

Orbital septum

 

 

 

Levator palpebrae

Levator

superioris

 

 

aponeurosis

 

 

Post-

 

 

Aponeurotic

 

 

space

Superior rectus

Mullers

 

 

muscle

 

 

Tarsus

 

 

 

Inferior rectus

Tarsus

 

 

Orbital

 

 

septum

Inferior

oblique

 

Pre-Aponeurotic fat pad

Orbicularis

Figure 1.1 Sagittal view of the eyelid structures.

The eyelids

The eyelids may be divided into anterior and posterior lamellae. The anterior leaf is composed of skin and orbicularis and the posterior of tarsus and conjunctiva. The “grey line” of the lid margin marks the separation

between conjunctiva which covers tarsus and squamous epithelium which covers orbicularis. In plastic surgery, procedures are often described as involving the anterior or posterior lamella.

The upper lid margin lies 1 to 2mm below the superior limbus, the peak lying just nasal to the centre of the pupil. The lower lid margin sits at the corneal limbus, its lowest portion lying slightly temporal to the pupil. The upper lid crease is 8 to 12mm above the lashes and is formed by the subcutaneous insertion of the terminal fibres of the levator aponeurosis. The lower lid crease is more poorly defined as there are no subcutaneous insertions corresponding to those of the upper eyelid. The nasojugal fold extends inferior and laterally from the medial canthal angle along the side of the nose and the angular blood vessels will generally be located in this fold.

Skin

Eyelid skin is thin allowing good mobility of the eyelids. In part due to this thinness, it has a tendency to stretch with age. The resultant excessive skin can be used for full thickness skin grafts. Such skin grafts take well as there is little subcutaneous fat. It should be noted that the lower lid has no vertical excess skin and one should excise lesions from the lower lid as vertically as possible to avoid a cicatricial ectropion.

1