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.
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Whitnalls ligament |
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Orbicularis |
Pre-Aponeurotic |
fat |
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pad |
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Orbital septum |
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Levator palpebrae |
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Levator |
superioris |
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aponeurosis |
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Post- |
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Aponeurotic |
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space |
Superior rectus |
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Mullers |
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muscle |
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Tarsus |
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Inferior rectus |
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Tarsus |
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Orbital |
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septum |
Inferior |
oblique |
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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
