- Surgical procedures are varied as to what is required in a particular situation. According to the type of disorder or disease, surgery may be indicated immediately or reserved as a later alternative in cases that do not respond well to other, less invasive, treatments.
See more under Refractive Surgery, Detached Retina, or individual names.
Cataract removal is the most common surgery performed in North America. There are three main types of cataract surgery: intracapsular, extracapsular, and phacoemulsification:
- Intracapsular removes the entire cataract with its surrounding capsule in one piece.
- Extracapsular opens the front of the capsule and separately removes the nucleus and cortex of the lens, while the clear back part of the capsule is purposely left behind.
- Phacoemulsification is the most common method of cataract removal. A small incision (or a no-stitch surgery) is performed on the side of the cornea, and a tiny probe is inserted into the eye. The probe produces ultrasound waves that break up the cloudy center of the lens. The liquified lens can then be suctioned out leaving behind the clear posterior capsule. After the cloudy lens has been removed, it is usually replaced with a clear artificial lens called an intraocular lens (IOL), which becomes a permanent part of the eye and does not require any additional care or attention. The person wearing the IOL does not feel or see it. In some cases, patients cannot have an IOL, because of problems that occur during surgery or another eye problem. In these cases, a soft contact lens or glasses may be used instead.
Corneal transplant, or keratoplasty uses a donor cornea to replace all or part of the diseased cornea and restore vision. A section of the donor cornea is measured to the precise needs of the host and removed with scissors. A corresponding section of the host cornea is measured and removed. The donor cornea is placed into the remaining cavity and sewn into position with small stitches or sutures. Cornea surgery may have to take place if the cornea becomes damaged by a deep scratch. Bacteria or fungi can pass into it and cause serious infection. Infection can also result from ocular herpes or herpes zoster. Such other conditions as keratoconus, Fuch’s dystrophy, and Lattice dystrophy can also cause corneal problems. If the cornea becomes too damaged, a corneal transplant may have to take place. About 40,000 such transplants take place each year in the US. Corneas are obtained from donors and stored in eye banks. During a cornea transplant, the diseased or damaged cornea is removed from the patient’s eye, and the donor cornea is stitched into place. The stitches are removed after the eye heals, usually after several months. A new type of corneal surgery is the insertion of small semicircular lenses into the cornea, outside the optical zone. These inserts, called Intacts (or Intrastromal Corneal Ring Segments), are designed to correct myopia (nearsightedness).
Enucleation is the surgical removal of an eyeball. It is performed when the eye contains a malignant tumor, when the eye is blind and causes pain, and when the eye is nearly blind and sympathetic ophthalmia is a risk.
Glaucoma surgery is sometimes indicated, depending on the type and condition. Two major forms of surgery are:
- Iridectomy – This is a surgical procedure in which a portion of the iris is removed to eliminate the blockage of angle-closure glaucoma and prevent further attacks.
- Trabeculectomy – This is a filtering surgery which bypasses damaged meshwork and creates a new drainage tract to allow the aqueous to flow from the eye.
Oculo-plastic surgery combines ophthalmology and plastic surgery. It is used to treat conditions and diseases affecting the eyelids, eyebrows, the tear system, and the bones around the eye. Children with congenital eyelid deformities and adults with drooping eyelids (ptosis) are just two such conditions that would require oculo-plastic surgery. Others include eyelid skin cancer, thyroid eye disease that results in bulging eyes, tear drainage system disorders, and any orbital disease. Procedures used to correct these and other condtions include blepheroplasty, dacrocystorhinostomy, and ptosis repair. Although rare, complications do happen as a result of anesthesia injections around the eye. Some of these include perforation of the eyeball, destruction of the optic nerve, interference with circulation of the retina, anpossible drooping of the eyelid, respiratory depression, hypotension (low blood pressure), stroke, bleeding behind the eye, and loss of life.
Radial keratotomy (RK) surgery is an elective surgery designed to improve myopia. The procedure uses radial cuts or incisions to reshape the cornea.
Tarsorrhaphy is a surgical procedure in which a section of the eyelids is stitched together at the corner of the eye. The surgery is performed in the treatment of dendritic ulcers, Bell’s palsy, thyroid disease, or any disorder in which the eye is in danger of overexposure or drying.
Tear duct surgery is often indicated in cases of wet eye. Obstructions are cleared surgically by simple probe and irrigation or silicone intubation procedures, or the more serious surgical procedure called a dacryocystorhinostomy.