Orbital Area Birth Defects
Congenital Orbital Abnormalities

CONGENITAL PTOSIS – DROOPING EYELIDS
Ptosis that is present at birth is called congenital ptosis.  Children born with moderate to severe ptosis may require treatment to allow for normal vision development. Congenital ptosis is thought to be caused by poor levator muscle development.  The levator muscle is the lifting muscle of the eyelids.

Children born with ptosis may also have:

• eye muscle abnormalities
• muscular disease
• eyelid or other tumors
• neurological disorders: refractive errors

The most obvious sign of ptosis in children is the drooping eyelid itself and the asymmetry that is typical of the upper eyelid creases.  Children suffering with ptosis often tilt their heads back into a chin-up position to be able to see from beneath their
eyelids.  Ptosis, if not corrected early on, can cause other childhood eye problems such as amblyopia (lazy eye), astigmatism, and may hide crossed eyes which often leads to astigmatism.  Dr. Cole encourages early diagnosis and treatment for congenital ptosis and often performs corrective surgery.  The technique will depend upon the overall strength of the eyelid muscle.  One of the following procedures will be used:

PTOSIS SURGERY – EXTERNAL
This involves and incision made in the crease of the eyelid through which Dr. Cole works to adjust the levator muscle to raise the eyelid to the correct position.

PTOSIS SURGERY – FRONTALIS SUSPENSION:
Incisions are made in the crease of the eyelid and above the eyebrow.  The eyelid muscle is then attached to the eyebrow muscle by using a silicone sling as a suspender. When the child raises his eyebrow, the eyelid raises as well.

NASOLACRIMAL DUCT OBSTRUCTION (Dacryostenosis)
Nasolacrimal duct obstruction (Dacryostenosis) simply means a tear duct is blocked. But the problems this causes are not so simple.  Tears help clean and protect the eye and are produced in the lacrimal gland under the bone of the eyebrow.  Tears from the lacrimal gland flow over the eye, through tiny ducts along the eyelid, and drain away from the eye through two small openings at the inner corner of the eyelids – where they then drain into a larger passage from the eye to the inside of the nose – called the nasolacrimal (tear) duct.  In some babies the openings have not been formed properly - causing blockage since the tears have no place to drain.  A blocked tear duct can occur in one or both eyes.

SYMPTOMS OF CONGENITAL BLOCKED TEAR DUCTS: (Dacryostenosis)

• tears pooling in the corner of your baby’s eye
• tears draining down your baby’s eyelid and cheek
• mucous or yellowish discharge in the eye
• reddening of the skin from rubbing the eye(s)
• blocked tear ducts may only be noticeable when your baby cries or in cold/windy weather when tears are stimulated
• blocked tear ducts may resemble other conditions or medical problems – so be sure to consult with your child’s pediatrician for a diagnosis

Dr. Cole treats severe cases surgically using the following approaches – depending upon the severity of your baby’s condition:

EXTERNAL DCR SURGERY:
Dr. Cole makes an incision inside the nose in the treat trough area.  Bony tissue is removed from the lacrimal passage to create more space for tears to drain.  A temporary tube is inserted and holds the passageway open while healing takes place.  The tube is typically removed 1-3 months after surgery. Residual tearing is normal while the tube remains in place since it is a temporary obstruction.

INTRANASAL DCR SURGERY:
Dr. Cole uses this technique to achieve the same thing as the external approach – but instead of having an incision on the face – the lacrimal system is opened by going through the nose.

CDCR TEAR DUCT SURGERY:
This approach involves inserting a tiny Pyrex glass tube which is permanent.  This allows free drainage of tears.

CONGENITAL MASS DEFECTS

DERMOID TUMORS/CYSTS:
Congenital Dermoid tumors are cysts that contain skin cells, hair follicles, oil glands and smooth muscle cells.  Often found behind the eyebrows, dermoids can occur anywhere on the skull and forehead.  The treatment is safe and simple involving an incision over the orbital (eye) area and then Dr. Cole dissects the mass removing it.  It is sent to pathology for analysis.  The incision is closed and dressed.

HEMANGIOMAS:
An infantile hemangioma or “strawberry mark” is a very common type of birthmark made up of blood vessels.  Most hemangiomas are not visible at birth and when they do appear, they show up as a small bruise, scratch or a tiny red bump.  Hemangiomas, unlike other types of birthmarks, grow and change greatly during the first months of your baby’s life. They may occur anywhere on the skin’s surface and all skin hemangiomas are clearly visible by 6 months of age. Hemangiomas are most common on the head or neck and Dr. Cole treats them surgically when it is required.  This involves excision of the hemangioma to prevent further problems – especially when it’s located on or near the eyelids.

PROBLEMS OF HEMANGIOMAS AROUND THE EYES:

• Rapid growth can obstruct your baby’s vision
• Obstruction can results in irreversible loss of sight
• Skin over the hemangioma can break down – become painful – cause infections

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BOARD CERTIFICATION

Dr. Cole is a quadruple board certified surgeon which means he has met the rigorous high standards and training requirements of four medical boards.  This involved several years more of specialized training and experience in all four areas – in addition to medical school, internships, residencies, fellowship training and vast experience. Board certification does not guarantee a certain outcome, but it does ensure specialized training skill and expertise far beyond the norm.
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