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Mohs surgery involves the systematic removal and analysis of thin layers of skin at the tumor site until the last traces of cancerous tissue have been eliminated. The immediate and complete microscopic examination and evaluation of excised tissue is what differentiates Mohs surgery from other cancer removal procedures. Only cancerous tissue is removed, minimizing both post-operative wound size and the chance of regrowth.
Mohs surgery is most commonly used for basal and squamous cell carcinomas, although it can be recommended for the eradication of other cancers such as melanoma. High precision makes Mohs surgery ideal for the elimination of cancers in cosmetically important areas such as the face (nose, eyelids, lips, hairline), hands, feet and genitals.
Trauma
Injury to the bones of the mid-face (upper jaw, cheeks and sinuses) and orbit (eye socket) can cause double vision and/or sinking of the eye into the socket or cheek. Repairing an orbital fracture provides support to the eye to prevent or correct these complications. The decision to perform surgery on the orbit depends on the severity of the injury as well as the doctor's and patient's preferences. Sometimes a CT scan will be done to help make the decision.
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Facial and lid lacerations are trauma-induced cuts, tears or ragged openings in the skin of the face or eyelid. Lacerations need to be surgically repaired to prevent or diminish the appearance of scars or other facial disfigurements. Eyelid lacerations need to be treated as soon as possible, since it may become difficult to restore normal eyelid function if the injury begins to heal incorrectly. If the lacerations affect the lacrimal system, more complex treatment is needed to reconnect the pathways in the eyelid.
Lid Malposition
Ptosis is a condition in which the eyelid droops. It is caused by a weakness or separation of muscles deep within the eyelid. Ptosis does not involve excess skin or tissue in the eyelid (a condition called dermatochalasis). It is usually a result of aging, but some people develop ptosis after eye surgery or an injury, and some children are born with the condition. A brief surgical procedure can eliminate the drooping. Many young patients with mild to moderate ptosis do not need surgery early in life. Patients who are also suffering from excess skin may choose to undergo blepharoplasty at the same time as ptosis repair. Children with ptosis should be examined regularly to check for other vision problems including amblyopia ("lazy eye"), refractive errors and muscular diseases.
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Retraction (pulling back) of the upper and lower eyelids results from a change in the normal resting position of the eyelid. Retraction can leave a person unable to close his/her eyes. The most common cause of lid retraction is eye protrusion (bulging) due to Graves' disease. It has also been linked to midbrain disease and blepharoptosis. Eyelid retraction can be easily characterized by the appearance of white space between the edges of the eyelids and the iris.
People who have had untreated lacerations of their eyelid(s) may find that scarring leaves the lid(s) malpositioned. Scar tissue doesn't have the same characteristics as the skin it replaces and thus can impede normal function of the eyelids. Some patients might not even be able to close their eyes, which may lead to irritation, corneal abrasion and corneal ulcer. In most cases, lid malposition can be surgically corrected.
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Entropion refers to an inward turning of the eyelid against the eyeball. Ectropion is the opposite, an outward turn of the eyelid in which the eyelid no longer comes in contact with the eyeball. Both conditions can lead to eye irritation, redness, and tearing, and entropion can result in a corneal ulcer as well. Irritation and redness is usually treated with drops to soothe and moisten the eye; however, the actual malposition of the eyelid must be resolved through surgery.
Blepharophimosis is a congenital (birth) deformity in the eyelid primarily characterized by ptosis (drooping). It can also include deformities of the surrounding tissues of the eye. People with blepharophimosis usually can't see past their eyelids very well, if at all. The condition is usually inherited, and can repaired through surgical correction.
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Canthal dystopia is an unusual facial feature characterized by a subtle deformation of the corners of the two eyelids (canthi). Dystopia occurs when the canthi are spaced farther apart than normal, creating an illusion in which the eyes appear to be widely spaced, even though they are not. The condition is normally associated with Type I Waardenburg syndrome.
Congenital lid defects are any of multiple different eyelid abnormalities that are present at birth. Most of these physical anomalies can be corrected. Dr. Christensen will evaluate the condition and recommend an appropriate course of action.
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Socket Abnormalities
The eye socket (orbit) can be affected by a variety of injuries, tumors and congenital defects. These abnormalities can usually be corrected with outpatient surgery. Consult with Dr. Christensen for a full diagnosis and treatment plan.
Enucleation refers to the surgical removal of the eyeball. The procedure removes the actual orb of the eye, but leaves all adjacent, internal structures in place, including the muscles of the inner eye socket and the eyelids. Enucleation may be prescribed when the patient has cancer of the eye, end stage glaucoma, congenital cystic eye, or severe injury of the eye. After the eye has been removed and the surrounding structures have healed, an ocular prosthesis (artificial eye) may be implanted. While the prosthesis does not restore sight, it does provide a natural appearance and restore volume to the eye socket.
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Evisceration is a surgical procedure in which the internal contents of the eye are removed but the sclera and extraocular muscles remain attached. A globe is inserted into the cavity and covered by a conformer to prevent contracture of the eye. Evisceration is usually prescribed for cases of antibiotic-resistant endophthalmitis and for improvement of cosmesis in a blind eye.
Ocular implants refer to devices that are surgically implanted in the eye to improve vision, replace an enucleated eye, or otherwise assist in the treatment or correction of an eye condition. Over 200 intraocular implant designs are in use today. The appropriate device is prescribed depending on examination results and diagnosis by Dr. Christensen.
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Socket reconstruction deepens and strengthens the internal structure of a contracted eye socket following enucleation (removal of the eyeball). This is done to enable implantation of an ocular prosthesis. During the procedure, the surgeon recreates and restores normal anatomic function to the structures and tissues of the orbital cavity, while also creating the extra space needed to accommodate the prosthesis.
Orbital Pathology
The orbit, or eye socket, is the cavity containing the nerves, muscles and structures surrounding the eye. It also refers to the bones that make up the cavity. This small, highly complex area is vulnerable to injury, including lesions or fractures. Abnormalities in any of the neighboring structures may cause deformities in the eye or orbital cavity. Given the orbit's relatively small area and tight confines, tumors or other conditions that cause orbital structures to grow may disrupt normal ocular function.
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Patients may notice the growth of an orbital tumor through symptoms such as reduced visual acuity, fullness of the eyelid, swelling, discharge and pain. Diagnosis is made after a full ophthalmic evaluation that usually includes an examination for surface deformities and a measurement of ocular globe displacement. Because of the numerous possible causes for an orbital tumor, a variety of tests are necessary on the orbital cavity as well as the surrounding structures.
An orbital fracture is a break in any of the bones in the eye socket. They usually occur after forceful trauma. Aside from pain, symptoms of an orbital fracture include bruising and swelling around the eye, double vision and decreased eye movement. Depending on the extent and location of the break, orbital fractures can lead to eye injury and permanent ocular damage. Since the symptoms that characterize an orbital fracture may resemble other eye conditions, it is important to see Dr. Christensen as soon as possible.
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Lacrimal Structures
Lacrimal structures produce and drain tears. The lacrimal apparatus encompasses a series of glands, ducts, sacs and cavities that runs from the top of the eye to the inside of the nose. In addition to tear production and drainage, the lacrimal structures drain mucous and bacteria from the surface of the eye.
Tearing is a common condition that occurs when the lacrimal glands produce too much fluid, typically to the point where tears run down the patient's face. It can be caused by dry eye syndrome, nasolacrimal duct obstruction, corneal abrasion, foreign bodies present in the eye, and a variety of other conditions. An ophthalmic exam will reveal the cause, enabling effective treatment.
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The nasolacrimal duct (NLD) is the pathway through which mucous and tears are drained from the eye into the nose. When this pathway becomes obstructed, or blocked, debris backs up in the duct, and will sometimes cause infection. An NLD obstruction generally does not put the eye itself in danger except in the rare case of a severe orbital infection. NLD obstruction typically presents few or no physical symptoms aside from tearing in the eye.
Pediatric lacrimal obstruction is a common condition in infants that is characterized by excessive discharge and crusting around the eye. The condition self-corrects in the majority of affected children at about one year, and so Dr. Christensen may recommend that you wait until after the first year to pursue treatment. In some cases, parents may be able to resolve the obstruction by gently massaging the side of the eye near the nose. Depending on the child's age and the severity of the problem, further treatment may be pursued.
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The punctum is the opening in your eyelid that drains tears from the eye surface into the lacrimal sac. There are a variety of punctal abnormalities that can form and impede lacrimal system or eyelid function. These abnormalities can be caused by congenital defects, trauma, tumors or infection, and can lead to more serious eye conditions if left untreated. Punctal abnormalities require surgical correction.
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Thyroid Eye Disease
Thyroid eye disease, also known as Graves' disease, is a common eye condition arising from problems in the thyroid gland. Located in the neck, the gland can produce excess thyroid hormone, which can lead to a variety of medical problems throughout the body. One of these is damage to the structures in and around the eye. Thyroid eye disease, also known as Graves' disease, is characterized by protrusion of the eye (proptosis, or exophthalmos), swelling of the tissues and muscles around the eye, eyelid retraction, and extremely dry eyes. All of these symptoms together can lead to significant damage or ulceration of the cornea. In rare cases, there may be damage to the optic nerve, causing blindness.
Retraction (pulling back) of the upper and lower eyelids results from a change in the normal resting position of the eyelid. Retraction can leave a person unable to close his/her eyes. The most common cause of lid retraction is eye protrusion (bulging) due to Graves' disease. It has also been linked to midbrain disease and blepharoptosis. Eyelid retraction can be easily characterized by the appearance of white space between the edges of the eyelids and the iris.
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Strabismus, or crossed eyes, is the term for when a person cannot align both eyes on an object at the same time. The condition occurs in about 5% of children, and many adults suffer from it as well. Strabismus can be congenital (present from birth) or acquired from eye injury, diabetes, stroke and other conditions. Strabismus may manifest at first as double vision. If left untreated, it can lead to visual impairment, loss of binocular vision, and blindness in the weaker eye. For children, early treatment is best, preferably before the age of six. Older patients can be helped as well; it's never too late to seek treatment.
Proptosis is a protrusion or bulging outward of the eye. Proptosis is not a disease in itself, but instead is caused by an underlying ocular disorder. The most common is Graves' disease. Other causes include hemorrhage (bleed) behind the eye due to trauma, orbital inflammatory pseudotumor, and severe inflammation (swelling) of the orbital cavity. Proptosis usually resolves when the condition causing it has been treated.
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