Dr Richard Allen Speaks on the Evolution of Oculoplastic Surgery for Children

At the American Academy of Ophthalmology's 2022 conference, Richard C. Allen, MD, PhD, FACS, an oculoplastic surgeon at Texas Children's Hospital and a professor at Baylor College of Medicine, spoke on how oculoplastic surgery in pediatric patients has changed.

Transcript

What advancements in oculoplastic surgery have improved patient outcomes related to operating on children?

So, ideally, in kids with congenital ptosis who are quite young, we're going to have to do a frontalis sling and use a foreign material or a synthetic material as a sling. By definition, that is going to wear out and we're going to have to repeat the surgery, so the advantage of the frontalis flap is that potentially this is going to be a one-and-done surgery for them.

And then in older children, where we would be able to take tissue from the leg, again, it's a good surgery, but it involves taking tissue from another side of the body, potentially giving them a scar on the leg that they don't like. And with frontalis flap surgery, that's going to obviate those sorts of things. So, I think it's a really exciting time with regard to treatment of congenital ptosis. I think this is going to change my practice. I'm very excited about it.

Other things surgically that we can think about in treating kids, there are a number of things that we do. Basically, when we think about the problems that children have that we're going to treat in oculoplastic surgery, we have ptosis, which we just talked about, and we have tearing, which is nasal lacrimal duct obstruction. Five percent of kids are born with clogged tear ducts; the vast majority will go away by the age of 1 year, but if they're still clogged at that age, then we're going to intervene. There haven't been a lot of advances with regard to treating that, but I think currently there are some newer things that we're looking at.

Some of the problems that we have in treating that is we often will put stents in and then those stents can prolapse early and cause problems. And I think there's some newer self-retaining stents and even people are just not tying the stent so that the stents won't cause a problem later.

With regard to other things that we see in oculoplastics and children, a big thing that's going on in oculoplastics overall is the treatment of neurotrophic keratopathy. This is not just for kids, but also for adults. And there's a new procedure called corneal neurotization, and I think that that's going to change our treatment of these kids who have congenital corneal anesthesia.

Previously, the way we would treat that is, hopefully, try to get them by with lubrication but sometimes we have to sew their eyelids shut. And, again, that is not an ideal surgery for these patients. So, with corneal neurotization, basically what we're doing is using a nerve graft to hook up one of the sensory nerves to the cornea and reestablish corneal sensation. So, really exciting time, I think, for that as well, and I think we've had some really promising results actually with that surgery.