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(Tumours of the eye and adnexa)
basal cell carcinoma
Here, A 66 year old lady presented with a history of a slow growing ulcerated mass near the corner of her eye. The lesion was treated with excision under frozen section control and a skin graft was placed. The lesion was a basal cell carcinoma - a commonly occuring skin cancer that can affect the eyelid and needs specialized care and skill to treat. At one year following surgery, there has been no recurrence.
Sebaceous Gland Carcinoma
Ocular oncology is a niche area of ophthalmology with only a handful of experts across the country. Dr Akshay G. Nair trained in ocular oncology at L V Prasad Eye Institute, Hyderabad, India and New York Eye & Ear Infirmary of Mount Sinai, NY, USA.
Ocular Oncology encompasses all tumours - benign and malignant that can effect every part of the eye - the eyelid, conjunctiva, choroid, retina, optic nerves and the orbit as well. A few typical cases, that are representative of the type of cases that Dr. Akshay Nair usually treats and operates upon are shown here:
Sebaceous Gland Carcinoma is one of the most common eyelid tumours, especially in the Indian subcontinent. This lower lid mass was detected earlier and operated upon by Dr. Akshay Nair and reconstructed using a Tenzel's semicircular flap. Dr Nair has written extensively about sebaceous gland carcinoma and has presented papers on this subject as well.
Orbital Cavernous hemangioma
In this case, CT scan of the orbit showed a large tumour behind the eye. The mass was excised in a way that no damage to the optic nerve or the eye occured and the tumour was completely removed as well with a smooth recovery. Below is a video of the surgery:
The tumour that was removed here measured nearly 3 cm x 3 cm - removed entirely through a scarless incision
An unusual eyelid mass
This is a case of an unusual, rare eyelid tumour called 'Trichoblastoma'. This tumour arises from the hair follicles of the eyelashes. This tumour was excised using a Cutler-Beard flap where the lower lid is used to re-create the upper lid. The aim of such reconstructive surgeries is to ensure complete removal of the tumour and aesthetic as well as functional reconstruction of the eyelid.
Tarsal dermoid or epidermoid cysts are common lid tumours. Here Dr. Akshay Nair has surgically removed this eyelid mass without leaving behind a prominent eyelid scar.
Orbital lymphangiomas are rare benign lesions that result from abnormal blood vessels. They have high chances of recurrences, bleeding and increasing in size if left untreated. The treatment can be tricky as surgery doesnt have very successful outcomes. Recently, a new technique was developed to treat orbital lymphangiomas called called sclerotherapy using a drug, Bleomycin. In the case shown above, Dr. Nair aspirated and sclerosed the anterior orbital lymphangioma with Bleomycin. At one month following treatment, the mass had completed regressed with excellent outcomes and no recurrence at 6 months.
As is visible from the picture above, conjunctival tumours can present in a variety or forms, shapes and colours. Conjunctival tumours can be benign as well as malignant. There are many different modalities for treating conjunctival tumours. For ocular surfce squamous neoplasia (OSSN) that are amenable to surgery, the 'no touch' technique is performed. Dr. Akshay Nair, in his practice, has performed hundreds of surgeries to treat such tumours of the conjunctival surface. This video below is one such surgery performed on an ocular surface squamous neoplasia (OSSN).
No-touch technique of conjunctival tumour excision
Surgeon: Dr. Akshay G. Nair
In some advanced cases of eyelid and conjunctival surface tumours, the entire eyelid and the eye or its surrounding tissue may be involved. This typically indicates orbital extension of the tumour. In select cases, a radical surgery like an orbital exenteration may be required. Here in this video, Dr. Akshay G. Nair performs an orbital exenteration in a patient who had orbital invasion of an ocular surface squamous neoplasm.
Surgeon: Dr. Akshay G. Nair
An upper lid Mass
Here, an upper eyelid schwannoma was excised using a lid crease incision. This is a technique that ensures a hidden scar that is virtually invisible.
Ocular Oncologists also diagnose and treat tumours within the eye. The most common intraocular tumours in adults are are choroidal melanoma and choroidal metastases. Dr Nair is also trained to treat retinoblastoma, a common tumour seen in children. The treatment of retinoblastoma (RB) is done in conjunction with a dedicated team of pediatricians and pediatric oncologists.
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