Children and Paediatric Oculoplastic Surgery

Mr Uddin has a wealth of experience spanning more than 25 years in ophthalmology and Oculoplastics treating children. He sees both common conditions as well as more complex and unusual conditions affecting the eyelid, orbit and lacrimal system (watery eye) in children. He has served as clinical lead for the paediatric adnexal (oculoplastic, orbital and lacrimal) service at Moorfields Eye Hospital, delivering excellent clinical and surgical treatment at the purpose-built Children’s Eye Centre. Due to his national and international reputation, he receives a wide range of referrals from the UK and abroad.

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For complex conditions that extend beyond the eyelids and orbit, Mr Uddin works with a team of world-class physicians and surgeons at institutes such as Great Ormond Street and St George’s Hospital Medical School.

Mr Uddin understands the anxiety felt by parents when trying to get the correct diagnosis, likely prognosis and progress of the condition. He is very aware of the worry that parents go through the effects on vision and facial development.

Timing of treatment and surgery is very important in children and needs to be carefully considered, taking into account both the child’s needs as well the parent's wishes. He feels it is exceptionally important to minimise stress and anxiety for the child and their family by establishing a relaxed, safe and comfortable environment.

Watery Eyes

Although watery eyes are common, especially for babies, they can be a sign of a blockage of the tear duct (Congenital Nasolacrimal Duct Obstruction). Symptoms usually appear in the first few months of life and include sticky eyes with mucus or pus on the eyelashes and redness of the skin surrounding the eye.

The majority of cases resolve with minimal medical intervention. Regularly massaging the area of the tear duct is usually effective in releasing the blockage. Topical antibiotics are used for any infections. For infants with a persistent blockage and watery, sticky eyes, where conservative treatment and time have failed.

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Syringe and probe

When a probe is passed down the tear drainage system to open it. Its performed with a GA. No cuts or incisions are made.

DCG - Dacryocystogram

DCG- Dacryocystogram an X-ray where dye is passed down the tear drainage system to assess the level of the blockage, narrowing or patency.

DCR (Dacryocystorhinostomy)

Surgery carried out to create a new connection between the tear duct sac and the nose (either externally or endoscopically).

Ptosis

Ptosis is defined as a drooping of the upper eyelid. If untreated in children, ptosis can lead to eyesight problems such as astigmatism or a lazy eye (amblyopia). Children with ptosis sometimes need to tip their head back to see (chin-up head posture), which can cause physical stress. In newborn babies (congenital ptosis) one or both eyes may appear smaller or closed.

Congenital ptosis, present from birth, is usually caused by a defect in the muscle which raises the eyelid. In rare cases, it can be caused by trauma during birth or by genetic conditions including Marcus Gunn ‘jaw winking’ syndrome and blepharophimosis syndrome.

Ptosis occurring later in childhood can be caused by an eyelid swelling, infection or trauma to the eyelid, or infrequently by a neuromuscular or nerve condition.

Ptosis surgery can be performed on children as young as six months and is done under general anaesthetic. The decision for a child to undergo surgery is determined by careful consideration of the cause of the ptosis, the effect on vision and the child and the parent's wishes.

The type of surgery is determined by the degree of ptosis and strength of the levator muscle (eyelid lifting muscle). Sometimes the “good” eye can also have surgery to improve symmetry.

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Epiblepharon, Entropion and abnormal eyelashes

It can be difficult sometimes to distinguish the exact problem. Careful examination is required. Children may have symptoms of a watery eye, aversion to light, intermittent red or sticky eyes.

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Eyelid lumps and bumps

It is common for children to develop swellings on the eyelid. The majority of these are styes or chalazion, caused by a blockage in the oil glands of the eyelid. In rare cases, these lumps may not be simple cysts, but have a more serious cause for the swelling including tumours.

Styes or chalazion will usually improve or disappear without any medical intervention, but can be treated using a warm compress. Sometimes a steroid injection or a short course of antibiotics may be needed. Chalazion are sometimes drained surgically.

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Tumours and swellings of the orbit

Tumours may present at birth or develop and become more apparent. It is important to assess and maintain visual development as well as diagnose and treat any conditions

Dermoids

Dermoids are the most common swelling, usually present at birth, but may become more obvious with growth. They are usually in the outer part of the eyelid. It is normally a clinical diagnosis, but occasional imaging is performed. Surgery is often the treatment to remove them

Malignant tumours may show as persistent cellulitis, lid swelling or protrusion of the eye.

Dermolipoma is uncommon.

Capillary haemagioma
Facial asymmetry
Rhabdomyosarcoma
Inflammation of the eye socket (Orbit)

Inflammation of the eye socket (orbit) in children can be caused by a number of conditions including infection, trauma and in rare cases a tumour. It can sometimes occur spontaneously (Idiopathic Orbital Inflammatory Syndrome). In older children it may be caused by TED.

Facial palsy

Children with facial palsy (paralysis or weakness of the facial muscles) may have a noticeable droop affecting one side of the face, excessive drool and difficulty feeding and speaking. It can be caused by a, trauma during birth or problems with the nerves such as Bell’s palsy.

Sometimes a tumour, genetic syndrome or abnormal development of the facial nerve or muscle in may cause the facial palsy.

Some non-surgical treatments can help resolve the nerve palsy for example treatment with steroids or anti-viral drugs. Speech Therapy is often also used to help recovery.

Eyelid abnormalities
Ectropion

Ectropion is a very rare condition where the eyelid droops and turns outwards. In children it can be caused by injury, an eyelid cyst, a skin condition or damage. In rare cases it can be the result of a facial palsy or due to a genetic disorder.

Contact us

Moorfields Private Outpatient Centre

9-11 Bath St EC1V 9LF
London (Central London)

Moorfields Private Practice

8 Upper Wimpole St W1G 6LH
London (Central London)

Parkside Hospital

53 Parkside SW19 5NX
London (Wimbledon)

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