Oculoplastic Aspects of Ocular Surface Disease

The chapter “Oculoplastic aspects of ocular surface disease” gives an overview on the oculoplastic surgeon’s view of chronic ocular surface disease, lid malpositions and changes of the lid margin. It discusses the diagnostic approach and identification of patients at risk who require special attention prior to oculoplastic procedures, either for aesthetic or functional reasons. Lagophthalmos, Meibomian gland inversion and conjunctivochalasis, including its grading, are addressed. Oculoplastic surgeons must distinguish the situation of elective surgery in the presence of ocular surface disease from the need for surgery to treat it. Several special procedures are aimed to improve patients with dry eye and ocular surface disease, ranging from punctal occlusion to amniotic membrane transplantation, mucous membrane grafts and to salivary glands and, as an evolving technique, engineered tissues. The chapter includes the topics of graft harvesting techniques, donor site morbidity and wound healing. The chapter concludes with the description of corneal neurotisation, a relatively new technique that may bring sensation to a previously denervated corneal surface by the use of sensory nerve grafting, either as a direct transfer or a free graft. It has the potential to fundamentally change the way of treating ocular surface disease due to permanent nerve damage.