Global Oculoplastics

A Guide to the Care of Patients in Resource-Poor Environments

1st Edition - December 1, 2024
Imprint: Academic Press
Editors: Morris E Hartstein, Cat Nguyen Burkat
Language: English
Paperback ISBN:
9 7 8 - 0 - 4 4 3 - 2 1 9 6 8 - 9
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 2 1 9 6 9 - 6

Global Oculoplastics provides details on addressing a large range of oculofacial plastic procedures with a focus on situations in the resource-poor setting where there may be min… Read more

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Global Oculoplastics provides details on addressing a large range of oculofacial plastic procedures with a focus on situations in the resource-poor setting where there may be minimal equipment or supplies. Through comprehensive descriptions, photographs, diagrams, and illustrations, practitioners will gain practical knowledge essential for providing high-quality care under challenging conditions. In addition, for those wishing to effect systemic change, there are chapters about working successfully in complicated medical situations worldwide.

This book is organized into two distinct parts. Part 1 delves into the foundational aspects of global ophthalmology, addressing why cultural sensitivity, ethics, and collaboration with local partners are crucial. It also prepares professionals for working in environments with limited resources, such as unreliable electricity, water, and sterilization facilities.

Part 2 shifts focus to the practical application of oculoplastic techniques. It covers various conditions encountered during global missions and offers guidance on delivering effective surgical care with limited resources and implants.

This book is designed to be a critical resource for practitioners facing the daily challenges of addressing complex oculofacial issues in resource-poor settings. Its straightforward, yet thorough, "how-to" method descriptions will be particularly useful for surgeons tackling a wide range of oculoplastic conditions.

Title of Book
Cover image
Title page
Table of Contents
Copyright
List of contributors
Introduction
Chapter 1. Why choose global health outreach experiences?
Abstract
Further reading
Chapter 2. Who to partner with?
Abstract
Introduction
Motivation
Values
Ethics
Geography
Impact
Logistics
Finding your place
Major organizations in global ophthalmology
Further reading
Chapter 3. The value of partnerships
Abstract
Partnerships
Established organizations
Local municipalities
Local community
Local embassy
Micro-level trust
Further reading
Chapter 4. Understanding culture in global health programs
Abstract
Introduction
Why is culture important?
What is our culture?
The culture of western medicine (historical origins and modern relevance)
Conclusion
Further reading
Chapter 5. Global ophthalmology and superstition: a review on eye-related cultural beliefs, myths, and superstition
Abstract
Introduction
The evil eye
The Hamsa hand
Sanpaku eyes
Ocular misalignment (Strabismus)
Unibrow
Blepharospasm
The red eye
Eye color and its associated meanings
Eye color in native American culture
Heterochromia
Stye (Hordeolum)
Eyelash myths and madarosis
Blinding diseases
Dry eye syndrome
Eye-related remedies
Eye of Horus
Eye of Ra
Eye of Providence
Conclusion
Further reading
Chapter 6. Global ophthalmology ethical considerations
Abstract
Introduction
Preparation
Standards? Where do we start building our ethical standards—and are they per country or is there a global standard?
Stewardship/leadership
Case
Medicines and supplies
Partnerships/reciprocity—shared decision making
Components of global ophthalmology—service, education, infrastructure, research—is there a boundary?
Research
Conclusions
Helpful principles in the global ophthalmology arena include
Further reading
Chapter 7. Economic impact to the host
Abstract
A story of economic impact
Unintended consequences
A story of prescribing solutions
A humble posture of learning
Bolstering prestige
The dilemma of private practice and universal health coverage
Conclusion
Key points
Further reading
Chapter 8. Elements of success in global health programs
Abstract
Editor’s note
Introduction
Measures of success
Conclusion
Chapter 9. Models of global outreach and surgical missions in ophthalmology
Abstract
Introduction
Historical context
Models of global outreach
Volunteer-based missions
Hospital partnerships
Telemedicine and remote support
Impact of surgical missions
Logistic considerations
Challenges and ethical considerations
Future directions
Conclusion
Further reading
Chapter 10. Follow-up care and wound healing
Abstract
Overview
Introduction
Factors influencing wound healing
Postoperative care
Follow-up schedule
Stress of surgery on wound healing
Managing complications
Conclusion
Further reading
Chapter 11. Planning for clinical research trials in low- and middle-income countries
Abstract
Planning for clinical research trials in another country
Ethical considerations and regulatory approvals
Informed consent
Staffing considerations
Equipment/drugs
Data management
Safety
Funding
Personal rewards
Key points
Further reading
Chapter 12. Developing sustainable global health education in ophthalmology
Abstract
Importance of global health
Current state of global ophthalmology training in residency
Current state of global ophthalmology fellowship training
Barriers in current global ophthalmology training
Ethical considerations in global ophthalmology
Establishing a gold-standard for global ophthalmology training
Conclusion
Further reading
Chapter 13. Planning for a trip and rethinking surgery
Abstract
Lighting
Operative room attire
Sutures
Implants
Reconstruction and pathology
Instruments and cautery
Conclusion
Chapter 14. Outreach considerations: preparing for the unexpected
Abstract
Planning a surgical mission
Choosing the remote site
Operating room surgical suite setup
Equipment
Beds
Electricity
Anesthesia
Hand scrubbing
Drapes
Instrument sterilization
Self-preparation
Key reminders
Further reading
Chapter 15. Informed consent in global outreach
Abstract
Challenges in obtaining informed consent
Further reading
Chapter 16. Regional nerve blocks of the face
Abstract
Introduction
Retrobulbar block
Supraorbital/supratrochlear/infratrochlear block
Zygomaticotemporal/zygomaticofacial blocks
Dorsal nasal block
Infraorbital nerve block
Mandibular nerve block
Mental nerve blocks
Greater auricular nerve block
Risks and complications
Key points
Further reading
Chapter 17. Management of trachomatous trichiasis
Abstract
Introduction
Management of mild trachomatous trichiasis in the absence of entropion
Surgical management of trachomatous trichiasis with entropion
Bilamellar tarsal rotation procedure
Posterior lamellar tarsal rotation or modified Trabut procedure
Postoperative care
Necessary instruments
Necessary consumables
Key points
Further reading
Chapter 18. Skin cancer excision without pathology and without frozen sections
Abstract
Introduction
Periocular skin cancers
Preoperative assessment
Treatment planning
Surgical techniques
Ethical considerations, future directions and innovations
Conclusion
Further reading
Chapter 19. Useful flaps as an alternative to skin grafts
Abstract
Introduction
Preoperative assessment
Surgical techniques
Complications
Key points
Chapter 20. Reconstruction of eyelid defects without eyelid-sharing procedures
Abstract
Introduction
Important considerations
1 Preoperative assessment
2 Surgical techniques
Direct closure
Internal cantholysis
External lateral canthotomy and cantholysis
Semicircular rotational myocutaneous advancement flap
Transpositional myocutaneous flap
Advanced techniques for larger or more complicated defects to avoid eyelid-sharing
Necessary equipment
Key points
Further reading
Chapter 21. Sutureless ptosis surgery
Abstract
Introduction
Technique
Key instruments
Key points
Further reading
Chapter 22. Functional autologous fat grafting
Abstract
Introduction
Surgical technique
Complications
Periorbital indications for autologous fat grafting
Instruments
Key points
Further reading
Chapter 23. Congenital ptosis repair with slings or frontalis muscle flap
Abstract
Congenital ptosis repair with slings or frontalis muscle flap
Surgical planning
Surgical technique
Complications
Frontalis muscle advancement
Surgical technique
Complications
Further reading
Chapter 24. Challenges and solutions in imaging and managing orbital disorders in resource-limited scenarios
Abstract
Conclusion
References
Chapter 25. External dacryocystorhinostomy and silicone intubation
Abstract
Introduction
Epidemiology: dacryocystitis in low-resource countries
Clinical presentations and diagnostic challenges
Challenges in diagnosing dacryocystitis
Comprehensive treatment approach
External dacryocystorhinostomy—history of surgical evolution
Intubation in routine dacryocystorhinostomy
Postoperative management
Conclusion
Further reading
Chapter 26. Nonendoscopic endonasal dacryocystorhinostomy
Abstract
Introduction
External versus endonasal approach
Endonasal dacryocystorhinostomy: surgical technique
Clinical evidence
Conclusion
Further reading
Chapter 27. Upper and lower eyelid retraction repair
Abstract
Introduction
Upper eyelid retraction repair
Lower eyelid retraction
Lower eyelid retraction: anterior lamellar repair
Lower eyelid retraction: middle lamellar repair
Graft considerations
Key point
Further reading
Chapter 28. Autologous spacer grafts
Abstract
Introduction
Risk factors
Surgical approach
Hard palate graft
Dermis fat graft
Ear cartilage
Nasal septal grafts
Tarsus
Fascia lata
Keypoints
Further reading
Chapter 29. Cicatricial ectropion repair without skin grafts
Abstract
Introduction
Reinsertion of inferior retractors technique
Lower eyelid cicatricial scar release/preparation of recipient site for flap
Rotational myocutaneous flap from upper eyelid
Medial canthorrhaphy/tarsorrhaphy
Instruments
Key points
Further reading
Chapter 30. Epicanthal and telecanthal repair
Abstract
Introduction
Surgical techniques & modifications
Mustarde and Anderson technique
Del Campo technique
Roveda technique
Simple Y-to-V epicanthoplasty
Telecanthus repair
Transnasal wiring
Conclusion
Further reading
Chapter 31. Treatment of periocular burns
Abstract
Introduction
Common causes of periocular burns
Mechanism of periocular burns
Management
Initial management
Symblepharon release and amniotic membrane graft
Temporary tarsorrhaphy
Conclusion
Key points
Further reading
Chapter 32. Traumatic lid and facial injuries
Abstract
Introduction
Anatomy
Clinical evaluation and supplies
Simple eyelid lacerations
Eyelid margin lacerations
Canalicular lacerations
Extended periocular and facial lacerations
Postoperative wound care
Conclusion
Key points
Further reading
Chapter 33. Orbital fracture repair with simple silicone implants
Abstract
Introduction
Types of orbital fractures
Preoperative assessment
Management
Orbital floor and medial wall fractures: transconjunctival approach
Zygomaticomaxillary fractures
Zygomaticomaxillary or superior rim fractures: coronal approach
Naso-orbito-ethmoid fractures
Sterilization
Ideal implant
Postoperative care
Further reading
Chapter 34. Blepharophimosis: a simplified approach
Abstract
Introduction
Blepharophimosis: genetic inheritance and counseling
Clinical presentation
Differential diagnosis
Management
Levator resection
Epicanthus correction
Canthoplasty or canthopexy
Conclusion
Suggested readings
Chapter 35. Enucleation and evisceration
Abstract
Introduction
Surgical steps for enucleation
Socket volume replacement: allogenic implant
Socket volume replacement: dermis fat graft
Postoperative course
Evisceration
Surgical steps for evisceration
Conclusion
Key points
Further reading
Chapter 36. Treatment for advanced retinoblastoma
Abstract
Treatment
Unique challenges
Workflow
Diagnostic evaluation
Treatment of advanced-stage retinoblastoma/ overt extraocular retinoblastoma
Further Reading
Chapter 37. Orbitotemporal neurofibromatosis and severe blepharoptosis: single stage surgical correction technique in adults
Abstract
Introduction
Surgical technique
Further reading
Chapter 38. Invasive fungal orbital disease
Abstract
Introduction
Natural history
Risk factors and global trends
Diagnostic evaluation
Radiologic features of invasive fungal rhinosinusitis
Histopathology
Medical management
Surgery
Sinonasal surgery
Caldwell-Luc procedure
Meatal antrostomy
Techniques in orbit surgery
Exenteration
Conclusion
Further reading
Chapter 39. Orbital exenteration
Abstract
Introduction
Equipment
Exenteration—eyelid sparing
Total exenteration—including eyelids
Socket reconstruction
Granulation (secondary intent healing)
Split-thickness skin grafting
Dermis fat graft
Further reading
Index

Morris E Hartstein

Morris Hartstein, MD, FACS, Clinical Associate Professor of Ophthalmology at Tel Aviv University-School of Medicine and Director of Ophthalmic Plastic and Reconstructive Surgery at Shamir Medical Center, is Founding Director of “Operation Ethiopia,” which provides eyecare to the disadvantaged, including treatment for and prevention of blindness and eye disease. Dr. Hartstein brought 18 Ethiopian ophthalmologists to Israel for advanced training, spending significant time training half the oculoplastic surgeons in Ethiopia. He edited four bestselling textbooks in oculoplastic surgery, authored over 40 book chapters, and, for the past 25 years, has directed a cadaver workshop at Saint Louis University for international physicians. He has treated 7,000 patients, overseen 1000 sight-restoring cataract surgeries, performed hundreds of complex oculoplastic procedures, and distributed thousands of free eyeglasses and medications. Dr. Hartstein received the American Academy of Ophthalmology Senior Achievement Award, the ASOPRS Research Award, and in 2022 received the AAO‘s Outstanding Human Service Award.

Affiliations and expertise

Clinical Associate Professor, Tel Aviv University School of Medicine, Raanana, Israel

Cat Nguyen Burkat

Cat Burkat, MD FACS is Professor in Ophthalmology and Co-Director of University of Wisconsin-Madison Global Ophthalmology. Fellowship-trained in an American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and facial surgery fellowship, she has written over 90 book chapters, Editor for 3 oculofacial surgery textbooks, and directed over 70 courses at AAO meetings. She served as 4-year Program Chair for ASOPRS Scientific Fall/Spring Symposia, and AAO Oculofacial Subspecialty Day. She is Editor-in-Chief and Oculoplastics Lead Editor of the AAO EyeWiki website, and received the AAO Senior Achievement and Secretariat Awards. She represents ASOPRS in the World Ophthalmology Congress/International Council of Ophthalmology, and is Founding Director of 2 nonprofit organizations for oculoplastics/ophthalmology trips worldwide. She received the 2022 University of Wisconsin Women of Color Award, 2022 ASOPRS Service Award, ASOPRS Outstanding Contribution Award, and ASOPRS 2022 Orkan Stasior Leadership Award for distinguished service in education, research, and humanitarian activities.

Affiliations and expertise

Professor, University of Wisconsin-Madison, Wisconsin, USA

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