Ophthalmic Plastic, Cosmetic, and Orbital Surgery Service

The University of Washington Eye Center is devoted to providing state-of-the-art diagnosis and treatment for patients with a variety of disorders of the eyelid, tear system, and orbit.

1. The eyelid provides protective mechanical coverage and cleans the front of the eye much as a windshield wiper cleans a windshield. As well, it protects the eye from noxious stimuli. It also contains several glands that produce tears to lubricate the eye's surface and provide an optically smooth surface for vision.
2. The tear system is like a sink consisting of a faucet (tear glands), sink basin (the space between the eyelids), and the drain (tear duct). The tears lubricate the surface of the eye, provide protection against foreign materials, and create a smooth surface. When too few tears are produced, a dry eye results. When the tear duct is blocked, the tears pour out over the cheek.
3. The orbit is the space formed by the bones surrounding the eye. In addition to the eyeball, it contains other vital structures such as nerves, blood vessels, muscles, and fat. The nerves provide vision, move the eye and eyelids, and provide sensation to the face and the eye. The fat and connective tissue provide lubrication for eye movement. The bone surrounds all these structures to support and protect them from external trauma.

The Ophthalmic Plastic, Cosmetic, and Orbital Surgery Service at the University of Washington provides care for diseases such as trauma, tumors, tearing, thyroid eye disease, and age-related changes. The latest techniques, including carbon dioxide laser skin resurfacing, endoscopic surgical techniques, and tumor marker determination are utilized. James C. Orcutt, MD, PhD, Professor, and Acting Assistant Professor Arash Jian-Amadi, MD jointly provide these comprehensive services. Each physician is Board-certified by the American Board of Ophthalmology. Doctors Orcutt and Amadi are members of the American Society of Ophthalmic Plastic & Reconstructive Surgery, and both hold Adjunct faculty appointments in the Department of Otolaryngology-Head and Neck Surgery at the University of Washington. Dr. Orcutt is internationally recognized in the field and has written more than 40 peer-reviewed journal articles and 25 book chapters. Below are brief descriptions of some of the procedures offered at the UW Eye Center for disorders of the eyelid, tear system, and orbit:

Blepharoplasty is a surgical technique that removes excess skin and/or fat from the upper or lower eyelids. As we age, tissues stretch and lose their support function. The stretched skin can fall in front of the eye, causing decreased vision. Also, the orbital fat can move forward, leading to "bags" in the eyelids. The reason for the removal of these tissues is because of visual obstruction (upper eyelids) or to improve appearance (upper and lower eyelids). Office examinations can determine if visual obtruction is present.

Ptosis, pronounced "toe-sis," is drooping of the eyelid and has several causes. In adults, the usual cause is thinning of the tendon of the muscle that raises the upper eyelid opening the eye. The surgical approach is similar to blepharoplasty and they may be combined.

Brow ptosis is the drooping of the eyebrow and has several causes. This includes aging and paralysis. Several surgical techniques are available and their use depends on several factors. These include the cause of the brow ptosis, the amount of the defect, location of the hairline, and others.

Endoscopic tear drainage procedures are performed through the nose for excessive tearing caused by a blocked tear duct. No visible scar is seen. Fiberoptic scopes that conform to the anatomy of the nose are used to visualize the surgical sight. The adjacent endoscopic photo shows a healed patent surgical drain opening in the nose.

Laser skin resurfacing is a technique designed to rejuvenate facial skin with fine and coarse wrinkles. Similar to a chemical peel, exposure of the layer beneath the skin produces a new flatter layer of skin without wrinkles. The advantage of a laser is more predictable depth of penetration compared to chemicals. Two lasers exist and include the carbon dioxide laser and the erbium YAG laser. Recovery time can vary, depending on the laser type used.

Botulinum toxin (Botox®) is a drug that blocks the transmission of nerve signals between nerve and muscle. It can be used for facial movement disorders (blepherospasm/hemifacial spasm) and for cosmetic concerns. Wrinkles can be caused by muscle contraction. Botox® is injected and temporarily paralyzes these muscles and helps to smooth out the wrinkles. The more common sites treated include the forehead (glabellar furrows) between the eyebrows, and crowsfeet. Patients tend to need retreatment about two to three times a year.

Orbital tumor markers help classify biopsy tissue leading to improvement in the diagnosis and prognosis of various orbital tumors. This service is provided in conjunction with the Department of Pathology at the University of Washington.


For further information on these and other surgical procedures, please click on the following link:
American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS)

To schedule an appointment for any of the above procedures described, the telephone number is (206) 598-8111.