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FELLOWSHIP IN OCULOPLASTIC, ORBITAL & LACRIMAL SURGERY

OBJECTIVES
The SNEC Oculoplastic, Orbital & Lacrimal Surgery Fellowship programme provides advanced training in the medical and surgical aspects of diseases of the ocular adnexae, orbit and lacrimal system. The programme also offers opportunities for exposure to peri-ocular aesthetic procedures and surgeries.

DURATION: One (1) year

PROGRAMME DETAILS:

Clinical Exposure
Fellows will be rotated through the Oculoplastic and general clinics which are run by different consultants of the faculty. A wide-ranging spectrum of conditions will be encountered. The fellow is expected to be well-versed in all of the topics and skills listed below to play an active role in the delivery of care for the patients:

General Knowledge
  • Anatomy and physiology of the orbit, eyelids, lacrimal system, nose, sinuses, and head and neck as it relates to the orbits and adnexa
  • Principles of plain films, computed tomography, magnetic resonance imaging and ultrasound imaging relating to the head and neck with particular emphasis on the orbit;
  • The appropriate imaging to order, given the clinical setting, and the ability to interpret the scan results

Eyelids
  • Diagnostic evaluation of eyelid malpositions (dermatochalasis, ptosis, entropion, ectropion and eyelid retraction)
  • Eyebrow position assessment for brow ptosis and paralysis, determining its relation to upper eyelid dermatochalasis and blepharoptosis. Evaluation of the effects of mid-face cicatricial, paralytic and involutional changes on the lower eyelid position
  • Assessment and management of childhood ptosis
  • Evaluation of eyelid neoplasms and principles of eyelid oncologic surgery and reconstruction after clearance
  • Regional anatomy including frequently used graft donor sites such as auricular cartilage, hard palate, buccal mucosa, posterior auricular and supraclavicular skin
  • Facial flaps for functional correction related to the management of periorbital malignancy
  • Eyelash abnormalities (trichiasis and distichiasis)

Lacrimal
  • Evaluation of the patient with tearing.
  • Principles for lacrimal procedures, including external and endoscopic dacryocystorhinsotomy, canalicular reconstruction, conjunctival-DCR with Jones' tube placement.
  • Understanding nasal endoscopy as related to the management of lacrimal and periorbital processes.
  • Understanding sinus surgery and endoscopy as related to periorbital and lacrimal processes.

Orbit and Socket
  • Common orbital problems of children including orbital cellulitis, benign and malignant tumours and congenital anomalies
  • Common orbital disorders of adults including orbital cellulitis, thyroid orbitopathy, idiopathic orbital inflammation, vasculitis, congenital tumours, vascular tumours, neural tumours, lacrimal gland tumours, fibro-osseus tumours, histiocytic diseases, lymphoid tumours and metastatic tumours
  • Different orbital approaches for exploration, biopsy and tumour excision.
  • Orbital trauma including the technique of orbital floor fracture repairs and the use of different orbital barrier implants
  • Indications for an evisceration, enucleation and exenteration
  • Management of the anophthalmic socket

Aesthetics
  • Concept of the face as a combination of individual harmonious aesthetic units and their inter-relationships to each
  • Fundamentals of peri-ocular cosmetic surgery and its complications with emphasis on the upper and lower eyelids, brows and mid-face
  • Use of neuromodulators (botulinum toxin) and dermal fillers for the management of skin contour abnormalities. Botulinum toxin is also used widely in the centre for functional improvement in patients with blepharospasms and hemifacial spasms
  • Principles of filler use for periorbital rejuvenation and orbital rehabilitation, including orbital volume replacement, eyelid malposition and periorbital volume deficiency
  • Principles of autologous fat grafting for orbitofacial volume restoration

It is the responsibility of the fellow to review all patients daily on the ward and be involved in their day-to-day management. He/she should actively participate in the postoperative care of surgical cases in which he/she will be part of the surgical team. This will play a big part in the fellows’ learning.
The fellow is the first port of call for all Accident & Emergency patients after hours every day. Together with the consultant, the fellow will be expected to perform the initial assessment and institute treatment for all acute cases.

Surgical Exposure
  • The fellow will be attached to a consultant in the operating theatre for all sessions. For most oculoplastic and lacrimal procedures, he/she will first observe and assist a minimum number of surgeries before proceeding to perform them under supervision. He/she will only be assisting or performing a part of the surgery for the majority of the orbital cases. For the aesthetic cases, the fellow can only assist.
  • The fellow is strongly encouraged to practise the basic suturing techniques outside of the operating theatre, leaving valuable operating theatre time for the acquisition of more advanced skills.
  • Minor surgeries and practical procedures can also be performed by the fellow in the treatment room at the end of each clinic session.

Educational / Research Exposure
Fellows are required to participate in clinical rounds and daily ward reviews, journal clubs/teaching programmes, retrospective and prospective clinical research and quality assurance audit programmes of the department. All fellows will also participate in teaching of residents and/or medical students and attend all SNEC meetings.

NUMBER OF PLACES AVAILABLE:
Two (2) every year

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