Introduction

Since the evolution of medical science, there were broadly only two branches namely, medicine and surgery, In India, everybody remembers the names of CHARAK and SUSHRUTA. With the advancements in these fields, the foundation of specialties started. In initial phases this division was made on the basis of the interest of the individual; later on it was made formal with its prescribed courses and qualifications.

Not far away in this 20th century, Ophthalmology and ENT used to be dealt by the same person. But in the later part of the same millennium, not only these specialties are dealt separately; also each one includes several experts in their respective and narrower fields. At the same time, his/her expertise will be based on profound knowledge and experience in that area called as super-specialty. Of course, it needs a lot of devotion and deprivations related to the broad specialty concerned.

With the fast advancement in technology, Ophthalmology is also one of the medical fields which maintained a pace in its development and advancement. In this process the specialty grew so much in a short span of time that it became practically impossible for an ophthalmologist to deal with the specialty of Ophthalmology. As a result person has to choose and decide his/her specialty care fully based not only on the interest also lot of other concerns of feasibility and other factors in that particular circumstances

Oculoplastics Association of Indian

Oculoplastics and orbital surgery as a super-specialty emerged recently. In India, it was properly recognized in late 80's, though many ophthalmologists were doing it as their personal level without naming it. The major chunk of these cases was used to be dealt by plastic surgeons and neuro-surgeons. The reason being that most of the ophthalmologists even today like to deal with intra-ocular surgeries which from a major chunk of the ocular surgeries. It was recognized as a separate specialty in 1989 when an official scientific Body Oculoplastics Association of Indian was constituted.

In fact the specialty provides a wider range of surgeries, a real surgical challenge, a pleasure of plastic and cosmetic surgery and at the same time it is much less expensive as far as its instrumentation goes than any other ophthalmic specialty. It does not cost anything extra what we routinely use except for the temperament to deal with the extra ocular and a bit bleeding operating field.
Some essentials are there before opting for this specially namely

• The person concerned must have interest in dealing with extra-ocular tissues, which needs to develop a little different attitude in ophthalmologists in general

• Basic principles of general surgery are mandatory

• Basic principles of plastic and cosmetic surgery are of utmost importance viz. various grafts, flaps, their mobilization and minimizing the scarring. Use of various artificial materials and devices in order to achieve the desired result is also very important

• Availability of advanced radio-imaging techniques is must. If not MRI at least CT scan and Ultrasonographic facilities must be readily available

• Some additional surgical instruments are necessary especially pertaining to plastic surgery viz. Humby's knife, Stripers (Fascia lata & Tendon), Spatulas, scales, etc.

• Patient expectations and probable out come must be known before the surgery and this part must be taken care of because most of the patients expect too much than reality. One should be ready to face these difficulties

• One must be selective in taking up the cases for surgery especially while the case is taken for orbitotomy. It is preferable to have access of neuro-surge on and ENT surgeon

• Facilities of radiotherapy and chemotherapy will add in over all out come therefore this is preferable.

• Last but the most important is that the ophthalmologist must ensure that there should be a reliable histopathological facility. Fortunately, we have been able to deal successfully with entire range of squint, oculoplastics and orbital conditions at present. We have dealt with temporalis transfer in lagophthalmos of leprosy patients in sizable number. For the same, we had conducted a workshop. Various surgeries and conditions which come in its purview are:

• Squints/Deviated Eyes

• Ptosis,)

• Lacrimal surgeries,

• Lagophthalmos,

• Fitting of Ocular Prosthesis,)

• Blepharo-plasty,

• Orbitotomies,

• Socket Reconstruction,

• Proptosis,

• Peri-orbital tumors, and

• All other Ocular Prwmesis.

As a conclusion, in today’s context it is a fast coming up, challenging, full of professional scope and satisfaction and satisfaction and pleasing specialty for young and enthusiastic ophthalmologist. It has got a vast range and amplitude of work. If one ophthalmologist desires to be an ophthalmologist, a general surgeon as well as a plastic surgeon by retaining its super-specialist identity, there is no better super-specialty then this. Unfortunately, so far in our country, there is no formal degree in ophthalmic super-specialties including this specialty.

E-mail: ramesh_rishabh53@rediffmail.com