The orbit is composed of the bone cavity that surrounds, along with the system of extra ocular muscle, tissues, and orbital fat. They serve the purpose of protecting and stabilizing the eye. Orbital surgery is a type of oculoplastic surgery that focuses on conditions occurring in the eye socket. These conditions include:
Thyroid Eye Disease (Grave’s disease)
Thyroid eye disease also known as Grave’s disease Graves’ eye disease, is an autoimmune condition in which immune cells attack the thyroid gland which responds by secreting an excess amount of thyroid hormone. As a result, the thyroid gland enlarges and excess hormones increase metabolism. The hypermetabolic state is characterized by fast pulse/heartbeat, palpitations, profuse sweating, high blood pressure, irritability, fatigue, weight loss, heat intolerance, and loss of hair and alterations in hair quality. When the immune system attacks the tissues around the eyes, it causes the eye muscles or fat to expand. The two most common signs of Thyroid Eye Disease (TED) are upper eyelid retraction and proptosis. About 3-7% of patients exhibit a severe sight threatening for of disease due to cornea exposure on compressive optic neuropathy.
Thyroid eye disease can cause following symptoms:
- Exophthalmos (bulging of the eyes )
- Inability to close eyes completely
- Dry eye
- Double vision
- Increased orbital pressure cause by muscle swelling
Orbital Tumor
Orbital tumors are abnormal growths of tissue in the structures that surround the eye. These lesions may be either benign or malignant, and may arise primarily from the orbit or may spread (metastasize) from elsewhere in the body. The most common types of orbital tumors vary considerably by age, but include cysts, vascular lesions (arising from blood vessels), lymphomas, neurogenic tumors (arising from nerves), and secondary tumors (either metastatic or spread directly from the surrounding sinuses or cranium).
Orbital Fracture (Enophthalmos, Sunken Eye)
An orbital fracture occurs when one or more of the bones around the eyeball break, often caused by a hard blow to the face. To diagnose a fracture, ophthalmologists examine the eye and surrounding area. X-ray and computed tomography scans may also be taken.
There are three types of orbital fractures:
- Orbital rim fracture— Often caused by car accidents, orbital rim fractures affect the thick bone of the outer edges of the eye socket.
- Blowout fracture— A break of the thin inner wall or floor of the eye socket. Getting hit with a baseball or fist often causes these breaks.
- Orbital floor fracture— A blow to the rim of the eye socket pushes the bones back, which causes the bones of the orbit floor to buckle downward. In elderly people, these breaks may result from a fall that causes their cheek to hit a piece of furniture or other hard surface.
Some most common orbital procedures:
Orbital Decompression is a type of surgery that removes the bones and sometimes the fat in the orbit (socket) of the eye. The most common reason for this surgery is thyroid eye disease also often known as Graves eye disease. The overall goal of the surgeries to create more space in the eye sockets to allow the eyes to move back to a normal position.
Evisseration/ Enucleation/Exenteration is a surgical procedure involving removal of the entire globe and its surrounding structures including muscles, fat, nerves and eyelids (extend determined by disease being treated). This differs from enucleation which is the removal globe while leaving all other surrounding structures and evisseration which is the removal of intraocular contents while leaving an intact sclera.
Some of the reasons why an eye may be removed are:
- Injury
- Glaucoma
- Infection inside the eye
- Eye tumors
The eyelids and structures around the eyes are critical for vision. Injuries, congenital defects, aging changes and tumors can cause pain, eye damage, vision loss and disfigurement. Changes in the eye’s appearance or the loss of an eye can decrease one’s ability to interact in social settings and in the workplace.
Along with a variety of cosmetic procedures, our surgeons can insert implants, reconstruct eyelids and eye sockets, correct eyelid-position abnormalities, remove growths and rebuild critical ocular structures.
Socket Reconstruction
In some eye conditions to ease severe pain and to protect the other healthy eye, the eyeball may need removal. Although this approach treats the eye condition, it can have a devastating effect on their psychology. Hence the doctor would take measures to offer the patient a “normal” look normal after surgery.
Conditions that may require socket reconstruction include:
- Anopthalmos: A very rare condition of the eye indicated by a complete absence of ocular (eye) tissue within the orbit (eye socket) at birth.
- Micropthalmos: A congenital condition of the eye characterized by the incomplete formation of the eye, leaving the infant with small eye(s).
- Contracted socket: Is a condition characterized by small-sized fornices or cavity of the eyeball, thereby creating difficulties in the retention of a prosthetic (artificial eye). This may be due to multiple socket operations, irradiation of the socket following enucleation (removal of a diseased or injured eye), severe socket infections/initial injuries, and surgery that may cause excessive destruction of the conjunctiva or formation of scar tissue in the conjunctiva.
The most common causes for socket reconstruction include congenital defects, trauma, cancer and scarring.
Prosthetic Eye
A prosthetic eye can help improve the appearance of people who have lost an eye to injury or disease. It’s commonly called a “glass eye” or “fake eye.” It’s not really an eye, but a shell that covers the structures in the eye socket.
The prosthetic eye includes:
- oval, whitish outer shell finished to duplicate the white color of the other eye
- round, central portion painted to look like the iris and pupil of the other eye
Implanting a prosthetic eye (ocular prosthesis) is almost always recommended after an eye is surgically removed due to damage or disease. This implant supports proper eyelid functioning.
