Orbital Surgery

Too much (hyperthyroidism) or too little (hypothyroidism) thyroid hormone may be produced.
An imbalance in either direction may cause inflammation in the orbit (eye socket) that can affect the eye and vision.
The inflammation varies from mild to severe and can be vision threatening.
Initially there is an active phase with active inflammation, which lasts approximately 12-18 months but can be longer.
After this the active inflammation subsides. The patient may return to normal or may be left with scar tissue that has altered their appearance or affected their vision.

The thyroid function should be evaluated and treated by an Endocrinologist.
In the active phase, regular monitoring of the eye disease is required.
Medical treatments including eyedrops are utilised.
If there is worsening inflammation, steroids, radiotherapy, or other immunosuppressive medications may be recommended.
It is unusual for surgery to be required in this phase.
Smokers have more severe inflammation which persists for longer.

In the stabilised phase, once the inflammation has burnt out and there is no change in the symptoms and signs of disease, surgery may be contemplated to correct protrusion of the eyes, double vision, eyelid retraction or redundant skin.
Surgery will not be required in all patients.

Orbital tumours are abnormal masses located within the orbit.
They may be benign or neoplastic and can arise from any of the structures found in the orbit.

The treatment depends on the likely diagnosis, the location of the tumour, the effect on vision, the patient’s age and wishes.
Imaging will be performed to aid the diagnosis and plan for surgery.
A biopsy may be performed to obtain a diagnosis.
Treatment options include surgical excision, radiotherapy, medications, chemotherapy.
Careful observation may be recommended if the tumour is felt to be benign and is not affecting the eye or vision.

The orbit is surrounded by the sinuses and the brain.
The most common cause of orbital infection is spread from sinusitis.
Other causes include cellulitis (infection of the skin) and trauma.

Orbital infections can be vision and even life threatening so must be treated accordingly.
Orbital infection can put pressure on the optic nerve or spread to the brain.

Treatment is based on the severity of the fracture and the symptoms.
Patients are treated conservatively, with monitoring and medication, or surgical repair is recommended to realign the bone and fix the bony defect.
Surgery may be immediate or delayed, usually 2 weeks.
Orbital implants can be placed over traumatic breaks in the orbital walls and can be useful to replenish the volume of the orbit and push the eye forward again.
Surgery is performed under general anaesthesia with admission overnight for monitoring.
Usually, patients will take a week off work.
Normally activity will be resumed over 1 to 2 weeks.

An enucleation is a surgical procedure to remove an eye.
This is combined with insertion of an implant to restore volume.
The most common indications for enucleation are an eye tumour or a painful, non-seeing eye.
During the surgery, the eye muscles are attached to the implant, to achieve the most normal movement of the artificial eye.
The surgery is usually performed under general anaesthesia with admission for 1 to 2 days.
The surgery takes approximately one and a half hours.

A dressing will be worn for 1 week after surgery.
The conformer, a clear plastic shell, inserted at the time of surgery is left after the dressing is removed.
The conformer is used to reduce contraction and scarring allowing space for the prosthetic eye to be eventually placed.
Once the swelling has resolved and the socket has healed, usually at 6 to 8 weeks after surgery, the artificial eye can be fitted by an ocularist.

There is postoperative discomfort which is managed with painkillers and controlled before discharge from the hospital.
Some patients experience more pain than others.
Swelling resolves over a few weeks.

The risks of surgery are uncommon.
There are risks of infection, bleeding, or wound breakdown.
If there is thinning of the lining of the socket, the implant can become exposed and infected.
There are risks associated with general anaesthesia, although uncommon.

Infection or inflammation of the eye socket can present, requiring treatment.
Secondary reconstructive surgery may be indicated to correct abnormal position of the eyelids, treat scarring, or restore lost volume to the orbit if a sunken appearance has developed.
Artificial eyes can wear out over time and patients may require referral for a new fitting.