One very critical part of the human skull is the socket of the eye. The socket acts as an anchoring point for eyes along with other anatomical structures like ocular blood vessels which supply blood to the eyes, optical nerves etc, which are integral parts of anatomy of the eyes.
Tumors can grown anywhere in the socket and they generally grow behind the eyes. But they can also enter the eye structure and affect the eyes from brain cavity, paranasal sinuses etc. tumors may occur on bones around the eyes. There are several types of orbital tumors that can occur. Some of the most common types of tumors are neurofibromas, orbital meningioma, hemangiomas, lymphangiomas etc.
The surgical procedure used to treat orbital tumors is called orbitotomy. The tumors can occur in children and adults. Mostly all orbital tumors are benign and can be treated fully if the treatment begins in time. Previously, less invasive techniques were not available and the orbital surgery could cause vascular damage to the nerves, directly or indirectly. The orbital surgery requires extreme precision and skill therefore only a highly experienced surgeon should perform this surgery. The surgery involves a lot of minute muscles and a complicated web of nerves. The surgery if not performed correctly can lead to blurred vision or complete vision loss.
Primary aim of orbital surgery:-
Saving the eyes of the patient along with healthy vision is the primary aim of any surgeon. Also, the surgeon also aims at keeping the nearby ocular components safe from any collateral damage. The surgery also is done to prevent the tumor from spreading and invading other body parts. The patient’s health and comfort should also be a good surgeon’s objective.
If the treatment is delayed or if the tumor has spread to other parts of the orbit, enucleation may have to be done. Enucleation is the procedure by which the eye is removed. The orbital surgery is not a one man show and requires a team of surgeons which includes neurosurgeon, plastic surgeon, ophthalmologist etc.
After enucleation, a prosthetic eye is placed in the empty socket and attached to the ocular muscles. The modern prosthetic eye looks natural and moves along with the other eye therefore it is better that the glass eyes which were used previously.
Approach during the surgery
It is often difficult for a surgeon to decide upon the perfect approach for the orbital surgery as not only the anatomy of the eye is complex but the access to the ocular structures is also limited. The surgery is very delicate and requires patience. A surgeon may decide to enter the eye from incisions above or below the eye or may decide upon taking a lateral approach.
Depending upon the size and severity of the tumor the surgery may take up to 10 hours. Post surgery reconstruction of the socket and the skull may also be required. Cases of tumors like Grave’s diseases, Paget’s disease and trauma call for post resection reconstructive procedures. Reconstructive procedures may also require skin grafting in which tissues are taken from the patient’s body itself. New materials and compounds like resorbable fixation device, porous polyethylene, hydroxyapatite etc are used as natural skin grafts substitutes. Damage to the neurovascular tissues and muscles can be minimized by using endoscopic techniques which is very less invasive.
Recovery from the surgery:-
The time length for recovery from the surgery is different for each person. The time to recover from the surgery is also dependent upon the severity and the extent of tumor. The patients are kept in observation for more than two weeks minimum. Residual bruising and swelling from the surgery get healed within 7 to 10 days. The recovery now a day is much shorter because the procedures are more likely to involve endoscopic approach. The patients are advised to refrain from watching TV or using mobile devices to avoid straining of the eyes. The patients are also told to take complete rest for a fortnight minimum. The scars from the surgery generally fade away within a year.
Symptoms of orbital tumors:-
Loss of vision, persistent watering of eyes, continuous reddening, burning sensation of the eyes, constant tiredness in the eyes could be an indicator of a possibility of a tumor. A doctor should be consulted without any delay if a patient is suffering from any of the aforementioned symptoms.
Permanent damage to the eye and loss of vision can be prevented if the treatment is performed in time. Presence or even a slight doubt about any symptoms should be a call for concern for a person. The orbital tumors can completely be treated if their treatment begins without any delay. To eliminate the possibility of the metastasizing of tumor or of enucleation, any changes in the vision or physical appearance of the eyes should be closely monitored.
Dr. Debraj Shome is super-specialized in all forms of orbital surgery and treats orbital tumors, orbital fractures and orbital masses of all kinds, with an aesthetic approach and minimally invasive techniques.