An orbital fracture is a serious break or crack in one or more of the bones of the eye socket. Depending on whether the eye muscles are injured or trapped in the fracture, an orbital fracture can cause double vision. Considerable swelling in the eye area typically accompanies this type of injury. Once swelling recedes, the eye may appear recessed more than is normal. It is often for both cosmetic and functional reasons that surgical treatment of an orbital fracture is necessary.
After an injury to the eye area, a thorough physical examination of the eye and its surrounding structures is necessary. In many cases, antibiotics are prescribed to prevent infection, and anti-inflammatory medications are prescribed to promote a rapid reduction in swelling. Imaging tests such as CT scans may be performed to determine the precise location of the injury and its severity.
Treatment of orbital fractures may begin with observation only, or surgery may immediately be deemed necessary. The type of treatment is determined by various factors, including location and severity of the fracture, as well as the age and health of the patient. If surgery is needed, incisions are usually small, and placed either inside the eyelid or in creases in the skin so that the resulting scar is hidden.
Enucleation and Evisceration
Eye enucleation is the removal of an eye due to:
- Eye pain
Usually the adjacent supporting structures of the eye socket and eyelids are not removed. An evisceration is a similar process that only removes the contents of the eye but leaves the shell of the eye itself. Indications and contraindications of both eviscerations and enucleations are varied, and will be discussed by your physician.
In most cases the enucleated/eviscerated eye is replaced with an orbital implant and a prosthesis, or artificial eye.
Orbital implants are attached to muscles and other structures in the eye socket at the time of surgery, so they feel secure. Patients are therefore able to retain the ability to move the artificial eye. 6 weeks after enucleation or evisceration, after the socket has healed, a prosthesis is designed and placed behind the eyelids by an ocularist. Ocularists are medical artists who fashion a prosthetic eye out of bio-compatible, non-toxic, and non-allergenic materials that look natural. The prosthesis is custom-fitted and colored to match the patient’s other eye.
Orbital Fat/Bone Decompression
Orbital Decompression is a common surgery that creates more space within the orbit, allowing the eye to return to a more normal position. The procedure is performed on patients with eye proptosis, a condition which results in eye displacement. Orbital decompression surgery focuses on removing bone from one or more walls of the orbit, and the removal of orbital fat.
Removing bone from the walls of the orbit will help maintain symmetry in the orbital tissues, will reduce proptosis, and will reduce any compression placed on the eyes. Orbital fat may also be removed in cases of severe eye proptosis.
The orbit of the eye consists of tissues surrounding the eyeball, including muscles that move the eyeball in different directions and the nerves attached to the eye. Orbital masses are lesions behind and around the eye which may impact the nerves, muscles, and blood vessels of the eyes. Common symptoms of these masses include double vision, severe pain, and vision loss.
Diagnosis of these orbital masses is essential for determining treatment, and imaging tests will assist in diagnosing whether or not these tumors are benign or malignant. A biopsy may be conducted to provide a definitive diagnosis. Most orbital tumors are benign, though if the tumor causes visual problems, surgical excision may be necessary even in these cases.
Orbital Reconstruction is a procedure which repairs various deformities and complications of the orbit, including orbital dystopia, fractures, and exorbitism, which occurs when normal orbital tissue exists, but a small bony orbit results in the eyes bulging outwards.
CT scans will help diagnose these deformities, and orbital reconstruction will help correct these deformities through many and various techniques.
Thyroid Muscle Strabismus Surgery
Hyperthyroidism, also known as an overactive thyroid gland, involves an excessive amount of hormone production that can lead to weight loss, irregular heartbeat, and irritability. One of the most common reasons for an overactive thyroid gland is Graves’ disease, an autoimmune disorder in which antibodies cause the thyroid muscle to produce too much of the hormone thyroxine. Common symptoms of thyroid eye disease include bulging eyes, swollen eyelids, and red eyes.
If conservative treatment measures, such as glasses and prisms, are not effective, than surgical treatment may be recommended. Strabismus surgery repositions fibrotic eye muscles to better align the eyes, and corrects the double vision associated with thyroid eye disease.