Lawrence G. Kass M.D.

OCULOPLASTIC & FACIAL

COSMETIC SURGERY


727.522.3223

St. Petersburg / Clearwater

Orbital Disease

The orbit is the bony socket that surrounds the eye. It contains the eye, arteries, muscles, and nerves; all of which are cushioned by supporting membranes and fat. Numerous medical and surgical problems may affect the orbit.


Orbital Fracture


Trauma may cause fracture of the orbital bone surrounding the eye. If not treated, such fractures may result in deformities of the face or in double vision


Blunt trauma to the eye and bones around the eye (such as by a fist) can lead to a fracture in the thin bones of the orbit behind the eye. Anyone with such injury should seek out a complete eye examination to rule out any other eye injury promptly. The floor and inside wall of the orbit are especially thin, and sinuses are on the other side of the bone. Blunt trauma can cause what is termed a "blow-out fracture", where the sudden rise in pressure in the orbit literally blows a fracture through the bone and into the sinus. If this involves the floor of the orbit, the cheek below the eye and upper gums in the mouth can often become numb due to damage to a sensory nerve that runs in the floor of the orbit.


If the fracture of large enough, the contents of the orbit can start to slip into the sinus, and the eye will appear to sink backwards. Sometimes an eye muscle can get trapped in an orbital fracture and become stuck. This leads to double vision especially if looking up, with pain. A CT scan of the orbit can diagnose fractures and entrapment of muscles. Entrapped muscles often have to be released surgically. Antibiotics are usually given after an orbital fracture, due to risk of infection from the sinus into the orbit.



Orbital Inflammation (Orbital Infection or Orbital Cellulitis)


An infection of the orbit, or boney eye socket, can lead to severe symptoms, one of which is double vision. Usually orbital infection spreads from adjacent sinuses, and sometimes from a skin or eyelid infection. Symptoms include pain, eyelid swelling and possibly a lump behind the eyelids that can be felt, eye and eyelid redness, discharge, blurred vision, eye displacement or protrusion, and double vision. The double vision comes from the infection preventing normal movement of the eye, and a misalignment may occur in certain positions of gaze. People with this condition are usually treated in the hospital with IV antibiotics. Diabetics are subject to a particularly severe and destructive fungal orbital cellulitis.


Orbital pseudotumor ("like a tumor") is an inflammatory condition which can simulate tumor or infection, but usually responds to steroids. A CT scan or MRI is usually done in cases of orbital infection, tumor, or pseudotumor to help make the diagnosis and guide treatment.


Orbital Tumors


Tumors may develop in any of the various tissues within the orbit and may also invade the orbit from the sinuses, brain, or nasal cavity, or it may metastasize (spread) from other areas of the body. Orbital tumors can affect adults and children. Fortunately, most are benign.


What are the symptoms of an orbital tumor?


Symptoms of an orbital tumor may include protrusion of the eyeball (proptosis), pain, loss of vision, double vision, redness, swelling of the eyelids, or an obvious mass. Some tumors are visible and therefore easily identified, while others may not exhibit symptoms until they are large enough to displace the eyeball. Prominence of the eyes is not necessarily the result of a tumor, but may result from inflammation such as that caused by Thyroid Eye Disease. In children, parents may first notice a droopy eyelid or slight protrusion of the eye.


Orbital tumors are most frequently diagnosed with either a CAT scan or MRI. If either of those tests look suspicious, a biopsy may be performed.


How are orbital tumors treated?


Treatment of orbital tumors varies depending on the size, location, and type. Some orbital tumors require no treatment, while others are best treated medically or with the use of radiation therapy. Still others may need to be totally removed by either an orbital surgeon or a neurosurgeon, depending on the particular case. After removal, additional radiation or chemotherapy may be required. Surgery has become much safer because CAT scans and MRI testing can help pinpoint the location and size of the tumor.


Final Reminders


To effectively treat the many varied conditions of the orbit requires a special understanding of the anatomy and pathophysiology of the orbit. Fellowship in the American Society of Oculofacial Plastic and Reconstructive Surgery (ASOPRS) indicates that the surgeon has greatest specialized training and expertise in treating patients with orbital problems.


If you have problems related to the orbit, please schedule a consultation with Dr. Kass who is fully trained to treat these problems and has been in practice for over 27 years.