Orbital Surgery

Orbital biopsy

Rarely, tumours or masses in the orbit require biopsy in order to determine the diagnosis and plan treatment. These tumours may be benign or malignant and depending on the likely underlying diagnosis, the biopsy may either be incisional (taking a small sample of the lump) or excisional (removing the entire lump). In some cases a biopsy of a lump reveals inflammation rather than a tumour.

Orbital biopsies are usually performed under general anaesthetic with an overnight hospital stay. The site of the incision varies greatly depending on the site of the mass, but is usually placed in such a position to disguise the scar, such as in the upper lid skin crease, or to completely hide the scar, such as under the eyelid.

The risks of an orbital biopsy vary depending on the size and location of the lump. For example, those masses placed most deeply at the back of the orbit, particularly those in close proximity to the optic nerve, may be at increased risk of visual loss or even blindness.

Orbital Decompression Surgery

Orbital decompression aims to reduce the bulging eye appearance associated with thyroid eye disease, by creating more space in the orbit by removing one or more of the bony walls of the eye socket, thereby allowing the eye to return to a more normal position.

It may be done as an emergency procedure to relieve pressure on the optic nerve in severe cases of thyroid eye disease. More commonly, it is performed as an elective procedure once you are in the “inactive” phase of your disease, to allow the eye to be positioned further back in its socket. This rehabilitative procedure can be done to reduce the bulging appearance of the eyes, or to improve eyelid closure and thereby reduce ocular discomfort,.

The number of walls and the selection of which wall is to be removed depends on the indications for surgery and the severity of proptosis (bulging eye). The operation is performed under general anaesthetic and overnight admission is required. Patients are advised to expect significant bruising and swelling and in some cases the swelling may take several months to settle.

Eye Removal

Evisceration

This operation refers to removal of the ocular contents, while leaving the white part of the eye (sclera) intact. It is most commonly performed for a painful blind eye and an orbital implant is often inserted at the time of the surgery in order to fill up the eye socket and prevent a sunken appearance. If the procedure is performed in the emergency setting of an overwhelming infection in the eye, then an orbital implant is usually not placed, and can be placed as a secondary procedure at a later date if required.

Enucleation

This procedure refers to removal of the entire eye including its scleral shell, but leaving behind the eye muscles, which are normally sutured to an orbital implant. This also may be performed as treatment for a painful blind eye or in rare cases to treat tumours in the eye.

Both procedures are usually performed under general anaesthetic. Patients may experience some pain and nausea after an enucleation. A clear plastic artificial eye (conformer) is usually placed in the socket at the end of the operation and it is important to keep this in the socket to prevent shrinkage until a bespoke artificial eye is fitted some weeks after the operation.

Patients should be aware that long term wear of an artificial eye can be associated with it’s own problems, such as socket inflammation, discharge or shrinkage and changes to the eyelids including lower lid laxity. Some of these problems may require subsequent surgery to either the socket or eyelids in the future. Patients with an artificial eye should have a check up with their prosthetist at least annually.