Proptosis, Exophthalmos, Orbital Disease & Orbital Surgery

0 Flares 0 Flares ×

What’s the Orbit?

The orbit is the socket or cavity of the skull in which the eye and its appendages are situated (Bony socket surrounding the eye). In the orbit, fat tissue, that surrounds the eyeball and its muscles, keeps the eye movements smooth & seamless.


Orbit – Bony Eye Socket (White Star)

Exactly what are the Typical Orbital Diseases & Disorders?

The typical orbital problems and conditions are:

In grownups:

· Grave’s Disease (Graves Disease / Thyroid Eye Disease / Thyroid Orbitopathy) – Most Typical Orbital Disease

· Orbital Lymphoma (Primary Orbit Cancer) –One of the commonest Orbital Tumors

· Orbital Cellulitis (Orbital Inflammation /Infection)

· Orbital Pseudotumor (“non-specific orbital inflammation”)

· Sinus mucoceles

· Secondary and metastatic tumors (cancer tumors spread from other areas of the body to the orbit)

· Lacrimal gland tumors like pleomorphic adenoma

· Meningiomas

· Vascular lesions & tumors (lymphangioma, carotid-cavernous sinus fistula, cavernous hemangioma, orbital varices)

· Dermoid and epidermoid cysts

In kids:

· Meningiomas

· Dermoid and epidermoid cysts

What’s proptosis? What’s exophthalmos?

The orbit is closed on all edges except the front side. Hence, any lesion in the orbit causes the eye to either get displaced or protruded anteriorly. Eye proptosis or exophthalmos is a condition ensuing in the eye’s forward displacement, because of an orbital lesion which pushes the eye forwards.  In very early phases of proptosis, all that one may be in a position to value are slightly much more prominent eyeballs and increased scleral show (White portion of the eye becomes more visible)


Proptosis (Exophthalmos) post surgery for thyroid orbital disease

Exactly how are orbital tumors and Thyroid Eye Disease treated?

An Orbitotomy operation is a cut made into the orbit during surgery, to enable the elimination of a tumour or foreign body, to treat a lesion, or to strain an abscess. In case of Thyroid Eye Disease, orbital decompression surgery is carried out so as to reduce forward eye displacement (proptosis) & exophthalmos.

Orbital Tumors and masses (e.g. neural cancers such as meningioma and glioma of the optic nerve, vascular tumors viz. cavernous hemangioma and lymphangioma, thyroid eye disease (TED), and cancers and neoplasms like orbital lymphoma) create axial protrusion (bulging ahead) of the eye (also known as proptosis) and displacement of the eye. Treatment / elimination of these orbital masses is done with the help of an oculoplastic surgical treatment known as an orbitotomy (indications for orbital surgery), a surgery performed to start the orbit and access the lesions and eliminate them.

Exactly what are the various kinds of orbitotomy?

Orbitotomies can be of numerous kinds – Medial Orbitotomy, Anterior Orbitotomy, Lateral Orbitotomy, and a combination of the Lateral and Medial orbitotomies. Oculoplastic Surgeons are the ones who perform Orbitotomy procedures.

The lateral orbitotomy is a surgical method in Oculoplasty that’s well matched to eliminate lesions of the inferolateral, superior, lateral, and posterior orbit (behind the eye). The primary benefit of the approach, besides a lot of exposure, would be the fact that the optic nerve lies medially in the orbit and therefore there are very few chances for it to get inadvertently damaged during surgery. A lot of different skin incisions have actually been utilized to approach this location. This treatment is done under general anesthesia.

An anterior orbitotomy is utilized for little tumors in the anterior orbit.

A medial orbitotomy is frequently needed to access orbital lesions that are positioned medial to the optic nerve.


Orbitotomy Surgery Incisions


Video on Lateral Orbitotomy (performed by Dr. Debraj Shome) to remove an orbital mass:

Proptosis Surgery Proptosis | Exophthalmos| Cavernous Hemangioma| Lateral Orbitotomy Surgery in Mumbai, India

What’s Graves Disease (also known as Thyroid Eye Disease or Grave’s Ophthalmopathy)?

The thyroid gland is a tiny, butterfly-shaped gland situated near the top of your windpipe (trachea) at the front side of your throat. It’s a crucial part in managing the rate at which chemical reactions take place in the cells throughout your body (rate of metabolism).

Autoimmune thyroid illness occurs as soon as the body’s antibodies attack the thyroid gland. In some individuals, these exact same antibodies additionally attack the orbital cells surrounding the eyeball. This is Thyroid Eye Disease (TED). It’s not understood precisely why this takes place in some individuals and not in other people. Therefore, TED is an autoimmune illness, most often occurring in accordance with an overactive thyroid gland. Thyroid eye disease (TED) or Graves illness is a disease marked by inflammation of the muscles and fatty cells surrounding the eyeball inside the eye socket (orbit). Grave’s disease causes the muscles and soft cells inside the eye socket to swell. This pushes the eyeball ahead (proptosis / exophthalmos) and causes different symptoms in the eye (Grave’s disease symptoms).

Thyroid Eye Disease

Exophthalmos secondary to Graves Disease

Just how is Graves Disease (Thyroid Ophthalmopathy) treated?

Graves Disease (Thyroid Eye Disease or Thyroid Orbitopathy) is treated with an orbital decompression surgery. Since the muscles and orbital cells become inflamed and the eye is pressed forwards, the optic nerve is placed under tension and the individual can become entirely blind in thyroid eye disease.

The main objective of an orbital decompression surgery is to produce more room in the orbit to enable the attention to return to a more regular place.

The indications for orbital decompression consist of:

  • Spontaneous globe prolapse
  • Compressive optic neuropathy
  • Disfigurement
  • Exposure keratopathy
  • Orbital congestion
  • Discomfort because of to orbital pressure/pain

As a result of orbital decompression surgery, space is created by removing areas of the orbital bone and removing orbital fat, thereby creating space for the protruded eyeball.

In summary, the orbit is the bony socket surrounding the eye. Any condition of the orbit can cause displacement, proptosis and exophthalmos of the eyeball and lead to disability of eyesight. The commonest illness impacting the orbit is Grave’s disease (Thyroid Eye Disease). Tumors can additionally impact the orbit, commonest being orbital lymphoma, orbital vascular tumors like cavernous hemangioma and lacrimal tumors like pleomorphic adenoma. Treatment of orbital tumors (neoplasms) and other lesions is by making use of a kind of surgery called an orbitotomy. Thyroid Eye Disease is treated with an orbital decompression surgery. Orbital surgeries are incredibly specific surgeries done by oculoplastic surgeons. Since oculoplastic surgeons have dual training in eye surgery as well as plastic surgery, they’re preferably prepared to treat orbital problems aesthetically and cosmetically, while preserving eyesight. Read more on oculoplastic and orbital surgery in our oculoplastics and oculoplastic surgery part on this blog site.

See Orbital Tumor Surgery Before After Photos-

Oculoplasty & Oculoplastic Surgery in India

Oculoplasty is a fast growing super-specialty in India, with many institutes now offering fellowship training programs for young oculoplastic surgeons. For eyelid, orbital, brow, lacrimal, socket and mid-face surgery, please seek and look for a good Oculoplastic surgeon, Mumbai, Delhi, Chennai, Hyderabad, Kolkata, Pune and most other Indian cities will have a few.

Best Oculoplastic Surgery Oculoplastic, Plastic, Cosmetic Surgery Trends & Costs in Mumbai, India- Dr. Debraj Shome

Most of the top oculoplastic surgeons are trained in the Western world and have come back to India post that and costs will be 1/5th the costs you would pay in the US, Europe or Singapore.

Orbital Plastic Surgery

Orbital plastic surgery uses new techniques to correct the defects in eyes and the orbit area of the eye. The orbital area is the bony socket that protects the eyes and the nerves surrounding it. The well being of the orbital structure is very important as any damage to the bony socket can lead to permanent damage to the eyes. Orbital plastic surgery can help correct many defects caused by ptosis, trauma, tumours, eyelash abrnomalities, socket defects, tear drainage system blockage, Graves eye disease and inflammations.  

Dr. Debraj Shome is a trained oculoplastic surgeon who has been trained in ophthalmic and plastic surgery of the eye area. Dr. Debraj Shome makes sure that the health of the eyes is always the prime consideration when performing the orbital plastic surgery. Orbital plastic surgery includes correcting defects in eyelids, eyebrows, eye socket and the lacrimal duct.

Orbital plastic surgery helps restore the natural appearance of the eye of the patient and help them see well. Dr. Debraj Shome uses the best and latest techniques in orbital plastic surgery to give the best results with minimal scarring and faster recovery times.

Dr. Debraj Shome is amongst the most experienced facial plastic surgeons in the world, with many thousand face procedures performed in his career. Dr. Shome is co founder of The Esthetic Clinics ®, a chain of centers located in Mumbai, India.


Leave a Reply

Your email address will not be published. Required fields are marked *


0 Flares Twitter 0 Facebook 0 Google+ 0 LinkedIn 0 StumbleUpon 0 Email -- 0 Flares ×