Orbit and tumors

The orbit refers to the box made of bone in which the eye sits safely. This protects the eye from injury. Sometimes there can be tumours in this bony cavity. The most common of these in adults is the cavernous hemangioma. This is a vascular tumor - soft and non cancerous. This tumor usually sits behind the eyeball and can be removed safely by a small incision in the outer wall of the orbit.

The surgery is minimally invasive, cosmetically not bad and can be done easily and safely by a trained orbit surgeon. Having removed many such tumors I have devised my own ways of making sure, the tumor is safely removed with minimal damage to the eye.

The patient if fine can go home the same day after surgery. Recovery to normal does not take too long and the patient can be allowed to resume normal activities in a weeks time.

Thyroid eye disease

Thyroid eye disease is an under diagnosed condition. Many patients are not diagnosed till late in the disease, when there are serious problems due to the disease. The eyes are usually red and congested. There is persistent watering from the eyes. The lids start to behave abnormally with widely open eyes which gives an angry look to the patient. The movements of the eyes can also get limited when the patient starts getting double vision. Protrusion of the eyes occurs due to the increase in fat in the orbit and enlargement of the eye muscles. The vision may drop when there is compression of the optic nerve by the eye muscles.

The serious manifestations are loss of vision and double vision. The treatment in the initial stages when the eyes are red is giving oral steroids or intravenous steroids so that the patient can tide over the inflammation or redness in the eyes.

Control of the thyroid status is also essential for the eye disease to become stable. For the double vision one can give prisms or even injection of botulinum toxin in the acute stages. Orbital decompression is needed if there is sight threatening optic nerve compression or for cosmetic reduction of the proptosis. Squint surgery may be needed for the double vision especially as there may be vertical displacement of images and adjustable sutures are used while performing the squint surgery.

I routinely perform surgery and manage many patients with thyroid eye disease, with a good outcome.

OCULOPLASTY

I am going to Amritsar today, for the Oculoplasty meeting there. The meeting will sure be interesting, there will be talks on ptosis, entropion, ectropion, blepharoplasty, thyroid eye disease, orbital decompression, orbital and lid tumors and many such topics.

I will be speaking on the relation between extraocular muscle disorders and oculoplastic surgery, Squint is tricky and may be associated with lid and orbital anomalies especially in conditions like craniosynostosis, Down syndrome and thyroid eye disease. Hence it is imperative that one carefully treats these conditions and takes care of both the aspects. With my experience and training in both aspects, I have been fascinated by the relation between the extraocular muscles and the lids and orbits. The talk will be useful to all I am sure. I am looking forward to the feedback from all the delegates....