Orbital diseases

While vision is preserved in most trauma, orbital damage such as a fracture may have occurred. When a trauma of sufficient energy impacts the eye, the eyeball itself transmits that impact force to the rest of the orbital structures.

The internal and lower bone walls of the orbit are formed by thin sheets of bone, so they can break with these traumas. When faced with an orbital trauma of a certain intensity, it is important to perform an orbital CAT scan.

Orbital fractures do not always require surgical treatment.

There are two situations in which it is necessary:

• When the fracture produces an alteration of the delicate musculature in charge of eye movement. If one of these muscles is trapped by the fracture, the eye will not be able to move normally nor will it be able to move in accordance with the other eye. Double vision (diplopia) is then produced, as one eye sees an image and the other sees the same image slightly displaced. The treatment consists of releasing the affected muscle and restoring the inegregation of the affected orbital wall. 
• Enophthalmos (sunken eye): If the fracture is of a considerable size, an expansion of the orbital cavity is produced. There is a redistribution of the orbital tissues through the new larger cavity and one eye becomes enophthalmic with respect to the other. The treatment is again to reconstruct the affected orbital wall

It is the most frequent cause of uni or bilateral proptosis. It is more frequent between 25 and 50 years old and in women. It is generally associated with hyperthyroidism (increased blood levels of thyroid hormones).

It is manifested as uni or bilateral proptosis, palpebral retraction, restrictive myopathy (the muscles lose their elasticity and behave like non-elastic cords) with double vision and, sometimes, compressive optic neuropathy (the optic nerve is compressed at the bottom of the orbit by the inflamed and thickened muscles).

Its treatment is medical and/or radiotherapeutic in the inflammatory phase, and surgical to correct the functional and aesthetic sequelae.

• Evisceration is a procedure that is performed when the eye has lost vision and is painful. It consists of emptying the eye contents while preserving its walls. The volume that is extracted is replaced with a spherical orbital implant. A few weeks after the surgery, the patient goes to the prosthesist, who adapts an external prosthesis that resembles the healthy eye. Pretty good cosmetic results are achieved and a great improvement in the patient's symptoms.
• Enucleation is usually performed on malignant intraocular tumors such as uveal melanoma. In these cases, it is advisable to remove the entire eyeball to avoid recurrence or spread of the tumor. As in the evisceration, an orbital implant is placed and then an external prosthesis. Both procedures can be performed painlessly under local anesthesia with sedation, but can also be performed under general anesthesia if the patient wishes.
• The orbital exenteration is a more aggressive surgery than the previous ones and consists of the emptying of all the orbital contents. It is reserved for cases of aggressive orbital tumors to prevent intracranial invasion.

Benign or malignant tumors can develop in the orbit and should be studied and treated by the orbital surgeon.

They are, in general, infrequent. There is a great variety of tumors that can affect the orbital cavity.

The most frequent benign orbital tumors are probably cavernous angiomas. They are lesions that are probably present from birth and grow very slowly. In adulthood they can cause symptoms because they occupy space in the orbit, but never destroy the surrounding tissues or metastasize. Their treatment is surgical. Other benign tumors are dermoid cysts, schwanomas, meningiomas and pleomorphic adenomas.

The most frequent primary malignant tumors at orbital level are by far the lymphomas. They represent up to 65% of cases. The treatment of these lesions is not surgical but medical, with radiotherapy and/or chemotherapy. Most orbital lymphomas are relatively benign. Other malignant tumors that may appear in the orbit are those derived from the lacrimal gland, sarcomas, or those related to the optic nerve.

The metastases of other tumors at orbital level are more frequent than primary malignant tumors of the orbit. The cancer that most frequently affects the orbit is undoubtedly breast cancer.