Orbital Surgery

The orbit is the bony socket that holds the eye together with its muscles, nerves, blood vessels and fat. Problems in the orbit can affect vision, eye movement and the position of the eye.

• Fractures: a blow to the face can break the thin floor or inner wall of the orbit, causing double vision, a numb cheek or a sunken eye.
• Infection: orbital cellulitis or an orbital abscess, usually spreading from the sinuses. It often affects children after a cold.
• Thyroid eye disease: swelling of the tissues behind the eye, causing bulging eyes, grittiness and double vision.
• Growths (tumours) in or around the orbit, which can push the eye forward or affect vision.

A red, swollen eyelid with fever, pain on moving the eye, a bulging eye or any drop in vision needs same-day medical attention.

• A full eye examination: vision, colour vision, eye movements and the position of the eye.
• A CT or MRI scan of the orbits is usually needed.
• For some growths, a small tissue sample (biopsy) is needed to make the diagnosis.
• Care is sometimes shared with other specialists, such as ENT surgeons, endocrinologists or neurosurgeons.

• Fractures: many do not need surgery, and double vision often settles within a few weeks. When repair is needed, an implant is usually placed along the orbital floor through the inside of the lower eyelid. Surgery is urgent if an eye muscle is trapped, which is more common in children.
• Infection: treated in hospital with antibiotics through a drip. An abscess is drained if vision is threatened or the infection does not improve.
• Thyroid eye disease: treated medically while the disease is active. Surgery to make more room in the orbit (orbital decompression) may be advised later, or urgently if the optic nerve is compressed. Squint and eyelid surgery follow if needed, in that order.
• Growths: may be monitored, sampled or removed through a surgical opening of the orbit (orbitotomy), usually through the eyelid crease, the inside of the eyelid or the side of the orbit.

• Recovery depends on the operation, from a short hospital stay to several weeks of healing.
• Swelling and bruising around the eye settle over a few weeks.
• After an orbital fracture, avoid blowing your nose for about four to six weeks.
• After decompression, activity is limited for about 10 days. The final result after fracture repair or decompression is judged over several months.

Every operation carries some risk. Your doctor will go through the risks that apply to you before you decide.

• Bleeding, infection and swelling.
• Double vision, which may continue after surgery or be new, particularly after decompression.
• Numbness of the cheek or upper lip.
• Movement of an implant.
• Rarely, loss of vision.