Orbit is the bony socket in the skull that contains the eye, extra ocular muscles, cranial nerves (II, III, IV, V and VI), orbital and retrobulbar fascia, lacrimal glands, lacrimal sacs, naso lacrimal ducts, eyelids, ligaments (medial, lateral palpebral and suspensory), septum, short ciliary nerves, fats and, blood vessels. The volume of this socket is about 30 mL, of which the eye constitutes 6.5 mL. Externally the orbital structure comprises of the forehead, cheekbone, sides of the nose and temples. Besides the protection it offers to the eye, the orbit is the site of operation for the lacrimal drainage system. The lacrimal glands of the eye secrete the tear film that protects the eye from external allergens and, trauma. However, the orbital structures are susceptible to infections in case of inflammatory disorders.
Inflammatory Disorders in the Orbit
Wegener Granulomatosis is an uncommon blood vessel disorder that can cause inflammation in the orbit of the eye, sinuses, nose, throat and lungs. The cause is attributed to an auto immune anomaly and, it slows down the blood flow to the internal organs. Nosebleeds, coughing, stuffiness, sinus infections, fatigue, numbness in arms, ear infections and weight loss are some of the common symptoms. Urine tests are conducted in severe case of Wegener Granulomatosis wherein, there is a possibility of damage to kidneys. Imaging tests such as CT and MRI scans are performed to check for the disorder in the orbital blood vessels and to assess if, the inflammation has spread to internal organs. Biopsies are conducted to check for signs of granulomatosis in the tissues. At early stage, corticosteroids are administered to mitigate the inflammation and, to suppress the immune system from causing further damage.
Scleritis is inflammation in the sclera, the outermost protective white layer of the eye. Auto immune disorders in the body can lead to severe inflammation in the sclera, thereby causing redness and swelling in the eye. Symptoms include severe headaches, increased sensitivity to light and double vision. Ultrasonography and biopsy are performed to gauge the affected area around the sclera and, to check for signs of any infection. Blood tests are conducted to evaluate any cascading symptoms of auto immune disorders. Immuno suppressants are administered carefully to the patient via a stepladder approach, considering the aim to first cull the inflammation in the sclera.
If the orbital structures such as, the tissues and the skin supporting the eyelid are inflamed due to an infection, the condition is known as Preseptal cellulitis. The cause could be sinusitis, conjunctivitis or an insect bite. Symptoms are usually reflected in the tissues around the eyelids as swollen and tender eyelids. The condition is treatable with medications and, it does not aggravate further if diagnosed early. However, if the infection sets in within the orbit by spreading into the tissues lining the orbit, the condition is known as Orbital cellulitis. Palpable symptoms include red eye, swelling in the eye, vision impairment and, palsy in the eye muscles. CT scan or an MRI scan is performed to evaluate the degree of the infection. Antibiotics are administered intravenously during the treatment. If not diagnosed on time, orbital cellulitis can lead to permanent visual impairment. Besides, if the infection has spread into the blood vessels, it can lead to cavernous sinus thrombosis.
Orbital Myositis is an auto immune disorder that causes inflammation and palsy in the extraocular orbital muscles. Symptoms are acute and can set in suddenly. Patients may experience swelling in the eyelids with restricted muscle movement. CT and MRI scans are conducted to assess the degree of swelling in the orbital muscles and, to locate the exact site of the inflammation. Treatment usually begins with the administration of corticosteroids to fight the inflammation caused by the auto immune response of the body. If the patient fails to respond to drugs, he is put through radiation therapy with immune suppressive agents. In extreme cases, intravenous immunoglobulins that contain healthy antibodies from healthy donors are given to the patient to fight the auto immune disorder in the orbital muscles.
Other factors that can cause inflammation in the orbit are lacrimal gland tearing and orbital tumors. Lacrimal gland tearing occurs when the tears are not drained normally into the nasolacrimal duct because of an obstruction in the lacrimal drainage system. The obstruction may be benign or malign. If malign, the chances of cancer cells spreading from the lacrimal drainage system into other parts of the body, run high. To assess if orbital tumors are metastatic by nature, biopsies are performed by removing a fragment of the affected tissue from the site of target. The fragment is thoroughly evaluated under the microscope post which, the treatment plan is drawn out for the patient.
Dr. Debraj Shome is a highly acclaimed oculoplastic surgeon who specializes in orbital surgeries that treat the above mentioned inflammatory disorders affecting the orbit of the eye.