The orbit is the eye socket which houses the eye and other parts of the optic anatomy such as the optic nerves, extra ocular muscles that help in the movement of the eye, the nerves and other associated structures that supply the blood to the eye structure.
Tumors of the orbit can appear anywhere in the orbital area and also tumors may invade the orbit while originating from surrounding areas such as brain cavity, the nasal cavity and the paranasal sinuses. The tumor may also grow on the bones and enter the confines of the orbit.
Orbital tumors can be of various types such as; dermoids, hemangiomas, neurofibromas, sarcoma, lymphangiomas, orbital meningioma and metastatic lesions.
Tumors of the orbit may affect adult and children as well. Fortunately, most orbital tumors are benign and can be treated completely. But if the tumor is not treated well in time, it may result in complete vision loss.
For the resection of orbital tumors a procedure known as orbital tumor surgery is performed, which is also known as Orbitotomy. The use of traditional techniques and procedures implies that the resection of tumors would involve the optic nerve and as a result the critical structures may get affected due to direct or vascular damage.
The surgery is complex as the anatomy of the eye is complicated as well as delicate. Therefore it should be performed only by very skilled surgeons. The orbital tumor surgery/Orbitotomy aims at:-
- To preserve the vision and preserve the eye of the patient.
- To prevent the tumor from spreading to other parts of the body.
- To relieve the symptoms of the eye cancer and restore the health of the patient.
In extreme cases, where the treatment is not done in time or not done properly, an enucleation (removal of the eye) may be required. Therefore, Orbitotomy should be performed by a team of highly skilled doctors and surgeons, including a plastic surgeon, an ophthalmic surgeon as well as a neurosurgeon. In the cases, where enucleation is done, a prosthetic eye may be attached to muscles. This gives more natural looking results because the eyes moves in conjunction which the other healthy eye.
Approach during the surgery
Since the eye orbit is area is delicate, one of the common difficulties happens in deciding in what approach to take for the resection of tumor. This is a complex and delicate procedure therefore in all major hospitals the procedure is generally carried out by a team of opthalmologists and neurosurgeons together. Depending on where the tumor is located the surgeons may be able to reach it from above or below the eye in which case the incisions are made either along the eyebrow or the eyelid or they may take a lateral approach.
The duration of the surgery may be between six to eight hours which depends on the complexity of the lesion. As part of the resection procedure, reconstruction of the eye orbit and the skull may also be required. Diseases which are acquired due to trauma or tumors like Grave’s disease or Paget’s disease may also require reconstruction. For reconstruction purposes, skin grafting may be done with tissues taken from the patients’ body. Modern advancements in medicine has led to the invention of materials which can be used as substitutes like hydroxyapatite cement, porous polyethylene, resorbable fixation devices etc.
In some extreme cases of Grave’s diseases, repositioning of the eyelids may be required. In few cases, repositioning of eyes may also be needed.
As the orbital areas, have limited access, endoscopic procedures are done to ensure limited manipulation of the tissues. With endoscopes it is also ensured that the neurovascular supply is not compromised.
The patient is hospitalized for one to two weeks depending upon the procedure. The rate of recovery differs from one patient to another. Also, it depends upon the size of the tumor, the complications of the procedure. Generally, the swelling and the bruising subside within two weeks. It is advised to the patients to restrict their general activities and rest as much as possible. Thanks to the modern minimally invasive procedures, the scarring is minimum and the scars fade away in a period of six months to a year.
It is important to recognize the symptoms of orbital tumor to make sure the treatment is done in time. It is advised to see an ophthalmologist immediately if a person is experiencing the following symptoms:-
- Double/ blurry vision
- Loss of vision
- Persistent redness in the eyes
- Continuous tearing of the eyes
- Abnormally large eyes or bulging eyes
- Constantly tired eyes
If someone is experiencing the aforementioned symptoms, it is advisable to consult an ophthalmologist without delay. If diagnosed in time, the orbital tumors are completely curable. The treatment should be taken from a reputed hospital or medical centre only.