The socket like structure in a human skull not only houses the eye but also other parts which are associated with the anatomy of the eye such as ocular muscles, optic nerves and blood vessels that supply blood to the eyes.
Orbital tumors can grow in any part of the eye structure. They can also enter and invade the orbital region from the nearby structures such as the brain cavity, paranasal sinuses and nasal cavity. In certain cases, the tumors can also grow on the bones. Some commonly occurring orbital tumors are:-
The tumors can happen both in children and adults. The good news, however, is that if detected well in time, orbital tumors can be treated completely. The tumors are surgically treated by a procedure which is known as Orbitotomy. Till a few years back, due to lack of better and lesser invasive techniques, the treatment of tumor caused direct or indirect vascular damage due to damage to the optic nerves. The orbital surgery is complicated as the nerves and the muscles in the eyes are very small and delicate. This surgery should be performed only by a skilled surgeon.
What are the objectives of orbital surgery:-
Undoubtedly the primary objective of orbital surgery is to save the vision and the eye. A good surgeon tries to minimize collateral damage to other associated nerves and muscles. The surgery is also performed to stop the tumor from metastasizing to other parts of the body. The surgery also alleviates pain and restores a patient’s health and comfort.
If the tumor is not detected in time or the treatment is not begun in time, the eye may have to be removed. This procedure is known as enucleation. Therefore, orbital surgery is not performed by a single surgeon but by a team of surgeons which includes a plastic surgeon, an ophthalmologist and a neurosurgeon as well.
If at all, enucleation has to be carried out, a prosthetic eye is placed in the socket. Modern prosthetic eyes do not look artificial like the traditional glass eyes. They are attached to the ocular muscles in the socket and they move along with the healthy eye.
Approach during the surgery
The socket of the eye and its components are not only delicate, but the accessibility is also very less. Therefore, deciding upon an approach for the surgery to resect the tumor is a common difficulty. The procedure needs patience as it is a complex as well as a crucial surgery. The position of the tumor dictates whether a lateral approach has to be taken or whether the surgeons would make an incision above or below the eye to reach it.
Depending upon how complex and vastly spread the tumor is, the surgery may take up to 8-10 hours. While the tumor is resected, the surgery of skull and socket with the purpose of reconstruction may also be required. Reconstruction is also done in cases of trauma and in tumors like Paget’s or Grave’s disease. Skin grafting is also an important part of reconstruction, in which skin tissues are taken from the patient’s body itself. Some new materials have been invented such as porous polyethylene, resorbable fixation device, hydroxyapatite etc which act as substitutes to natural skin grafts. Due to restricted accessibility, endoscopic surgeries are also performed to minimize the damage to the tissues. Endoscopic surgery does not cause any neurovascular damage.
Recovery from the surgery:-
The patient is kept under observation for around a fortnight. The time to recuperate from the procedure is different for each person. The recovery time is also dependent upon how far the tumor had spread and eventually how complicated the procedure was. The normal bruising and swelling that happen with every surgery usually go away within ten days. The patients are advised to take complete rest for two to three weeks to ensure full recovery. They are also advised to not indulge in any activity which may strain their eyes. The procedure these days are not very invasive, therefore recovery duration is much shorter. Also the residual scars from the surgery fade within six months to a year.
Symptoms of orbital tumors:-
If a person experiences even one of the following symptoms, a doctor should be consulted as soon as possible;
Orbital surgery can definitely treat a tumor provided the tumor is diagnosed in time. Therefore it is crucial that a person keeps a careful watch for the symptoms mentioned above. And in case something abnormal is noticed, a surgeon should be visited immediately. Timely carried out procedure can surely prevent any permanent damage to the eyes.