Eye Socket (Orbit)

An orbital tumor is any abnormal growth that develops in the orbit, the bony socket that surrounds and protects the eye. Tumors in the orbit can affect the muscles, nerves, fat, and tissues that support the eye. Some are benign (non-cancerous), while others may be malignant (cancerous), and they may occur in children and adults.

Symptoms of orbital tumors:

• Bulging or protrusion of the eye (proptosis)
• Vision changes (blurry vision, double vision, or vision loss)
• Eye pain or discomfort
• Swelling or fullness around the eye
• Limited eye movement
• Drooping eyelid or noticeable asymmetry

If Dr. Stewart has concern for an orbital tumor based on your symptoms and detailed examination, she will order scans of your eye socket to further evaluate.  If a tumor is found on a scan, a biopsy or complete excision of the mass may be recommended.

Tumor types include:

• Cavernous hemangioma
• Lymphoma
• Dermoid
• Meningioma
• Optic nerve glioma or sheath meningioma
• Rhabdomyosarcoma
• Inflammatory conditions that mimic tumors (called pseudotumors)

Treatment Options:

Treatment depends on the tumor type, size, location, and whether it's benign or malignant. Options include:

• Observation (for small, non-growing tumors)
• Surgical excision
• Radiation therapy
• Chemotherapy
• Targeted or immunotherapy

An injury to the eye socket may cause an orbital fracture, which occurs when one or more of the bones surrounding the eye are broken.  This usually happens due to blunt force from an accident, fall, sports injury, or assault. These injuries can affect your vision, eye movement, and the appearance of your face.  A CT scan following an injury can help determine if any bones are broken, and how extensive the injury is.  Any time the eye socket is injured, it is also important to have a full eye exam to ensure the eye is healthy and uninjured.

Symptoms of orbital fractures:

• Swelling or bruising around the eye
• Pain or tenderness, especially when moving the eye
• Double vision when both eyes are open
• Bulging or sunken appearance of the eye
• Numbness in the cheek or upper lip (due to nerve injury)
• Difficulty opening or moving the eye

Treatment Options:

• Observation: For minor fractures without vision or movement problems
• Surgery if there is:
  • Double vision from trapped muscles
  • Significant bone displacement
  • Facial deformity (sunken or misaligned eye)

Surgery aims to reposition bones, release trapped tissues, and restore normal eye function and appearance. It is important to have surgery with an oculoplastic surgeon who is experienced working in the eye socket to minimize complications of surgery.

Orbital Inflammatory Disease is a rare condition that causes swelling and inflammation in the tissues around the eye (called the orbit). This can affect the muscles, fat, and other structures that help the eye move and function properly. It may occur after a viral illness, with other autoimmune conditions (like lupus, sarcoidosis or amyloidosis), or may be idiopathic (unknown cause).  It is often mistaken for cellulitis or an infection around the eyes but won’t respond well to antibiotics.  Imaging like a CT scan or MRI may be useful to distinguish the cause.  Dr. Stewart may also order some lab tests and may recommend a biopsy of the affected tissue to confirm the diagnosis.  Many people respond well to treatment, especially when diagnosed early. However, ongoing care may be needed to manage flare-ups.

Symptoms of Orbital Inflammation:

• Pain around or behind the eye
• Redness or swelling of the eyelids
• Bulging of the eye (proptosis)
• Double vision
• Difficulty moving the eye
• Blurred vision (in more severe cases)

Treatment Options

Treatment depends on the cause and severity:

• Steroids (like prednisone) to reduce inflammation
• Immune-suppressing medications for autoimmune causes
• Antibiotics if infection is present

Unfortunately, sometimes an eye has so much damage from an injury, disease or tumor that it becomes blind, painful or infected.  At this point, Dr. Stewart may discuss removal of the eye with you.  This is typically a last resort and performed only when you are ready.

There are two main types of eye removal surgeries:

1. Enucleation

• The entire eye is removed, including the wall of the eyeball itself.
• The eye muscles are left intact and can be attached to an implant to allow for movement.
• Used when the removal is done because of cancer within the eye

2. Evisceration

• The contents of the eye are removed, but the outer white part of the eye (sclera) and eye muscles are left in place.
• Often done for severe infections or in cases where the eye structure is not cancerous.
• Leaves slightly more natural movement of the prosthetic

A prosthetic eye (also called an ocular prosthesis or artificial eye) is a custom-made device used to replace an eye that has been surgically removed. While it doesn’t restore vision, it helps improve appearance and supports the natural shape and function of the eyelids.

At the time of eye removal surgery, an orbital implant is placed in the socket to replace the volume of the removed eye and support natural movement. You should never see this orbital implant, as it is within the eye socket. Once the area heals (usually after 4-6 weeks), a custom-made prosthetic eye is made and fit over the implant. The prosthetic is made by a specialist called an ocularist, who hand paints it to match your healthy eye.

It doesn’t move or see, but when attached to an implant and muscles, it often moves with your other eye in a natural way.

Caring for a Prosthetic Eye

• Can usually be comfortably worn full-time
• Remove and clean occasionally with gentle soap and water if desired
• Dr. Stewart will check the fit and movement of the prosthetic at least once a year