Eye Socket (Orbital) Disorders

Common orbital disorders include:

• Thyroid eye disease (Graves' ophthalmopathy)
  An autoimmune condition associated with hyperthyroidism, causing inflammation and expansion of orbital fat and muscles. This may result in proptosis (bulging eyes), eyelid retraction, restrictive strabismus (double vision), optic nerve compression, and exposure keratopathy.

• Orbital fractures
  "Blow out" fractures of the orbital floor or medial wall following blunt trauma can entrap orbital muscles, producing double vision, restricted eye movement, and enophthalmos (sunken eye).

• Orbital tumours
  Both benign (such as cavernous haemangiomas and dermoid cysts) and malignant growths (including lymphomas, lacrimal gland tumours, and secondary metastases) may arise within the orbit, requiring imaging and often biopsy.

Apart from fractures caused by trauma, eye socket symptoms generally depend on the cause of the problem. They include:

• Bulging of the eye (proptosis or exophthalmos)
• Double vision (diplopia)
• Eye pain, particularly with eye movement
• Restriction of eye movement
• Swelling and redness of the eyelids
• Reduced vision or visual field loss
• A feeling of pressure behind the eye
• Headache or facial pain
• Asymmetry of the eyes

When you visit us at Sutherland Eye Surgeons, some of the tests that we perform may include:

• Visual acuity testing
  Assessment of your best corrected vision

• Colour vision testing
  Assessment of colour perception, which may be affected by optic nerve compression

• Pupillary assessment
  Evaluation for an afferent pupillary defect (APD), which may indicate optic nerve compromise

• Ocular motility assessment
  Assessment of eye movements in all directions of gaze to identify restriction or diplopia

• Exophthalmometry
  Measurement of the degree of forward displacement of the eye using a Hertel exophthalmometer

• Slit lamp examination
  Assessment of the anterior segment for signs of exposure keratopathy, corneal ulceration, or conjunctival injection

• Fundoscopy
  Examination of the optic disc for signs of swelling (papilloedema) or optic atrophy

• Visual field testing
  Assessment of peripheral vision, which may be affected by optic nerve compression

• Orbital imaging (CT or MRI)
  Essential for characterising orbital pathology, including assessment of soft tissue, bone, and neurovascular structures

Thyroid eye disease
Management focuses on optimising thyroid function and smoking cessation. During active inflammatory phases, corticosteroids or newer biologic therapies may be used to reduce swelling. For dry eye or exposure problems, lubricants and moisture shields are recommended. Surgery, including orbital decompression (to create more space for the eye), eyelid surgery, or double vision correction, is generally delayed until the disease has stabilised.

Orbital fractures
Surgery is recommended for fractures that trap eye muscles, cause significant displacement, or result in a sunken eye. The procedure involves repairing the fracture with small plates or grafts to restore the normal shape of the eye socket. Surgery is usually performed within two weeks of the injury.

Orbital tumours
Management depends on the type and location of the growth. Stable, benign tumours may simply be observed. Symptomatic, growing, or malignant tumours require surgical removal, with the approach carefully planned to preserve vision and eye movement. Radiation therapy or chemotherapy may be needed for certain cancers.