Orbital Disease

Diseases or tumors that affect the eyes can range from simply irritating to life threatening. Patients who experience eye inflammation, possible infection, or other problems should see a physician for an evaluation.

Inflammation

Many conditions can cause orbital (or eye socket) inflammation. Any or all of the structures within the orbit may become inflamed. Causes can range from thyroid eye disease or infectious cellulitis to systemic inflammatory disorders or ocular tumors.

Even with a systemic (body-wide) inflammatory disorder, the inflammation sometimes only affects the eye. Examples include Wegener’s granulomatosis, in which there is generalized inflammation of blood vessels (known as vasculitis) that can affect the eye. Inflammatory disorders that affect only the eye include scleritis, an inflammation of the white coat of the eye (the sclera).

Causes and Treatments of Inflammation

Inflammation of the orbit can be the result of a body wide (systemic) inflammatory disorder. Sometimes the inflammation affects multiple areas, but sometimes it affects only the eye. Several inflammatory disorders can affect the eye.

  • Wegener’s granulomatosis, a condition with generalized inflammation of blood vessels (called vasculitis). Wegener’s is a systemic inflammatory disorder that can affect the eye.
  • Scleritis, in which the white coat of the eye (sclera) becomes inflamed. Scleritis is an inflammatory disorder that only affects the eye.
  • Inflammatory dacryoadenitis, which affects the lacrimal gland (located at the upper outer edge of the orbit)
  • Myositis, when inflammation affects one of the muscles that moves the eye
  • Inflammatory orbital pseudotumor or nonspecific orbital inflammation, which affects the entire orbit and its contents. Although the name includes “tumor,” the condition is not a cancer and a tumor is not present.

Symptoms of eye inflammation vary, depending on which structures are inflamed. Symptoms generally start rather suddenly, over a few days. Pain and redness of the eyeball or eyelid occur, with pain sometimes being severe and incapacitating. Abnormal bulging of the eyes (proptosis), double vision, and vision loss are also possible.

The physician can diagnose eye inflammation by computed tomography (CT) or magnetic resonance imaging (MRI) tests. A surgical biopsy from the inflamed area may be necessary for examination under a microscope biopsy to determine the cause.

Treatment of inflammatory eye conditions often involves a corticosteroid medication. Patients can take corticosteroids by mouth, or intravenously (by vein) if the inflammation is severe. Physicians might also sometimes use radiation therapy or drugs and treatments that change the body’s immune responses.

Infection

Preseptal cellulitis is a common infection of the eyelid and soft tissues around the eyelids characterized by acute eyelid redness and edema (swelling). The infection usually results from the spread of an upper respiratory tract infection, external ocular infection, or following trauma to the eyelids.

Physicians normally treat patients with preseptal cellulitis medically, as an outpatient. The exact location of inflammation is necessary for proper diagnosis and treatment planning. A CT or MRI scan can help diagnosis the type of inflammation present.

Orbital cellulitis (postseptal cellulitis) can seem like preseptal cellulitis when symptoms appear, but is a more dangerous infection with potentially serious complications. In orbital cellulitis, the patient has an acute infection of the tissues immediately surrounding the eye, including the eyelids, eyebrow, and cheek.

Bacteria from a sinus infection usually cause orbital cellulitis in children. Fortunately, infections that were caused by one particular bacteria are much less common in young children now because of the HiB (Haemophilus influenza B) vaccine.

Other causes of orbital cellulitis include a stye on the eyelid, bug bites, or a recent eyelid injury. Orbital cellulitis infections in children may worsen very quickly and can lead to blindness. Because of this, immediate medical attention is needed. The patient usually needs to stay in the hospital for treamtnets including intravenous antibiotics. Surgery may be necessary to drain the abscess or to relieve pressure in the orbital space around and behind the eye. With prompt treatment, the patient can make a complete recovery.

Tumors

Tumors can occur behind the eye. They often push the eye forward, causing an eye bulge known as proptosis. The most common causes of proptosis are lymphoid tumors (a specific cell type within the orbital tissues) and thyroid eye disease.

Other types of eye tumors include:

  • Vascular tumors (known as hemangiomas or lymphangioma)
  • Lacrimal gland tumors (called dacryoadenitis, benign mixed tumor, sarcoidosis, and adenoid cystic carcinoma)
  • Growths that extend from the sinuses into the orbit (such as squamous carcinoma or mucocele)

Metastatic cancer, inflammation(pseudotumor, sarcoidosis), or infection (abscess) can also cause orbital tumors.

Tumor Symptoms and Treatments

Most patients with orbital tumors notice a bulging of the eyeball.  Infections, inflammations and certain orbital cancers can also cause pain. Orbital tumors might also be an incidental finding on a CT or MRI scan of the head, sinuses, and orbit, though this is a less common channel of discovery.

Physicians can make a probable diagnosis by CT, MRI, or ultrasound. Most orbital tumors, however, are diagnosed by a surgical biopsy called an orbitotomy.  A specimen is sent to a pathologist, who helps determine the exact diagnosis.

Treatment includes removal of the orbital tumor, when possible. If the tumor cannot be removed or if removal will cause too much damage to other important structures around the eye, the surgeon can remove a piece of the tumor and send it for evaluation by an eye pathologist. Occasionally, an orbital tumor is too big for complete removal or involves the sinuses and requires more extensive surgery.

Most orbital tumors can be treated with external beam radiation therapy if they cannot be removed during surgery. Certain rare tumors require removal of the eye and orbital contents. In certain cases, the physician might use orbital radiotherapy to treat any residual tumor, in an effort to spare the eye and the patient’s vision.