Orbital Oncology and Ophthalmic plastic surgery may be a subspecialty that focuses on the surgical treatment of tumors of the eye, orbit, eyelid, conjunctiva and other ocular adnexal structures, as well as reconstructive surgery within the periocular region in cancer patients. At Hashmanis, the primary goals of this subspecialty are surgical elimination of ocular and orbital cancers while preserving the eye and vision, and restoring function and cosmesis within the periocular region.
Orbital tumors are abnormal growths of tissue within the structures that surround the eye. These lesions could also be either benign or malignant, and will arise primarily from the orbit or may spread (metastasize) from elsewhere within the body. The foremost common sorts of orbital tumors vary considerably by age, but include cysts, vascular lesions (arising from blood vessels), lymphomas, neurogenic tumors (arising from nerves), and secondary tumors (either metastatic or spread directly from the encompassing sinuses or cranium).
On occasion, these tumors could also be symptom-free, and patients may develop their symptoms slowly over an extended period. Other patients have a really rapid onset of symptoms, and therefore the location and nature of their symptoms are often important clues to work out whether a problem is benign or malignant. Many patients develop a bulging of the eye (proptosis or exophthalmos) from the orbit that contains the tumor. Because the eye could also be pushed forward, the eyelids often appear to be retracted from it. Some tumors can actually be seen or felt on examination. Some orbital tumors may cause decreased vision, transient episodes of vision loss, or double vision.
A variety of treatment options exist for these tumors, and therefore the modality used depends on the sort of tumor. Whenever possible, these lesions are removed using careful surgical techniques. However, not all tumors require surgical excision and in some, radiation, chemotherapy, or immunotherapy could also be the indicated type of treatment.
As a result, we work closely with several other services to make sure the most effective possible outcomes for our patients, including neurosurgery, otolaryngology, radiation oncology, radiology, plastic surgery, and internal medicine.
Graves’ disease is an autoimmune disorder that causes hyperthyroidism, or overactive thyroid. With this disease, your system attacks the thyroid and causes it to form more thyroid hormone than your body needs. The thyroid is a small, butterfly-shaped gland within the front of your neck. Thyroid hormones control how your body uses energy, so that they affect nearly every organ in your body—even the way your heart beats.
If left untreated, hyperthyroidism can cause serious problems with the heart, bones, muscles, menstrual cycle, and fertility. During pregnancy, untreated hyperthyroidism can cause health problems for the mother and baby. Graves’ disease can also affect your eyes and skin.
Common signs and symptoms of Graves’ disease include:
- Anxiety and irritability
- A fine tremor of the hands or fingers
- Heat sensitivity and a rise in perspiration or warm, moist skin
- Weight loss, despite normal eating habits
- Enlargement of the thyroid gland (goiter)
- Change in menstrual cycles
- Erectile dysfunction or reduced libido
- Frequent bowel movements
- Bulging eyes (Graves’ ophthalmopathy)
- Thick, red skin usually on the shins or tops of the feet (Graves’ dermopathy)
- Rapid or irregular heartbeat (palpitations)
- Sleep disturbance
What are my treatment options for Graves’ disease?
You have three treatment options: medicine, radioiodine therapy, and thyroid surgery. Radioiodine therapy is the most typical treatment for Graves’ disease, but doctors are starting to use medicine more often than in the past. Based on factors like your age, whether you’re pregnant, or whether you’ve got other medical conditions, your doctor may recommend a selected treatment and may assist you decide which one is correct for you.
For radioiodine therapy, you’re taking radioactive iodine orally as a capsule or liquid, at a higher dose than the dose used for imaging tests, slowly destroys the cells of the thyroid gland that produce thyroid hormone. The dose usually used for radioiodine therapy doesn’t affect other body tissues.
Although it’s unlikely, you’ll need more than one radioiodine treatment to bring your thyroid hormone levels into the normal range. Within the meantime, treatment with medicines called beta blockers can control your symptoms.
The least-used treatment for Graves’ disease is surgery to get rid of the thyroid gland. Sometimes doctors use surgery to treat people with large goiters, or pregnant women who are allergic to or have side effects from antithyroid medicines.
Before surgery, your doctor will prescribe antithyroid medicines to bring your thyroid hormone levels into the standard range. This treatment prevents a condition called thyroid storm, a sudden, severe worsening of symptoms, which will occur when people with hyperthyroidism have general anaesthesia .
After surgery to get rid of your thyroid, you’ll develop hypothyroidism and need to take thyroid hormone medicine on a daily basis forever. After surgery, your doctor will still check your hormone levels and adjust your dose as required .
Eye Evisceration and Enucleation
Enucleation is the surgical removal of the whole eye. Evisceration is the surgical removal of the contents of the attention , leaving the white a part of the attention (the sclera) and therefore the eye muscles intact.
Removal of an eye could also be required following a severe injury, to manage pain during a blind eye, to treat some intraocular tumors, to alleviate a severe infection inside the eye, or for cosmetic improvement of a disfigured eye.
Enucleation is that the procedure of choice if the eye is being removed to treat an intraocular tumor, or try to reduce the danger of developing a severe auto-immune condition to your healthy eye called sympathetic ophthalmia following trauma. In most other situations, either enucleation or evisceration can each achieve the specified objective. Your surgeon will assist you to work out which surgery is most appropriate for your condition.
Both surgeries are usually performed within the operating theater under local anaesthesia with sedation or general anaesthesia .
After enucleation or evisceration, most of the lost volume is replaced by a spherically shaped implant or fatty tissue from the patient’s own body placed within the eye socket. Implants are often made from a spread of materials including acrylic, hydroxyapatite, porous polyethyline, or dermis fat, among others. In most cases, the eye muscles are attached to the implant following enucleation, so as to preserve eye movement. Counting on availability, the implant could also be wrapped with sclera from a cadaver (this tissue is thoroughly tested for diseases) to ease attaching muscles to the implant and to permit for a smooth surface interface with the patient’s own tissue which will cover the implant.
Most patients head home the same day as surgery. Some patients will have an outsized pressure dressing or bandage placed on the eye for one week to stop bleeding. You’ll be asked to take medications after surgery like antibiotics, steroids, or pain-relievers. Patients may wear a patch after surgery for several days to several weeks, until they receive their prosthesis.
Eye Socket Reconstruction
There are situations when, in order to alleviate severe pain, to shield a healthy contralateral eye, to enhance aesthetics or maybe to save the life of a patient, the eyeball must be removed. Although this approach solves the patient’s ill health , by changes in physiognomy it can have a devastating effect on their perception and self-confidence. Ahead of a patient in whom visual function can’t be recovered the doctor should take all measures to supply the patient a “normal” look normal after surgery.
While this surgery is employed as a final resort, reasons to have all or a part of the eye or eye socket removed or modified include:
- Trauma – A severely damaged eye sometimes can’t be repaired and has got to be removed so as to stop infection and sympathetic ophthalmia (a rare disease where the immune system attacks not only the damaged but also the normal eye).
- Pain – A blind eye commonly becomes painful and has got to be removed for comfort, in addition to cosmetic reasons
- Cancer of the eye – If cancer is present within the eye itself, it’s sometimes necessary to get rid of the whole eye
- Orbital tumors – While tumors can grow inside the eye, they’ll also grow within the eye socket (the orbit) which surrounds and protects the eye
- Sunken eye (enophthalmos) – Usually refers to a sunken appearing prosthetic eye and may be treated by various procedures that increase the volume of the eye socket to bring the prosthetic eye forward, in line with the normal eye.
Surgical procedures for eye removal
Our oculoplastic surgeons will help determine if partial eye removal will be more beneficial, or if removing the whole eye is the only option. These procedures are used only absolutely necessary.
The three main surgical techniques for partial or complete eye removal are:
- Evisceration – Evisceration surgery involves removing the eye contents, while leaving the sclera (the white part of the eye) and therefore the muscles liable for the eye movements intact. This is often the least traumatic procedure for the eye socket and typically yields the most effective cosmetic result.
- Enucleation – Enucleation surgery involves the removal of the whole eye (including the sclera), but leaves the eye muscles and therefore the orbit intact
- Exenteration – The foremost radical of the three procedures, exenteration involves removing the whole eye, the eye muscles, most of the orbital soft tissues and sometimes a part of the orbital bones. This procedure is reserved for severe cancers or life-threatening infections.
Eye trauma refers to damage caused by a direct blow to the eye. The trauma may affect not only the eye, but the surrounding area, including adjacent tissue and bone structure.
There are many different forms of trauma, varying in severity from minor injury to medical emergencies. Even in cases where trauma seems minor, every eye injury should be given medical attention.
Symptoms of Eye Trauma
Symptoms of eye trauma may include:
- Trouble seeing
- Cuts to the eyelid
- One eye not moving as well
- One eye sticks out
- Blood in the clear part of the eye
- Unusual pupil size or shape
- Something embedded in the eye
- Something under the eyelid that cannot be easily removed
Treatments for Eye Trauma
Every eye injury should be given medical attention; do not touch, rub or try to remove any object in the eye. If the eye has been cut or there is an object in the eye, rest a protective shield – such as a paper cup – on the bone around your eye. Make sure there is no pressure on the eye itself. Seek immediate, professional medical attention.
In minor cases of trauma, such as a black eye from a sports injury, applying cold to the affected area can help bring swelling down, and allow the affected area to heal faster. However, even in cases where trauma seems minor, every eye injury should be given medical attention.
The best way to avoid eye trauma is to prevent it by using protective eyewear while doing things that may put them at risk. Activities include home repair, yard work, cleaning, cooking, and playing sports. In most cases of injury, people report not properly protecting their eyes – which shows that proper precautions may prevent an eye injury.