Orbital Inflammation and Orbital Tumors

There are a diverse variety of diseases that can cause orbital inflammation and a number of different orbital tumors that can be either benign or malignant. The issue with orbital inflammation and disease is commonly that the orbit is a closed space filled with important structures like blood vessels, nerves, muscles and of course the eye. When inflammation or a tumor appears in the orbit, because of the limited space, as the condition worsens, it pushes and squeezes those important structures which can result in problems like pain, swelling, double vision or loss of vision

Orbital Inflammation

Orbital inflammation refers to the swelling and inflammation of the tissues surrounding the eye within the orbit. It can be caused by infection, autoimmune disorders, or other underlying conditions, and it typically presents with symptoms such as eye pain, redness, swelling, and impaired eye movement. The management of orbital inflammation varies widely, but if you have an underlying disease causing the inflammation for example sarcoidosis, the treatment of the orbital disease is often done in conjunction with other physicians such as rheumatologists who manage the systemic disease with systemic medications.

Thyroid Eye Disease

Thyroid eye disease is the most common orbital disease and indeed is the most common cause of both one sided and both sided bulging of the eyeballs (called proptosis). This is a very complicated disease which has a range of severities. New medications such as Tepezza are being released to treat this life changing disease, but not all patients are candidate. Below we will briefly explain thyroid eye disease, what you can do as a patient to help mitigate the disease

Thyroid eye disease, also known as Graves' ophthalmopathy or Graves' orbitopathy, is an autoimmune condition primarily associated with an overactive thyroid gland (hyperthyroidism), but can be associated with any thyroid state. In this condition, the immune system mistakenly targets the tissues surrounding the eyes, leading to inflammation and swelling. The muscles and fatty tissues within the orbit become enlarged, causing various eye-related symptoms. These may include bulging or protrusion of the eyes (exophthalmos), redness, swelling of the eyelids, double vision, dryness or irritation of the eyes, difficulty in moving the eyes, even blindness in severe cases. Most patients have one or two flare ups of the disease, and these flare ups typically last 6 to 12 months with varying severity/symptoms. The disease follows a pattern we call Rundle’s curve in which the disease flares up, reaches a peak and then slowly gets better, eventually stabilizing to what we call quiescent disease. However, once you have a flare up of thyroid eye disease, you will not return 100% back to normal on your own, you will have some residual effects from the disease. As such, if you have thyroid eye disease, it is extremely important to control the things that we suspect can make thyroid eye disease worse to give yourself the best chances of keeping your disease under control.

Thankfully, the severity and specific manifestations of thyroid eye disease can vary widely among individuals, and most patients only have mild disease. However, it is crucial to seek medical evaluation and management from an oculoplastic surgeon familiar with this condition, like Dr. Chen or Pharo.

What Can I Do To Help My Thyroid Eye Disease?

  • Do not smoke - smoking has been proven without doubt to make thyroid eye disease worse and flare up more frequently.

  • Follow up regularly with your oculoplastic surgeon, regular eye doctor and your endocrinologist or PCP who is managing your thyroid.

  • Keep your eyes well lubricated.

  • Keep you allergies under control.

  • Try to avoid elective procedures around the eye until the disease has calmed down.

  • Keep stress under control.

Medical and Surgical Treatment of Thyroid Eye Disease

The medical treatment of thyroid eye disease aims to manage the underlying autoimmune process, control inflammation, and alleviate symptoms. In mild to moderate cases, management involves the use of lubricating eye drops or ointments to relieve dryness and irritation. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) or low dose corticosteroids may be prescribed to reduce inflammation and swelling. In more severe or active cases, immunosuppressive medications such as high dose corticosteroids (systemic or intraocular) or immunomodulatory drugs may be recommended to suppress the immune response. A newer drug, called Tepezza is now FDA approved for active thyroid eye disease, but not everyone is a candidate for this drug. In certain situations, orbital radiation therapy may be considered to help control inflammation and reduce eye protrusion. The choice of treatment depends on the severity of the disease, individual patient factors, and the expertise of the healthcare team. Regular monitoring and follow-up with an ophthalmologist or an oculoplastic surgeon is crucial to assess treatment response and make any necessary adjustments to the management plan.

Surgical options for thyroid eye disease are typically considered in cases of severe or progressive disease that do not respond adequately to medical management or when there is a significant impact on visual function. Orbital decompression surgery is can be performed to alleviate pressure on the optic nerve and create space for the swollen tissues within the orbit. This can help reduce eye bulging and improve visual function. Eyelid surgery, such a retraction repair or entropion repair, may be performed to correct eyelid retraction or improve eyelid closure. Strabismus surgery can help realign the eyes and improve double vision. The specific surgical approach is tailored to the individual patient's needs and may involve a multidisciplinary team of oculoplastic surgeons and strabismus surgeons. Regular follow-up visits are essential to monitor post-operative healing and optimize outcomes.

Orbital Tumors

Orbital tumors are rare, but can be very worrisome. They can be benign or malignant, but as described above even benign tumors can cause problems. The most common orbital tumors include:

  1. Cavernous Hemangioma: This is the most prevalent benign tumor of the orbit. It is composed of enlarged blood vessels and typically manifests as a painless mass that can cause proptosis (bulging of the eye) and visual disturbances.

  2. Optic Nerve Glioma: These tumors typically arise from the optic nerve and predominantly affect children. Optic nerve gliomas can cause vision loss, abnormal eye movements, and other neurological symptoms.

  3. Meningioma: Meningiomas are usually benign tumors that develop from the meninges, the protective membranes surrounding the brain and spinal cord. When they occur in the orbit, they can lead to gradual vision loss, proptosis, and displacement of the eyeball.

  4. Lymphoma: Lymphomas can involve the orbit either as primary orbital lymphoma or secondary involvement from systemic lymphoma. Orbital lymphomas may present as a painless swelling or pink mass, often affecting elderly individuals.

  5. Rhabdomyosarcoma: This is a rare malignant tumor that primarily affects children and arises from the muscle tissue. When it occurs in the orbit, it can cause proptosis, vision changes, and eye movement abnormalities.

  6. Metastasis: Often, a tumor elsewhere in the body can metastasize to the orbit and cause orbital symptoms.

Prompt evaluation and diagnosis of any orbital mass or swelling are essential to determine the nature of the tumor and appropriate management. A thorough examination by an oculoplastic surgeon, along with imaging studies such as CT or MRI scans, are typically necessary to establish an accurate diagnosis and guide the treatment plan. Treatment options may include surgical excision, radiation therapy, chemotherapy, or a combination, depending on the type and extent of the tumor.