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Orbit (Eyesocket) & the Tear Duct System
Orbital Trauma
In the United States, injuries to the eyes and eye socket are unfortunately common place. Eyelid laceration, tear drain injuries, bleeding within and bruising around the eye, and fractures of the bones of the eye socket can all occur. These injuries often occur from sporting activities like baseball, soccer or football. In addition car accidents, fist fights, and dog bites are other common causes. Trauma to the orbit and eye area most often results in bruising, eyelid lacerations, and fractures of the orbital bone Since the bones of the eye socket done move like your arm or leg, they don’t all need to be fixed. Fractures causing double vision or large fractures into the sinus should typically be repaired in a timely fashion. Sometimes this is not possible but late repairs, despite being more difficult, can still be done.
Sometimes trauma is severe enough to irreparably injure the eye. Along with diseased eyes that are blind, painful and disfiguring, the removal of an eye (enucleation) is indicated when the eye can not be salvaged. Reconstruction of the eye socket, followed by fabrication of a prosthetic eye (performed by an ocularist), typically leads to a very pleasing result. Regular examinations are required as occasionally further reconstruction may be needed to retain proper fit of an eye prosthesis.
Orbital Tumors & Infections
Orbital infection, or Orbital cellulitis, is an aggressive sight, and even life, threatening process. Usually arising secondarily from an adjacent sinus infection, this situation must be treated swiftly and aggressively with antibiotics and often surgery. Close follow up and monitoring is required to treat these infections, but is typically successful. Of note, not all infections occur as an extension of sinusitis. This can also occur after trauma to the eyelid, eye or orbit as well as in patients whose immune system is challenged.
In both children and adults, a variety of tumors can occur in the eye socket. Some grow slowly, and go unnoticed while others can grow rapidly; impairing vision and causing even greater problems. CT scans and MRI’s are the best method for detecting and differentiating these lesions prior to having surgery. Once the location is identified, along with the general characteristics of the lesion, a treatment plan can be created. In some instances your orbital surgeon can treat these tumors on their own, often as an outpatient. On the other hand, aggressive tumors may require the help of other surgical specialist and in patient hospital treatment.
Tear Duct System—The Tearing Patient
The tear film on the surface of the eye is a critical component of maintaining vision. Tears nourish and lubricate the surface of the eye as well as wash away debris. A smooth, balanced tear film (consisting of water, oil and mucus) also allows light to enter the eye in an optimal fashion. If there is a disturbance of the tear film, patients will often experience tearing, burning, irritation and most importantly blurred vision, which often fluctuates. Patients who experience tearing either have a problem with ocular surface lubrication and tear production, or tear drainage.
Increased Tear Production and Dry Eyes
The eye has two sets of structures that produce tears. Smaller tear glands help maintain a baseline level of moisture on the surface of the eye. Unfortunately, inflammatory conditions like rheumatoid arthritis, Sjogrens disease as well as aging and menopause lead to decreased tear production. As tear production diminishes, the surface of the eye starts to dry out. Further, inflammation of the oil glands along the edge of the eyelid, common in patients with roseacea, also causes early breakdown and evaporation of the tear film. The brain senses the eye is both dry and irritated and in turn signals the main tear gland to flush the eye. As a result, the dry eye paradoxically tears and becomes watery. Patients with dry eyes note intermittent tearing of the eyes during activities like reading, driving, watching TV, using a computer or going outside on a windy day. These all cause the eye to dry out because the eye blinks less during these activities. The treatment for dry eyes includes 1) replacing tears with artificial lubricants which can be bought over the counter, 2) medications like Restasis that decrease inflammation in tear glands and encourages natural tear production to resume and finally 3) plugging of the tear drain. Other causes of increased tear production exist like allergies, infections and eyelashes poking the eye. These conditions can often be found during examination.
Frequently Asked Questions
Why should you see Dr. Amadi for your Orbital Disease?
The orbit is a small, compact and complex structure. Oculo-Facial surgeons have undertaken the extra training to deal with the nuances of treating orbital disease and injuries. When choosing a surgeon to evaluate and treat your orbital problem, look for an Ophthalmic Facial plastic & reconstructive surgeon who specializes in the eyelid, orbit, and tear drain surgery. Dr. Amadi is a member of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and has extensive training required to care for these problems in children and adults. Membership in ASOPRS indicates your surgeon is not only a board certified ophthalmologist who knows the anatomy and structure of the eye and orbit, but also has expertise in ophthalmic plastic reconstructive Surgery to appropriately care for your problem.
What Are the Causes of Obstructed Tear Ducts?
An obstruction of the tear ducts may occur due to numerous reasons (aging, trauma, inflammatory conditions, medications and tumors) and cause numerous signs and symptoms ranging from wateriness or tearing to discharge, swelling, pain and infection. These signs and symptoms may result from the tear drainage system becoming obstructed at any point from the puncta to the nasal cavity.
What Are the Symptoms of Obstructed Tear Ducts?
If the tear passageways become blocked, tears cannot drain properly and may overflow from the eyelids onto the face as if you were crying. In addition to excessive tearing you may also experience blurred vision, mucous discharge, eye irritation, and painful swelling in the inner corner of the eyelids. A thorough examination by an ophthalmic plastic surgeon can determine the cause of tearing and recommended treatment.
How is an Obstructed Tear Duct Treated or Repaired?
Depending on your symptoms and their severity, your specialist will suggest an appropriate course. In mild cases, a treatment of warm compresses and antibiotics may be recommended. In more severe cases, surgical intervention to bypass the tear duct obstruction (dacryocystorhinostomy or DCR surgery) may be recommended. A DCR is performed by creating a new tear passageway from the lacrimal sac to the nose, bypassing the obstruction. A small silicone tube called a stent may temporarily be placed in the new passageway to keep it open during the healing process. In a small percentage of cases, the obstruction is between the puncta and the lacrimal sac. In these cases, in addition to the DCR procedure, the surgeon will insert a tiny artificial tear drain called a Jones Tube. A Jones Tube is made of Pyrex glass and allows tears to drain directly from the eye to the lacrimal sac.
Where Is The Surgery Performed?
DCR surgery is usually performed as an outpatient procedure. Patients usually have some bruising and swelling on the side of the nose that subsides in one to two weeks. In general, surgery has a greater than 90% success rate and most patients experience a resolution of their tearing and discharge problems once surgery and recovery are completed.
Who Should Perform DCR Surgery?
When choosing a surgeon to perform a dacryocystorhinostomy or DCR, look for an ophthalmic plastic reconstructive and cosmetic surgeon who specializes in the eyelids, orbit, and tear drain system. It’s also important that he or she is a member of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). This indicates your surgeon is not only a board-certified ophthalmologist who knows the anatomy and structure of the eyelids and orbit, but also has had extensive training in ophthalmic plastic reconstructive and cosmetic surgery.