A great variety of tumors can grow in the orbit and its correct diagnosis will be confirmed through a biopsy. The patient must be aware of the exact procedure and if the biopsy will be taken on the mass, or in the contrary, if a total excision will be performed.
The surgical treatment depends on the nature of the tumor, it can be performed as simple resection (in the case of neurofibromas and inflammatory pseudotumors), an enucleation, where the entire eyeball is removed with the orbital portion of the optic nerve, and even an exenteration, which is the removal of the balloon and also the entire content of the orbit (performed when malignant tumors have a tendency to metastasize).
For any ophthalmologist exenteration of the orbitary content is a very complicated surgical procedure because it causes a huge physical and psychological trauma in the patient. It is also a radical technique, and the alternatives for reconstruction are really poor and disfiguring.
Although we are not used to this “mutilant procedure”, we must have the certainty that it is a surgical option because it is the only chance for saving patient´s life and with the exenteration we are able to limit the cause.
After the surgery, the patient should be oriented with regard to vision, bleeding and pain.
Vision may result affected in the intraoperative period. In this case, doctors will be in charge of this for at least 2 hours, and also the papillary and extra ocular muscle function will be evaluated.
Hemorrhage may appear in the orbit and it can be blinding, so it will be examined closely.
Pain is a common complication, but if nausea and vomiting (caused by pain medications or surgery) appear its indicated treatment must be applied in order to avoid this and decrease venous pressure. This may cause orbital congestion that leads to compression of the optic nerve.
The patient will be evaluated the day after surgery. Complete examination is performed to check any changes regarding vision, extra ocular motility and papillary function. In sighted patients, doctors do not indicate patching the eye for fear of passing over a hemorrhage and result in increased orbital pressure, causing a compromise of the intraorbital structure.
The worst and undesired complication in this type of tumor surgery is loss of vision. This may be caused by the excessive pressure with retraction of the globe. It is worth noting that compression of the central retinal artery can provoke irreversible blindness.
Another complication is the hemorrhage; it can appear in any moment during the surgery or after it, causing compression of the central retinal artery. It may also be a result of laceration of either the anterior or posterior ethmoidal arteries.
Monopolar cauterization is performed carefully, because the current can be transmitted to the optic nerve and produce visual loss. Also, the close proximity to the anterior cranial fossa can unintentionally cause injury. Another complication is the direct perforation of the globe and this occurs when adequate protection such as a corneoescleral shield is not used. Neurologic or direct muscular injury may cause diplopia or other extraocular muscle disturbances. A serious complication is paresthesia when there is injury to the infraorbital, supraorbital, or supratrochlear nerves.
What is the Orbital Tumor Surgery Recovery Period?
In approximately 48 hours the intervened zone starts to edematize. Antibiotics are prescribed. In special cases, eyes are occluded. Cold and constant washing are advised.
In all cases, during the first 10 days after the surgery, patients can carry a normal life without performing great physical efforts. Rest is not indicated.
In the period of 20 days to 1 month the patient usually recovers satisfactorily.
The types of surgeries performed in case of orbital tumors are really complex and for that reason the patient should be fully aware (and this should be documented) of the risks, benefits and alternatives. It is crucial for the patient to be informed of the probability of enucleation or exenteration if indicated.
- American Academy of Ophthalmology. Orbital Tumor Surgery. https://www.aao.org/eye-health/treatments/orbital-tumor-surgery
- Cleveland Clinic. Orbital Tumor Surgery. https://my.clevelandclinic.org/health/treatments/15246-orbital-tumor-surgery
- Journal of Neuro-Ophthalmology. Perioperative Care in Orbital Surgery. https://journals.lww.com/jneuro-ophthalmology/Fulltext/2002/03000/Perioperative_Care_in_Orbital_Surgery.10.aspx