The Orbit

The orbit is the bony socket that surrounds the eye. The orbit contains the eye, the muscles that move the eye, arteries and nerves including the nerve with which you see (the optic nerve). All of these structures are enveloped in and cushioned by an intricate system of supporting membranes and fat.

Thyroid Eye Disease (Grave’s Disease):
One of the most common thyroid diseases is hyperthyroidism, in which there is an overproduction of thyroid hormones. Patients with hyperthyroidism may experience varying degrees of eye difficulty. Thyroid eye disease is a medical condition that causes many problems around the eye including enlargement of the muscles that move the eye and opening the eyelids too widely. As these muscles slowly enlarge, the eye is pushed forward and its movement is restricted. The swelling of the muscles can become so severe that the blood flow to the optic nerve is strangled resulting in a slow loss of vision. There may also be pressure around the eyes, double vision, excessive tearing and irritation of the conjunctiva (the mucous membrane that lines the lids).

 

Thyroid Eye Disease is a condition in which there is overproduction of thyroid hormones (hyperthyroidism).  Abnormal antibodies attack the thyroid gland and cause it to become overactive.  This may also cause swelling and inflammation of the soft tissues around the eyes and the muscles that move the eyes and eyelids.  As a result, the eyes may protrude, lids open too widely, or the eyes may not move together well causing double vision.

 

For many people, the discomfort can be treated with lubricants, wrap-around tinted glasses, and sleeping with eye shields along with the head elevated.  When there is active inflammation with more severe symptoms, oral cortisone or other anti-inflammatory medications may be needed to reduce swelling.  Radiation is sometimes used to treat active inflammation as well.  If the swelling is severe enough, surgery may be necessary to decompress the orbit.

 

 

The function and appearance of the eyes can usually be improved by reconstructive eyelid or orbital surgery.  Surgical treatment is generally delayed until the active inflammation subsides. Orbital decompression (removing part of the bony orbit and fat behind the eye to relieve pressure within the eye socket) can prevent damage to the optic nerve, and allow the eyes to move back into a more normal position in the eye socket.  Eyelid surgery to adjust the position of retracted lids can improve eyelid closure and restore eyelid function.  Removal of excessive fat from the eyelids can also improve their appearance.*

 

Dr. David Cowen specializes in the management of deformities and abnormalities of the orbit.  He believes in a conservative approach and works closely with other specialists in the management of thyroid patients; only recommending a surgical approach when necessary.

 

*American Society of Ophthalmic Plastic & Reconstructive Surgery

 

Orbital Pseudotumor:
Orbital pseudotumor is defined as an acute or chronic inflammatory disorder of orbital tissues. Although it occurs in all age groups it is seen bilaterally more in children. Tenderness, lid edema and erythema, lacrimal gland enlargement, pain and limitation of extraocular movements, proptosis are all signs of pseudotumor.

 

Orbital Tumors:
Tumors or cancers around the eye and involving the eye socket (orbit) are often complex and difficult to remove. Dr. Cowen has organized a multi-specialty approach to tumors (cancer) in this area. Specialists in surgical oncology, radiation oncology, hematology oncology, Mohs micrographic surgery, Gamma knife surgery, neuroradiology, and pathology work together to more accurately diagnose and treat cancers in this complex and delicate area.