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The orbit, or eye-socket, is the bony cavity that holds the eye and its appendages in place. There are a wide variety of orbital disorders, which include inflammatory, infectious, hormonal, tumour-related, trauma-related and congenital conditions.
Graves’ disease (also known as Graves’ Orbitopathy, Thyroid Eye Disease, or Basedow-Graves disease) is an autoimmune condition that affects the thyroid gland as well as the eye socket, and indirectly causes inflammation of the muscles and fatty tissues around the eye. The increased volume caused by the swollen tissues makes the eye protrude (bulge forwards) and results in double vision. It may also lead to loss of vision in rare cases if left untreated.
Inflammatory orbital syndromes are a group of inflammatory conditions that affect one or more of the structures contained within the eye. When the cause is unknown, it is called Nonspecific Orbital Inflammation, or, more often, Idiopathic Inflammation. If a diagnosis is made, the inflammation is then described as specific. A number of diseases, such as Vasculitis (inflammation of the blood vessels), or certain granulomatous conditions (such as Sarcoidosis or Tuberculosis), may be accompanied by orbital inflammation.
Orbital tumours are lesions that may occur around the eye. Many of these tumours are benign, although some may become cancerous (malignant). The first steps in diagnosis involve scanning the eye socket (CT or MRI scans). However, the most reliable test for determining the nature of a tumour is a biopsy. If appropriate, it may be suggested that a sample be taken from the lesion, in order to determine the best possible treatment. Orbital tumours may also present as a large lump on the eyelid, or as signs of inflammation (redness, pain, swelling) around the eye.
The most common clinical symptom of these conditions is exophthalmia, which is when the eyeball protrudes outside the socket. This is known as unilateral exophthalmia when only one eye is affected, or bilateral exophthalmia in cases where both eyes protrude.
Generally speaking, a sudden onset of exophthalmia suggests the presence of an inflammatory disease or localized injury. A more gradual appearance of exophthalmia, however, tends to be linked to an endocrine condition, such as Graves’ Disease, or a tumour.
Graves’ Orbitopathy (Basedow-Graves or Thyroid Eye Disease): treatment is determined according to how severely the orbit is affected. If the disease is mild, only remedial measures, such as artificial tears and Selenium supplements (a natural anti-inflammatory), may be proposed. It is also necessary to ensure your thyroid function is monitored by an endocrinologist. For more severe cases, the only approved treatment to date is Methylprednisolone (cortisone). Depending on severity, it may be necessary to add other immunosuppressants or radiotherapy. In rare cases, you may be advised to undergo orbital decompression, or surgery to realign the eyes in the case of double vision, or to reconstruct the eyelids.
Orbital inflammation: treatment depends on the cause, but is most often based on corticosteroid therapy either on its own or in combination with, and sometimes followed by, other treatments.
Orbital tumours: treatment depends largely on the type of tumour. The treatment you will be offered will be tailored to suit the type of lesion present.
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