Treatment of orbitopathy
The treatment of orbitopathy is the treatment of all diseases affecting the orbit.
The orbit is the bony cavity that houses the eye and its associated structures.
It is a bony framework formed by several bones of the skull. Within the bony framework, the orbit contains a number of structures:
- the eye itself
- the oculomotor muscles responsible for eye movements,
- the orbital fat, which protects the eyeball,
- the optic nerve responsible for vision,
- the blood vessels,
- the lacrimal gland.
The function of the orbit is to protect the eye from injury and trauma while providing support for the functions essential to the eye, particularly those of the eye muscles.
Pathologies that can affect the orbit called “orbitopathies” are classified according to their causes:
- inflammatory:
- specific inflammatory syndromes including dysimmune orbitopathy (dysthyroid orbitopathies of Graves’ disease)
- inflammatory syndromes non-specific
- tumoral: benign or malignant orbital tumors
- traumatic: orbital fractures,
- infectious: preseptal or retroseptal orbital cellulitis
The treatment of orbitopathy is therefore the treatment of the cause at the origin of this orbitopathy as well as the treatment of the symptoms associated with this orbitopathy.
The most common symptoms of orbitopathy are:
- exophthalmos and eyelid malocclusion
- decreased vision,
- increased eye pressure,
- edema and inflammation of the periocular tissues with swelling of the eyelids,
- limitation of the function of the oculomotor muscles responsible for double vision or diplopia.
Ophthalmologists and surgeons specializing in oculoplasty like Doctor Bela are qualified to assess and treat all related problems. to the orbit and associated ocular structures, to ensure your visual health and optimal functioning of the eye.
dysthyroid orbitopathy
Dysthyroid orbitopathy is an autoimmune disease of the orbit that can accompany certain thyroid diseases (Graves’ disease and Hashimoto’s thyroiditis). In these cases, there is hyperaction of the thyroid gland secondary to the circulation of autoimmune antibodies. These antibodies will attach to receptors located in the orbit and cause inflammatory symptoms.
These symptoms are grouped into a clinical entity called orbitopathy and results in:
- exophthalmos (protrusion of the eye forward, linked to inflammation of the fat and muscles of the orbit)
- a diplopia (double vision, linked to an infiltration of the eye muscles which limits their movements)
- abnormalities in the eyelids (eyelid edema, eyelid retraction)
- eye damage (dilated conjunctival vessels and ocular redness, swelling of the conjunctiva and chemosis, painful eye)
- in severe forms, there is a loss of vision (by compression of the optic nerve or by corneal ulcers) which requires emergency treatment .
Dr Bela will work closely with your attending physician and your endocrinologist to organize a complete diagnostic assessment:
- Ophthalmological assessment
- Orthoptic assessment
- MRI or Scanner
- Blood test
The treatment acts on two axes: that of the thyroid and that of the orbit.
- Thyroid treatment
Thanks to close collaboration with your endocrinologist, treatments will be implemented to stabilize thyroid function, depending on the case:
> medical treatment with synthetic antithyroid drugs or radioactive iodine
>surgical treatment by ablation of the thyroid - Treatment of orbitopathy
Outside of the absolute emergency setting, the treatment of orbitopathy is an oral or intravenous anti-inflammatory treatment to relieve ocular symptoms, most often with corticosteroids.
It is sometimes necessary to consider immunomodulatory medications.
Stopping smoking is essential. Secondly, when the function of the thyroid is stabilized and the eye no longer presents inflammatory symptoms, it will often be necessary to carry out reconstructive surgery. Doctor Bela will discuss with you the intervention necessary for your pathology:> treatment of exophthalmos by bone or fat decompression surgery
> treatment of diplopia by surgery of the strabismus and oculomotor muscles
>treatment of eyelid retraction by eyelid lengthening surgery
orbital inflammatory syndrome
Inflammatory diseases of the orbit are called orbital inflammatory syndrome. These can be specific or non-specific. The diagnosis depends on the organ affected in the orbit:
- dacryoadenitis if the lacrimal gland is involved
- myositis if the oculomotor muscles are affected
- orbitopathy inflammatory if the intraorbital fat is affected
It results in various symptoms:
- a exophthalmos (protrusion of the eye)
- diplopia (double vision)
- abnormalities in the eyelids (eyelid edema, eyelid retraction)
- eye damage (red, painful and swollen eye)
- in severe forms, there is a decrease in vision (by compression of the optic nerve or by corneal ulcers) which requires emergency care .
When the cause is found, we speak of a specific inflammatory syndrome. Sometimes the cause is unknown, we then speak of a nonspecific inflammatory syndrome.
Here are some examples of general diseases giving a specific inflammatory syndrome:
- Vasculitis (Wegener, Churg and Strauss syndrome, Polyarteritis nodosa)
- Granulomatous pathologies (Sarcoidosis, Tuberculosis)
- IgG4 syndrome
Routinely, the assessment to confirm the diagnosis and find the cause is as follows:
- Ophthalmological assessment
- Orthoptic assessment
- MRI or Scanner
- Blood test
- Sometimes a biopsy of diseased tissue in the operating room is necessary to analyze the cells of this inflammation
When, despite extensive additional examinations in search of a cause, everything returns to normal, the orbitopathy is then qualified as non-specific inflammatory orbitopathy.
When a cause is found, the treatment is for both the orbitopathy and the associated systemic disease responsible for this inflammation. This is why Dr Bela works closely with your GP to organise treatment in conjunction with the network of family doctors and internists.
When no cause is found, treatment is essentially symptomatic. This involves instituting anti-inflammatory treatment with oral or intravenous corticosteroids. In the event of recurrence or resistance to treatment, immunosuppressive drugs may be required to control the inflammation.
TUMOURS OF THE ORBIT
Orbital tumors can affect any tissue in the orbit.
Their classification is very broad. It depends on :
- the structures affected
- whether they are benign or malignant.
- MRI or CT scan
- Ophthalmological assessment
- Orthoptic assessment
- Blood test
- From a biopsy of the affected tissues in the operating room
- From the complete surgical resection specimen
The management of orbital tumors will depend on the nature of the tumor.
Most often it is a surgical treatment.
Thanks to collaboration with an anapathomopathologist present in the operating room, the tumor can be biopsied in order to have the certain diagnosis immediately. Then Dr. Bela will perform a total excision of the tumor and you will benefit from an on-site check to ensure that the excision limits are healthy.
If the tumor is too large to be removed in its entirety or if there is a risk of recurrence, surgical treatment is sometimes combined with complementary radiotherapy.
Some tumors must be treated with chemotherapy alone without surgery.
Other diseases of the ocular orbit
The orbit refers to the bony cavity located around the eye. Inside this orbital framework are located the eyes, the muscles of the eye, the fat of the orbit, the nerves, the arteries and the veins.
Orbital pathologies can therefore affect all of these structures. More generally, it involves classifying them by etiology.
Infectious pathologies, the most common of which is orbital cellulitis, is a bacterial infection affecting the orbit coming from neighboring structures and can extend to the front of the orbit or to the back of the orbit.
Traumatic pathologies such as fractures of the orbital bone framework most often affecting the lower wall of the orbit and causing double vision, swelling, pain, bruising and reduced motility of the eye.
How to treat the disease Basedow
Graves' disease, and more specifically Graves' dysthyroid orbitopathy, must be treated by several specialists in a coordinated fashion. The role of the endocrinologist is to balance the function of the thyroid responsible for this orbital inflammation. Medicinal treatment is then instituted in the form of neomercazole, for example, until thyroid hormones are normalised. The role of the ophthalmologist specialising in oculoplasty is to assess the factors of severity and activity of dysthyroid orbitopathy. In the case of active disease, anti-inflammatory treatment with corticosteroids, usually intravenous, is started. In the event of a life-threatening emergency, the ophthalmic surgeon will perform orbital decompression surgery to relieve the pressure around the eyes and the optic nerve.
Is exophthalmos reversible?
In the context of dysthyroid orbitopathy, exophthalmos is common and can cause real suffering in patients' social lives. The reversibility of this exophthalmos depends on the severity of the orbitopathy and the effectiveness of the treatment. In the early stages of the disease, exophthalmos may be mild and reversible, with no need for specific treatment. In more advanced cases, where the exophthalmos is severe and persistent, different options may be proposed alongside stabilising hormonal treatment and anti-inflammatory treatment with corticosteroids. In this case, treatment may involve orbital decompression surgery, which consists of removing part of the orbital bone in order to reduce the pressure around the eyes and free up more space in the bone cavity to move the eye backwards and thus treat the exophthalmos.
Does the thyroid affect eyesight?
The thyroid can affect vision when it is affected by an autoimmune inflammatory disease known as thyroiditis. The most common of these diseases is Graves' disease. In this case, circulating antibodies can reach the orbit and cause orbitopathy. There are many symptoms, ranging from mild and transient to severe and permanent impairment of vision. If you notice the slightest symptom, contact your ophthalmologist for a complete eye examination.
What are the symptoms of eye cancer?
When we talk about eye cancer, we can be talking about the eyeball and intraocular structures, but also extraocular structures. The symptoms are then different. When cancers affect the structures around the eye, in the orbit, there is a forward displacement of the eye caused by the tumour, resulting in exophthalmos and sometimes even a limitation of eye movements causing double vision. When the cancer affects the surface of the eyeball or the eyelids, it is most often visible to the naked eye and can be assessed by your ophthalmologist during a consultation to determine the cause. When the cancer affects the inside of the eye, the patient experiences indirect symptoms of these tumours. Most often, this involves a reduction in visual acuity. That's why we advise you to contact your ophthalmologist as soon as possible if you experience any unusual or new ophthalmological symptoms.