Common Symptoms of Orbital Diseases: Swollen eyelids, protruding eyes, and double vision (diplopia). Sometimes accompanied by pain and decreased vision. Among these, eye bulging and restricted eye movement are the main signs that are easily recognizable.
The Orbit is a pyramidal bony cavity, with the apex directed backward and the base extending forward, formed by the skull and facial bones. The soft tissues of the orbit do not directly contact the bony membrane but are enveloped by fascia. Therefore, pathological processes can evolve either within or outside the fascia.
Orbital Structures include: the Tenon’s capsule surrounding the eyeball from the corneal margin to the optic nerve. From the Tenon’s capsule to the orbital wall and fatty tissue, there are numerous fibers that help maintain the eyeball in a certain position and facilitate movement when the muscles contract; the extraocular muscles consist of four rectus muscles and two oblique muscles; the orbital venous system; and the lymphatic system. These factors keep the eyeball in a fixed position within the orbit, making it easy to recognize changes caused by orbital diseases.
Below are some common orbital diseases:
Thyroid Eye Disease (Graves’ Disease): Causes eye protrusion.
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Eye bulging in Graves’ Disease |
The patient often feels no pain unless there is a corneal exposure pathology. The eyes typically bulge on both sides simultaneously. A CT scan shows thickening of the extraocular muscles without tendon or muscle damage.
Idiopathic Orbital Inflammation: Patients often experience pain and fever, but the white blood cell count remains normal. CT imaging reveals thickening of the extraocular muscles associated with tendon damage. The sclera, orbital fat, and lacrimal gland may also be involved. Acute cases usually respond well to systemic steroids.
Orbital Cellulitis: Patients often present with fever and elevated white blood cells. CT scans frequently show sinusitis, especially ethmoid sinus involvement.
Orbital Tumors: Upon examination, the doctor may palpate an orbital mass. The eyeball may be displaced away from the tumor. The tumor is more clearly seen on CT imaging.
Trauma: Such as globe hemorrhage or foreign bodies in the orbit. Both occur due to trauma; however, foreign bodies may not cause immediate signs in the orbit for a long time. Therefore, accurate diagnosis requires supportive measures like ultrasound or CT scans.
Vascular Inflammation of the Orbit: Such as Wegener’s granulomatosis, polyarteritis nodosa, etc. Patients typically exhibit systemic signs and symptoms, especially in the sinuses, kidneys, lungs, and skin, with fever and significantly elevated erythrocyte sedimentation rates.
Mucormycosis: This disease manifests in the orbit, nose, and sinuses in individuals with diabetes, immunocompromised states, or systemic weakness. These patients are at high risk of mortality.
Venous Dilation: Dilation of the veins in the orbit causes eye bulging when engorged with blood. When not engorged, the eyes do not bulge. CT imaging clearly shows dilated veins. If CT does not reveal venous dilation but there are still suspicious signs, a venography may be necessary.
When a patient has eye bulging, it is also essential to differentiate pathological eye bulging due to systemic diseases and changes in the orbit from pseudo-exophthalmos. Pseudo-exophthalmos may occur in the following cases:
Abnormal shape and size of the eyeball: severe myopia due to astigmatism (especially when unilateral). Congenital glaucoma, also known as buphthalmos, where the eyeball is waterlogged, corneal dilation, or both corneal and scleral dilation.
– Asymmetrical size and shape of the orbits due to congenital or acquired causes.
– Increased fatty tissue volume in obese individuals and the elderly.
Conversely, the opposite of eye bulging is when the eyeball has a normal size and shape but is retracted into the orbit. The distance from the corneal apex to the outer margin of the orbit is shorter than normal by approximately 2-9mm. Pseudo-enophthalmos often occurs in cases of small eyes, small corneas, atrophy of the eyeball, severe hyperopia, eyelid edema, or in significantly emaciated patients.
The above are some orbital diseases. The clinical presentations are extremely diverse. Treatment depends on the specific underlying condition in the orbit. When suspecting an orbital disease, patients should visit a specialized ophthalmology facility for accurate diagnosis and appropriate treatment methods.
