Exophthalmos, which occurs when the eyeball protrudes from the orbit, is, as well as an aesthetic problem, a warning sign to go and visit the ophthalmologist. The “bulging eye” appearance can be caused by serious diseases such as thyroid orbitopathy or certain orbital tumours, whose expert treatment is key to determining the prognosis of the disease.
Dr. Ramón Medel, head of IMO’s Oculoplastics Department and a leading expert in Spain in the field of orbital diseases, has extensive experience in the management of patients with thyroid orbitopathy, the most common disease of the orbit, affecting 50% of patients with hyperthyroidism.
An extremely complex procedure
Since the orbit is a rigid cavity, treatment of this inflammatory disease involves regaining the space lost through the thickening of the orbital fat and the muscles surrounding the eye. It is what is known as orbital decompression, and is achieved by removing one or more of the walls of the eye socket during a procedure that very few specialists are able to perform.
According to Dr Ramón Medel, “it is a highly complex surgical procedure because it is necessary to access the orbit without damaging the ocular structures”. This is, for many patients that come to IMO, an “urgent solution”, adds Dr Eva Ayala, also a member of IMO’s Oculoplastics Department.
As highlighted by the ophthalmologist, “thyroid orbitopathy, besides causing exophthalmos, strabismus and eyelid retraction, can damage the cornea and optic nerve, leading to irreversible blindness”. Hence the importance of patients putting themselves from the outset in the hands of specialists to ensure complete rehabilitation.
The surgeon determines the prognosis
Acting quickly, effectively and safely is also essential in the diagnosis and treatment of orbital tumours which, despite not being directly visible, are usually manifested as exophthalmos. Because of this, we have to be especially attentive to this symptom.
“We have to be aware that, if the tumour is malignant, time can be crucial to saving the eye, vision and even the patient’s life”, emphasises Dr Medel, who adds that “the first surgeon to treat the case is the one who determines the prognosis”. Dr Ayala explains that “the tumour has to be completely removed and, because of its particular location, an expert surgeon is required who can work in a confined space where delicate structures are found”.
To do so, a useful instrument unique in Spain is used for this complex orbital surgery: the head microscope, which enables the oculoplastic ophthalmologist to enjoy freedom of movement without compromising on precise and detailed visualisation.
Towards minimally-invasive treatment
The application of the latest technology and the knowledge of IMO’s oculoplastics specialists make it possible to perform microincision techniques with local anaesthesia on an outpatients’ basis, achieve the best functional and cosmetic results and reduce postoperative and recovery time.
With the aim of improving the quality of life of patients and progressing towards minimally-invasive treatment, even in the severest cases, IMO’s Oculoplastics Department is involved in developing new lines of study and, currently, is the only centre in Spain that performs brachytherapy associated with surgery in malignant tumours of the lacrimal gland.
“This innovation allows us to apply the maximum radiation dose very selectively in order to reduce side effects for patients with this type of particularly difficult to tackle orbital tumour”, concludes Dr Medel.