Orbital Conditions & Surgery
The orbit (eye socket) is a complex bony cavity housing the globe, six extraocular muscles, optic nerve, and lacrimal gland. Disease here can threaten both vision and life.
Orbital Conditions
Orbital Inflammatory Disease
Non-infectious inflammation affecting the orbital tissues, ranging from self-limited to systemic disease.
- Idiopathic orbital inflammation (pseudotumor)
- IgG4-related orbital disease
- Orbital sarcoidosis
- Granulomatosis with polyangiitis
Orbital Tumors
Benign and malignant masses arising within or spreading into the orbit — diagnosis guides surgical approach.
- Cavernous hemangioma (venous malformation)
- Orbital lymphoma
- Meningioma & nerve sheath tumors
- Rhabdomyosarcoma (pediatric)
- Metastatic orbital disease
Thyroid Eye Disease
Graves' orbitopathy — an autoimmune condition causing proptosis, diplopia, and sight-threatening optic nerve compression.
- Proptosis (exophthalmos) & periorbital swelling
- Restrictive myopathy & diplopia
- Exposure keratopathy
- Orbital decompression surgery
- Eyelid retraction & strabismus repair
FDA-approved biologic therapy available:
Tepezza (teprotumumab) medication guide →Orbital Trauma
Blowout fractures and orbital injuries — timely evaluation prevents long-term diplopia and enophthalmos.
- Blowout fractures (floor & medial wall)
- Orbital wall repair
- Retrobulbar hematoma
- Traumatic optic neuropathy
When to Seek Urgent Evaluation
These findings require same-day or emergency ophthalmologic evaluation. Do not wait for a routine appointment.
- Sudden or progressive vision loss
- Proptosis (bulging eye) developing over days
- Painful restriction of eye movement
- Fever with orbital swelling (possible orbital cellulitis)
- Ptosis with dilated pupil (possible CN III palsy)
- Pulsatile proptosis with bruit (possible carotid-cavernous fistula)
Orbital Anatomy at a Glance
The adult orbit holds roughly 30 mL of tissue — fat, muscle, nerve, and globe
Roof (frontal bone), floor (maxilla/zygoma), medial (ethmoid/lacrimal), lateral (zygoma/sphenoid)
The orbital apex transmits the optic nerve and ophthalmic artery through the optic canal, plus cranial nerves III, IV, V1, and VI through the superior orbital fissure
Orbital fat cushions and supports the globe; loss (e.g. from aging or radiation) causes enophthalmos
Six extraocular muscles rotate the globe: four recti (superior, inferior, medial, lateral) and two obliques
The orbital septum divides preseptal from postseptal space — the critical divider in orbital vs. periorbital infection
For a full interactive anatomy guide, see the Orbital Anatomy page.
Diagnostic Approach
History & Examination
- Onset and tempo (acute vs. chronic vs. intermittent)
- Pain, proptosis, diplopia, vision change
- Systemic symptoms (weight loss, night sweats, sinusitis, thyroid disease)
- Exophthalmometry — measures globe protrusion in mm
- Forced duction test — distinguishes restrictive from neurogenic diplopia
Imaging
- CT orbit (bone windows) — first-line; best for fractures, calcified lesions, sinus disease
- MRI orbit (fat-suppressed T1 + T2, gadolinium) — best for soft tissue characterization, nerve involvement, intracranial extension
- CT chest/abdomen — staging for lymphoma, sarcoidosis, metastatic disease
Related Pages
Orbital Surgery Expertise
Schedule an evaluation with Mark S. Brown, MD. Orbital conditions — from inflammation to tumors to fractures — are evaluated and treated here.