Orbital Surgery
The orbit — the bony socket surrounding the eye — is one of three core anatomical regions in oculoplastic surgery. Orbital conditions range from benign tumors and inflammatory disease to autoimmune conditions and serious infections. Dr. Brown has fellowship training in all aspects of orbital surgery and is one of the Gulf Coast’s most experienced orbital specialists.
Orbital Inflammatory Disease
Non-infectious orbital inflammation — orbital pseudotumor (OIS), IgG4-related orbital disease, sarcoidosis, and granulomatosis with polyangiitis. Diagnosed by biopsy; treated with steroids, immunosuppressants, or biologics.
- Orbital inflammatory syndrome (OIS)
- IgG4-related orbital disease
- Orbital sarcoidosis
- Granulomatosis with polyangiitis (GPA)
Orbital Tumors
Benign and malignant orbital masses — cavernous hemangioma, dermoid cysts, lymphoma, lacrimal gland tumors, rhabdomyosarcoma, and metastatic lesions. Evaluated with MRI/CT; treated surgically or with directed therapy.
- Cavernous hemangioma
- Orbital lymphoma
- Lacrimal gland tumors
- Dermoid cysts
- Metastatic lesions
Thyroid Eye Disease
Autoimmune orbital inflammation driven by TSH-receptor antibodies — the most common cause of proptosis in adults. Active disease is treated with Tepezza (teprotumumab) infusion; inactive disease with orbital decompression, strabismus surgery, or eyelid surgery.
- Graves' orbitopathy (TED)
- Proptosis / exophthalmos
- Restrictive strabismus
- Compressive optic neuropathy
- Tepezza infusion therapy
Orbital Infections
Bacterial orbital cellulitis and abscess — usually from ethmoid sinusitis. Requires CT imaging, IV antibiotics, and often surgical drainage. Mucormycosis is a rare fungal emergency in immunocompromised patients.
- Orbital cellulitis
- Subperiosteal abscess
- Intraorbital abscess
- Cavernous sinus thrombosis
- Mucormycosis
The Orbit — Anatomical Overview
Full orbital anatomy →The orbit is a bony pyramid approximately 40 mm deep and 35 mm wide at its entrance, widening slightly just behind the orbital rim before tapering to the narrow optic canal. Its fixed volume — roughly 30 mL — is the key anatomical fact in orbital surgery: any mass expanding within this rigid cavity must displace something, and that something is almost always the globe (producing proptosis) or the optic nerve (threatening vision).
Seven orbital bones
Frontal, zygomatic, maxillary, sphenoid, ethmoid, lacrimal, palatine
Volume
~30 mL; the bony orbit is a fixed compartment — any space-occupying lesion displaces the globe forward (proptosis)
Six extraocular muscles
Four recti (medial, lateral, superior, inferior) + two obliques; all pass through or near the orbital apex
Optic nerve
Travels from retina through the optic canal to the chiasm; vulnerable to compression at the orbital apex
Lacrimal gland
Superolateral orbit — produces reflex tears; biopsy site for IgG4, sarcoidosis, and lymphoma
Intraconal vs. extraconal fat
The muscle cone divides orbital fat into compartments; lesion location guides surgical approach
Evaluating an Orbital Mass or Proptosis
An orbital mass or new proptosis requires a systematic evaluation. The clinical history — onset (acute vs. chronic), pain, laterality, prior thyroid disease, systemic symptoms — guides the differential diagnosis before any imaging is ordered.
Clinical history & exam
- Onset and progression
- Pain with eye movement
- Bilateral vs. unilateral
- Systemic symptoms (thyroid, sinus, autoimmune)
- Visual acuity and color vision
- Pupil reactions (APD)
Imaging
- CT orbit & sinuses with contrast — first line for acute proptosis, infection
- MRI orbit with fat suppression — superior soft-tissue detail for tumor characterization
- Ultrasound — useful for lacrimal gland and anterior orbital lesions
Laboratory & biopsy
- TSH, TRAb, anti-TPO (thyroid)
- Serum IgG4 and IgG subclasses
- CBC, ANCA, ANA, ACE (sarcoid/GPA)
- Biopsy — required for OIS (to exclude lymphoma), IgG4, any atypical mass
Warning Signs — Seek Urgent Evaluation
- !Rapidly progressive proptosis over hours to days
- !Decreased vision or loss of color saturation
- !Pain with eye movement and fever
- !Afferent pupillary defect (APD)
- !Ophthalmoplegia (inability to move the eye)
- !Proptosis in a child — always urgent (consider rhabdomyosarcoma)
Schedule an Orbital Consultation
Fellowship-trained orbital surgeon — Mobile and Daphne, AL.