5 Common Orbital Conditions And How To Manage Them

We are able to see the world around us thanks to our eyes. Our eyes are housed in the bony sockets of the skull known as the orbits. Orbital eye conditions, which involve the structures within the orbits and sometimes the orbital bone itself, may pose a threat to vision due to direct impact on the eye itself or indirectly by affecting the optic nerve that connects the eye to the brain.

Here are 5 common orbital eye conditions and how to manage them:


1. Orbital Cellulitis

Orbital cellulitis refers to infection of the soft tissues located within the orbit.  Symptoms include pain, severe eyelid swelling, eye redness, fever and possibly a drop in vision and/or double vision. This condition represents an ophthalmic emergency. It is most commonly associated with prior primary infection in adjacent areas. For example, neglected sinusitis or an infected tear sac (due to tear duct obstruction) could result in spread of the infection to the orbit. Orbital cellulitis has the potential to cause blindness if it is not addressed urgently.

By the time a patient develops symptoms and signs of orbital cellulitis, they will require admission for urgent imaging and intravenous antibiotics. Occasionally, surgery is necessary to clear any developing abscesses. If you have marked symptoms like those described above, you should consult a doctor immediately.


2. Thyroid Eye Disease

An autoimmune illness called thyroid eye disease causes swelling of the fat tissue and muscles surrounding the eyes. Hyperthyroidism, a condition in which the thyroid gland overproduces the thyroid hormone, is most frequently linked to this problem.

Bulging and staring eyes, double vision, eyelid swelling and eye redness are some signs of thyroid eye disease. In the active phase of the disease, the inflammation can be suppressed with the use of intravenous steroid and other immunosuppressive medications and/or radiotherapy. In the later inactive phase of the disease, surgery may be considered to address residual changes brought on by the condition. Surgical procedures include orbital decompression to reduce the degree of eye bulging, squint surgery to correct any double vision, and upper lid lowering surgery or lower lid lengthening surgery to correct the upper and lower lid retraction respectively.


3. Orbital Fractures

Sports or motor vehicle accidents that result in blunt force trauma to the orbits may cause fractures in the bony sockets. In addition to double vision due to difficulties moving the eye around, an orbital fracture may cause discomfort or soreness, significant bruising and swelling around the eye. It is also important to ensure that no other eye injuries are sustained during the initial blunt trauma.

Some orbital fractures are mild with little impact on vision or appearance of the eyes. These may be left alone to heal on its own. The more severe fractures will usually require surgical repair. It is best to consult an oculoplastic doctor to make this distinction as fractures are best repaired within a two week period.

It is important to note that some fractures in children are not well recognised as the eye may not be red at all. These “white-eyed” fractures in children may be associated with significant pain, nausea and vomiting, due to the tethered muscle caught at the fracture site. Early repair is recommended in this type of orbital fracture.


4. Orbital Tumours

Growths that develop within the orbit are known as orbital tumours. These tumours, which may be benign or cancerous, can manifest as a variety of symptoms like discomfort, blurred vision, double vision and eye bulging. Imaging is very useful in the assessment of orbital tumours. Very often, an orbital biopsy is required to make a definitive diagnosis. The nature and location of an orbital tumour will largely determine the appropriate course of treatment. Surgery to remove the tumour may be recommended if surgical risks are manageable. Radiation therapy and/or chemotherapy may also be employed in managing malignant tumours.


5. Orbital Vascular Malformations

Some individuals are born with abnormal blood vessel lesions in their orbits. These may or may not be obvious at the time of birth. Over time, they may present with symptoms such as increasing eye bulging, double vision, decrease in vision or recurrent swelling or blood-shot eye appearance. Some may present with an increasing sunken appearance of the eye. The symptoms that appear depend on the type of vascular malformation the individual has ie whether it is arterial, venous or lymphatic or a mixed malformation.

These malformation are complex to deal with and consultation with an orbit specialist is crucial to make the appropriate management decisions.



In conclusion, orbital eye conditions are more complex eye disorders which require medical attention from an oculoplastic surgeon trained specifically in the area of orbital surgery. Some pose threat to vision and constitute ophthalmic emergencies.

At Ava Eye Clinic, Dr Audrey Looi provides expert sub-specialty care and advice in the management of orbital conditions.

Besides orbital disease management, Ava Eye Clinic also provides a range of eye treatments, including ptosis eye surgery, cataract surgery in Singapore and more.

To learn more, do not hesitate to get in touch with us today!