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Orbital Surgery

Orbital surgery includes the management of orbital tumours, the treatment of orbital fractures and orbital decompressions. Orbital decompression surgery is one of the treatment modalities for Thyroid Eye Disease

Symptoms and management of orbital tumours

Orbital or eye tumours are abnormal growths in the internal area around the eye. They can often occur spontaneously and can pose a serious health risk.

Orbital tumours may push the eye forward creating a bulging of the eye called proptosis. This may make it difficult to close the eye completely. If it is malignant, it may spread to other parts of your body.

Symptoms of an orbital tumour include:

  1. Increased discomfort or pain around the eye
  2. Decreased vision in one eye
  3. Double vision
  4. Bulging forward of the eyeball
  5. Droopy or swollen eyelid
  6. Inability to close an eyelid or move one eye in sync with the other
  7. A scratchy or irritating feeling on the surface of the eye

It is imperative that you consult your specialist immediately should you experience any of these symptoms. They will examine you carefully and devise a management plan.  For better visualization of the tumour a CT or MRI may be performed.

Treatment of orbital fractures

If you are diagnosed with an orbital fracture, you will receive the initial treatment and follow up care and in severe cases, surgical intervention.  They are usually a common result of blunt force trauma which can include an assault, a motor vehicle accident or a sports injury.

It is important to note that not all orbital fractures will require repair. Your oculoplastic surgeon may observe, monitor and advise you on the necessary precautions to take after your diagnosis. If you are diagnosed with an orbital fracture, you will receive the initial treatment, follow-up care, and in severe cases, possibly surgical intervention.

Some orbital fractures will not require any treatment other than applying ice compresses. However, it is important to see the ophthalmologist soon after the injury as some repairs will be more successful if performed soon after the trauma. Your ophthalmologist will warn you to avoid blowing your nose and will prescribe systemic antibiotics and a decongestant. It is advisable to also avoid situations that may increase your chances of sneezing

Orbital decompressions

Orbital decompression surgery is done to remove the bones and in some cases, the fat in the eye socket. It relieves orbital pressure and expands the eye socket allowing the eyeball to settle back. It is most commonly performed on patients with thyroid eye disease also known as Graves’ eye disease.

Orbital decompression surgery is performed under general anaesthesia meaning you will sleep during the operation. 

Your ophthalmologist will evaluate you before your surgery and also discuss the risks and benefits of orbital decompression. Your pain will be managed with medication to help reduce swelling and the chance of getting an infection.

Orbital decompression surgery involves incisions in your natural skin creases and should therefore not cause marked scarring post-operatively.

Orbital Surgery for patients in KZN

Dr. Ladner is an ophthalmologist that practices at Parklands Hospital in Overport, Durban as well as at the Kloof Medical Centre in KZN. He has a special interest in oculoplastic procedures. Should you, or someone you know experience any vision problems, set up an appointment with Dr. Ladner today

Orbital Surgery

  • Orbital decompression is a procedure to remove bone or fat from the eye socket to create more space for the eye. At our Berea and Kloof clinics, Dr Grant Ladner performs this primarily for patients with Thyroid Eye Disease (Graves' Disease) to reduce "proptosis" (bulging eyes) and relieve pressure on the optic nerve. 

  • No, many small orbital fractures can be managed conservatively with monitoring and specific safety precautions. Surgery is typically reserved for severe cases where the eye muscle is trapped or there is significant "enophthalmos" (the eyeball sinking back into the socket) following blunt force trauma. 

  • Common signs include a bulging eye (proptosis), double vision, or difficulty closing the eyelid completely. Because these abnormal growths occur in the internal area around the eye and can pose a serious health risk, Dr Ladner uses surgical biopsies to diagnose and treat tumours within the eye socket. 

  • No, orbital surgery typically involves incisions made within the natural skin creases to ensure no marked scarring post-operatively. Dr Ladner’s specialized training at Moorfields Eye Hospital in London focuses on oculoplastic techniques that preserve the aesthetic appearance of the mid-face area. 

  • Most patients require 1–2 weeks of initial downtime, though internal healing and the settling of tissues can take several weeks. Your pain and swelling will be managed with specific medication at Parklands Hospital or Hillcrest Private Hospital to reduce the risk of infection and ensure a smooth recovery. 

  • Yes, orbital procedures such as decompressions and tumour removals are performed under general anaesthesia to ensure the patient is asleep and comfortable. Dr Ladner will conduct a thorough evaluation before surgery to discuss the specific risks and benefits tailored to your condition. 

  • Numbness in the cheek or upper teeth is common after a "blowout" fracture due to bruising of the infraorbital nerve. While this sensation often resolves on its own as the swelling subsides, Dr Ladner will monitor the nerve's recovery during your follow-up appointments in Durban. 

  • Yes, as a leading oculoplastic specialist, Dr Ladner provides advanced orbital care for patients across KwaZulu-Natal. With practices in both Overport (Durban) and Kloof, he is uniquely qualified as the current President of the South African Oculoplastic Society to handle complex orbital trauma and reconstructive cases. 

  • Orbital decompression is typically performed once the "active" inflammatory phase of Thyroid Eye Disease has passed and your vision has stabilised. Dr Ladner monitors patients in Durban to ensure the eyes are in the "burnt-out" or stable phase, as performing surgery during active inflammation can lead to unpredictable results and higher complication rates.

  • Rehabilitative surgery for TED follows a specific sequence: orbital decompression first, followed by squint (strabismus) surgery, and finally eyelid retraction repair. Dr Ladner follows this internationally recognised "staging" approach at our Kloof and Berea clinics because changing the volume of the eye socket (decompression) can alter the position of the eye muscles and lids.

Dr Grant Ladner | Eye Surgeon