Dion Paridaens is our eyelid and orbital surgeon at the ELZA. In addition, since 1996 he has been a senior physician at the Eye Clinic Rotterdam and an internationally known and awarded eyelid and orbital surgeon. Dr. Over the course of his career, Paridaens has trained dozens of ophthalmologists in Europe in the field of eyelid and orbital surgery and has a proven track record of over 20,000 operations.
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Activities:
Need more info? The links on this page refer to ELZA pages (in English) with more detailed information on the topic.
Modern ophthalmology has made tremendous progress in recent decades. When it comes to the implementation of technological innovations, our specialty is regularly at the forefront of medicine. Nevertheless, despite all of this progress, there are still limits on what we can do. So it is unfortunately necessary in some cases to remove an eye and replace it with an artificial eye.
This can be the case:
Most people believe that an “artificial eye” is a “glass marble” with an eye drawn on the front. It is not so. Rather, an “artificial eye” consists of the invisible implant located in the depth of the eye socket and a thin shell, the actual prosthesis, which sits on the conjunctiva-covered implant.
This prosthesis is made by hand by a specialist, called an ocularist, so that it is deceptively similar to your natural eye. It consists of either glass or plastic. Such a prosthesis can be worn day and night. However, it should be taken out every 1–2 weeks and cleaned with water. You can easily do this yourself after you’ve received instructions from the ocularist.
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Can you tell which one is the artificial eye?
The orbital surgery is usually performed under general anesthesia and lasts one and a half to two hours. In a first step, the conjunctiva and the underlying Tenon layer are detached from the eyeball. Afterwards, the eye muscles are also detached from the eyeball. Now the removal of the diseased eyeball takes place. To replace the volume that is missing by the removal of the eyeball in the eye socket, an implant is inserted. This has a spherical shape, a diameter of 16 to 20 mm and is made of acrylic, which is easily tolerated by the body.
The implant is now inserted into the “bag”, which consists of the obtained Tenon layer and conjunctiva. The “pocket” is also sewn up at the front, so that the implant is always “invisible” later. Finally, the outer eye muscles are sutured to the implant in order to allow a certain degree of mobility of the artificial eye after the procedure.
The actual “artificial eye” is a flat prosthesis shell, which sits on the conjunctiva-covered graft. At the end of the operation we use a provisional prosthesis. This has the important advantage that you already see a cosmetically appealing result immediately after the operation. This temporary prosthesis will later be replaced by a definitive prosthesis.
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In an evisceration procedure the entire eyeball is not removed, just the cornea and the inner eye. The actual (now empty) eyeball is preserved and an implant is inserted into it. The greatest advantage of the evisceration over enucleation is a larger mobility of the ocular prosthesis after the surgery. However, evisceration is not always possible and we will discuss with you exactly what type of surgery should be performed on you.
Why is an implant used? After removal of the eyeball, there is usually very little tissue volume in the eye socket. If this volume is not replenished by an implant, anatomical changes of the eye socket and the eyelids will occur with time, which is termed PESS (post enucleation socket syndrome). This usually worsens the cosmetic aspect considerably.
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Chronic immune system-mediated inflammation can lead to an increased amount of connective tissue forming behind the eye, which pushes the eyeball forward – and severely limits its mobility. These changes also cause the eye muscles to swell.
In active endocrine orbitopathy, treatment usually comprised of medical therapy (with certain drugs) and/or surgical treatment of the thyroid. Orbital decompression surgery, to relieve these issues, only becomes an option once the diseases has stopped progressing for a period of at least one year.
Orbital decompression surgery involves removes bone from the eye socket so that the swollen eye muscles have more space to reside, and no longer push the eye forward. Clearly, this does not treat the underlying disease, but rather, but it can greatly improve a patient’s quality of life, as it ensures normal eyelid closure and also helps restore the patient’s own self-image: looking in the mirror and seeing a reflection of themselves with bulging eyes can be difficult to bear.
There are a number of surgical techniques that can be used to achieve orbital decompression, performed by various specialists, including facial surgeons, ear, nose and throat surgeons and orbital surgeons. The latter are highly specialized eye surgeons who treat all diseases around the bony eye socket.
There are several techniques that can be used to perform this surgery – and they differ in both approach and result.
Most facial surgeons prefer “transantral” approach, in which the facial skin is released at the top of the skull and “folded” down, so that the eye socket is freely accessible. You can appreciate why we chose not to show illustrations of this approach on the website.
Most orbital surgeons, including Dr. Dr. Paridaens, prefer access via the lower eyelid with a ~3 mm-long, hidden, cut. This has the benefit of much easier and faster wound healing, as the incision is far smaller than the transantral approach.
Below are illustrations (© Dr. Dr. Paridaens) that show the different stages of orbital decompression surgery using his preferred approach via the lower eyelid.
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Pictures © Dr. Paridaens
The word “tumour” means a lump or swelling – and these can sometimes occur in the eye socket (also known as the “orbit”). Tumours are usually benign, irrespective of whether they occur in childhood and in adulthood. But there are also harmful, malignant forms, and the most common forms of eye cancer in adults are lymphoma, and metastases from other tumours. These forms can also be found elsewhere in the body, but again, fortunately, these are rare occurrences.
Benign orbital tumours
Benign tumours in the eye socket are often congenital, growing slowly from birth, and typical include dermoid cysts (a cyst filled with skin components, including fat) and haemangioma, a benign vascular tumour where a small collection of blood vessels form, that can grow significantly after birth. Benign tumours can also develop later in life and can occur in any of the different types of tissue in the orbit.
A malignant tumour in the orbit occurs when body cells divide without inhibition. Sometimes this is caused by a defect in the patient’s immune system, or through genetic mutations. The cells continue to increase in number and form a lump in the orbit that may press on the eyeball and/or cause double vision. Malignant cells can spread through blood vessels or along nerves to other places in the body (where they form elsewhere, these tumours are called metastases).
A rare malignant orbital tumour in childhood is rhabdomyosarcoma, which grows fast and needs urgent treatment. Lymphoma is the most frequent primary malignancy of the orbit in adults, but metastases from tumours elsewhere in the body can also start to grow in the orbit.
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The symptoms of the different types of orbital tumors are:
The thought of having a lump near to the eye can cause patients a lot of anxiety. If your doctor or ophthalmologist refers you to ELZA for an examination, you will quickly know what the situation is. In addition to extensive ophthalmic examinations, we often request additional imaging from a nearby radiology department. we can assess the size and location and tissue characteristics of the tumour, with a special scan of the head. When choosing a treatment, we not only look at the type of tumour, but also at your overall health.
The treatment of a benign or malignant tumour in the orbit differs. Benign orbital tumours can usually be treated by complete excision.
Our surgeons prefer to remove lesions with maximal preservation of cosmesis. Incisions are made in the natural skin folds so that scars are best concealed, hence the term “hidden incisions”. We then examine the “biopsy” – the piece of tumour removed – to see what type of tumour it was, and whether it was malignant or benign.
What if the tumour appears to be malignant after the biopsy? Then our eye surgeons, in collaboration with a team of other specialists provide treatment. In addition to surgery, radiation therapy (radiotherapy) or chemotherapy may also be required if the tumour is malignant. Because our specialists have a great deal of knowledge and experience in treating both benign and malignant orbital conditions, the operating results are generally very good.
There are also so-called “pseudotumours” in the orbit, which occur mostly in adults. A pseudotumour is a benign accumulation of inflammatory cells and looks like a swelling. This inflammatory swelling is usually treated with medication, and sometimes an examination by an internist might be necessary to see whether inflammation also occurs elsewhere in the body.
It is often not clear from the tumour itself whether it is malignant or not. That is why we often take a biopsy for tissue analysis by a pathologist.
A special scan of the orbits is made to examine the expansion and location of any swelling in the orbit. This scan is made in a radiology department.
We carefully remove a small piece of the tumour. This is called a biopsy. This piece is examined microscopically. This way we can see if the tumour is malignant or not.
The ophthalmologist will photograph your eyes and face, before and after treatment, for documentation.
