Orbital Surgery

ELZA’s experience in Orbital Surgery

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. 

Find out more here.

Activities:

  • President of the European Society of Plastic and Reconstructive Eyelid and Orbital Surgery (ESOPRS)
  • Founding member of the Dutch Orbita Society and elected member of the Anglo-Spanish Orbital Society
  • Medical adviser to Oog Patient Foundation in the Netherlands
  • Medical Advisory Board of 2 medical thyroid patient associations in the Netherlands
  • Instructor of young specialists in eyelid and orbital surgery since 2002
  • Over 100 scientific publications on the subject of orbital surgery.

Need more info? The links on this page refer to ELZA pages (in English) with more detailed information on the topic.

Artificial Eyes

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:

  • in the presence of a malignant tumour
  • when a blind eye causes pain
  • when a blind eye is cosmetically disfiguring
  • where an accident seriously injures the eye.

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.
Read more…

Can you tell which one is the artificial eye?

Enucleation

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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Evisceration

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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Before
After
Before
After

Orbital Decompression

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.
Read more…

Pictures © Dr. Paridaens

Our Results: Before – After

Before
After
Before
After

Orbital Tumors

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.

Typical appearance of child with dermoid cyst of the orbit (right eye, left on picture)

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.
Read more…

Symptoms of orbital tumours

The symptoms of the different types of orbital tumors are:

  • protrusion of one or two eyes;
  • movement of an eye to the outside / inside / above / below;
  • double vision;
  • disturbed vision;
  • usually painless, sometimes painful.

Techniques

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.

Hidden incisions

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.

Pseudotumours

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.

Investigations

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.

Imaging

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.

CT scan showing a tumour in one of the orbits
(horizontal line shows the width of the lesion)

Key terms

Biopsy

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.

Facial pictures

The ophthalmologist will photograph your eyes and face, before and after treatment, for documentation. 

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The ELZA Institute

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Augeninstitut ELZA
4.8
Based on 109 reviews
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mike
mike
09:02 04 Jan 23
Overall as a 50 year old, who wanted to continue to avoid wearing glasses and/or contact lenses, my goal was 100%... achieved with ELZA and Dr. Hafezi. I greatly appreciated the overall approach by Dr. Hafezi and his friendly and competent team in reviewing my vision at the start and following a comprehensive eye exam- the explanations of my options. For me I chose PRK in one eye for a monovision solution to correct short sightedness which was becoming more prevalent in night driving and sports such as skiing and cycling. PRK heals slowly but the outcome is worth the wait- and the cost- you use your eyes every waking moment- and for me I cannot see any reason not to pursue better vision with the ELZA team! A great quality of life enhancement!read more
Zuzana Fecko
Zuzana Fecko
21:48 31 Oct 22
Thank you so much, Dr. Torres and prof. Hafezi. 26 years I was only “dreaming” about the eye surgery due to possible... complications. I was worried ..Thank you for encouraging me to make a decision and thank you for your professionalism, explanations and great work!I wish you all the best, lots of success and only happy patients!read more
Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!read more
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Squitieri Elias
Squitieri Elias
12:43 08 Sep 21
Die Behandlungen waren bei mir erfolgreich, alle waren sehr nett und haben mein Leben vereinfacht.Danke
Eliane Bossart
Eliane Bossart
13:01 05 Sep 21
Vor einem Jahr war ich einer ganz verzweifelten Situation und total im Stich gelassen. Meine Augen wurden aufgrund... eines ausgeprägten Kerakotonus immer schlechter, ich hatte Angst und war alleine mit meinen Problemen. Zudem vertrug ich die Kontaktlinsen nur noch ganz schlecht und hatte jeden Tag Schmerzen.Professor Hafezi hat mir mit zwei Operationen wieder das auf Grund der Situation mögliche an Lebensqualität zurückgebracht. Es war ein starpaziöses Jahr mit vielen Entbehrungen aber es hat sich gelohnt! Herzlichen Dank fuer die Unterstützung.read more
Gabriela Meyer
Gabriela Meyer
18:32 22 Aug 21
Ich wurde von meiner Optikerin auf Prof. Dr. Dr. Hafezi aufmerksam gemacht. Es war mir vorher nicht bewusst, dass meine... Augenkrankheit (Keratokonus) operativ mittels Cross Linking behandelt und so gestoppt werden kann. Die Beratung und Behandlung war sehr kompetent und ich fühlte mich jederzeit wohl. Die Operation verlief gut und das Ergebnis ist einwandfrei.read more
Naomi
Naomi
11:38 11 Aug 21
Ich bin sehr glücklich, dass ich das Elza Institute gefunden habe. Ich wurde von anderen Augenärzten abgewiesen, da... meine Augen zu kompliziert/schwierig zu behandeln waren. Prof. Dr. Dr. Hafezi konnte mir jedoch helfen und ich bin sehr glücklich und zufrieden mit dem Resultat. Vielen Dank!read more
Till B
Till B
08:30 19 Jul 21
Ich habe eine überaus kompetente Beratung und Behandlung erlebt. Die gesamte Betreuung war sehr freundlich und... professionell. Herzlichen Dank!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
Michele Aggiato
Michele Aggiato
18:17 10 Jan 20
The day I had Prof Hafezi checking my keratoconus I knew I was finally in the right place after years of searching for... a good ophthalmologist. Prof Hafezi recommended a surgery due to a drastic degeneration of my cornea. The surgery was performed by himself with the assistance of Dr Rodriguez, one more collaborator of Prof Hafezi’s team who got my full trust.read more
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with... cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.read more
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