Orbital Surgery: Evolution and Revolution

Abstract

This article traces the development of orbital surgery and its subsequent modifications. It also points out the importance of defining one's goal before embarking on orbital surgery. Although generally considered part of ophthalmology, surgery on the orbit has been relatively neglected and not routinely practiced. This article reviews the history of development of orbital surgery, both the revolutionary ideas and the evolutionary changes. There are multiple orbital lesions that do not need to be treated with surgery at all. These days chemotherapy, radation therapy, or even immunotherapy may be more appropriate. The most common orbital pathology, that is thyroid orbitopathy, the physician needs to decide whether or not the orbit needs to be decompressed or whether there are problems related to motility that can be dealt with by eye muscle surgery.

Keywords: Krönlein's orbitotomy; computerized axial topography; fine needle aspiration biopsy; orbital deconstruction; orbitototomy; transconjunctival incisions.

Fig. 1

Stele illustrating the Code of Hamurabi; copy at the Library of the History of Medicine, Kansas City.

Fig. 2

Enucleation as illustrated by Bartisch.

Fig. 3

“Anesthesia” cica 1583.

Fig. 4

Crawford Long.

Fig. 5

William Morton.

Fig. 6

Karl Koller.

Fig. 7

Proptosis (and probable buphthalmos.

Fig. 8

Luedde exophthalmometer.

Fig. 9

The Krönlein skin incision.

Fig. 10

The Krönlein bone incisions.

Fig. 11

Transcranial orbitotomy.

Fig. 12

Transfacial Weber–Fergusson approach.

Fig. 13

Benedict's brow incision.

Fig. 14

Davis' inferior rim approach.

Fig. 15

The Berke lateral orbitotomy.

Fig. 16

The Berke bone incision modifications.

Fig. 17

The Czermak bone modifications.

Fig. 18

Wright's S -shaped lateral orbitotomy incision.

Fig. 19

John Jane's orbital rim modification of transcranial approach.

Fig. 20

Orbital contrast study.

Fig. 21

Orbital venogram.

Fig. 22

Early computed tomography (CT) scan orbit demonstrating a hemangioma.

Fig. 23

Transcutaneous approaches to the orbit.

Fig. 24

Bony disassembly of the orbit.