Ophthalmic plastic and orbital surgery is a sub-specialty that encompasses the treatment of an extensive number of diseases affecting the eyelids, the lacrimal pathway and the orbit. The range of alterations is so long and wide that it would be difficult to list and summarise them all in one course or publication.
The oculoplastic surgeon needs to master a large number of surgical techniques to treat each pathology (as we can use about 10 different techniques to fix an eyelid pto-sis, 6 or 7 approaches to the orbit, and at least 3 ways to correct an epiphora). In addition, anatomical knowledge and dissection skills beyond the eye make the difference with the rest of sub-specialties since we often have to work in areas outside of our comfort zone (eyeball and eyelids) to obtain good results in the maintenance of eyelid architecture and function, as is the case when we move to the region of the midface and forehead. It is also essential to know and control the haemostatic techniques since uncontrolled bleeding can lead to loss of function or vision.
The orbit is perhaps the great unknown for the majority of ophthalmologists, but perhaps the most exciting. Learning how to diagnose and treat orbital diseases is more difficult as the orbit is a somehow hidden space that is hard to approach, both clinically and surgically. Therefore, learning how to use all the tools available to properly examine, diagnose and treat these patients is crucial.
An extra challenge we must face when dealing with problems of the orbit is the management of oncology patients. Very few training programs teach how to deal with these problems that often radically alter the patient's life or may even result in death at a very early age.
This branch of our specialty is impossible to assimilate in short periods of time and requires a special interest and dedication, given the dramatic consequences that may impact the patient. It is a sub-specialty that requires the participation of multiple specialties such as endocrinology, oncology, radiology, pathology and haematology.
This is why we chose the orbit for the first ESASO Course Series in Orbital, Lacrimal and Ophthalmic Plastic Surgery, as it is less frequent and therefore largely unknown. The concepts this book covers have been widely exposed in the ESASO Oculoplastic Surgery Module, carried out in Malta every year by top-level experts in orbital surgery who also contributed to the production of this publication.
This monograph is addressed to general ophthalmologists with a special interest in oculoplastic surgery and intends to review basic concepts handled every day by orbit experts, but which can also be useful to any ophthalmologist. It is not intended to be a guide for action to treat patients with orbital pathology, especially in the presence of oncology patients or with complicated orbitopathy. Ramon Medel, Barcelona Luz Maria Vasquez, Barcelona

List of Contributors vi

Preface vii

Medel, R.;Vasquez, L.M. (Barcelona)

Basic Concepts in Orbital Examination 1

Vasquez, L.M. (Barcelona)

Orbital Decompression in Thyroid Eye Disease 18

Baldeschi, L; Boschi, A. (Brussels)

Orbital Fractures and Management of Diplopia 34

Morax, S.; Bok-Beaube, C. (Paris)

Approach to Diagnosis of Orbital Tumours 46

Medel, R; Balaguer, 0. (Barcelona)

Evisceration, Enucleation and Exenteration 73

Tyers,A.G. (Salisbury)

Anophthalmic Socket 92

Hintschich, C. (Munich)

Subject Index 113

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