Introduction:
The displacement of fat within the eye refers to prolapsed orbital fat. The incidence of orbital fat prolapse is challenging to determine. However, clinical studies say it is a rare phenomenon affecting males more than females. It occurs bilaterally in about 50 percent of the cases with the superotemporal (outward and upper) quadrant of the subconjunctival space, called the subconjunctival prolapse. Most cases are asymptomatic. Generally, the prolapse of orbital fat can disturb a person but might not be painful or harmful.
What Is Orbital Fat Prolapse?
Orbital fat prolapse, also referred to as orbital fat herniation, is a benign condition where the orbital fat is displaced or extruded out of its anatomical bed. The displacement of orbital fat can happen in various spaces, like the intracranial, subconjunctival, and infratemporal fossa. This condition is usually accompanied by surgery, trauma, and aging.
What Is the Cause of Orbital Fat Prolapse?
There is no single causative agent for orbital fat prolapse, a combination of factors is attributable to the development of orbital fat prolapse.
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Trauma.
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Dehiscence.
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Surgeries like eyelid surgery.
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Aging.
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Genetically predisposing factors.
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Grave’s disease (an autoimmune disorder affecting the thyroid glands).
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Chronic eye strains.
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Allergies and inflammation.
What Is the Pathophysiology of Orbital Fat Prolapse?
Orbital fat generally pervades the area proximal to the extraocular muscles and the protective cushion-like structure called the globe of the eye. The orbital fat constitutes two compartments, namely intraconal and extraconal. The intraconal and extraconal fats are composed of adipose tissue that supports and protects the neural and vascular networks of the eye. It also contains the tenon’s capsule, orbital septum, and periorbita. Any weakness in this tendon capsule makes the orbital fat move to the anterior (front) region, resulting in infiltration into the subconjunctival space. In contrast, any problem with the orbital septum causes the orbital fat content to herniate towards the retro and subocular fat pads (fat pads lying beneath the orbicularis muscles).
In certain rare instances, the orbital fat can move posterior ku (backward) through the superior orbital fissure. This condition is mostly seen in thyroid eye disease. Moreover, orbital fat can herniate Inferiorly (downward) towards the infratemporal fossa through the inferior orbital fissure.
What Are the Clinical Features of Orbital Fat Prolapse?
The orbital fat prolapse, particularly the subconjunctival fat prolapse, generally results in the supertemporal (outward and upper corner) quadrant. The orbital fat appears as a soft, yellow-colored soft subconscious mass or growth composed of fine blood vessels on its covering. The orbital fat seems mobile and sometimes becomes prominent. On rare occasions, individuals with subconjunctival fat prolapse are generally asymptomatic rather than experiencing mild discomfort and epiphora (excess tearing due to increased tear production or poor drainage).
Therefore, individuals with subconjunctival orbital fat prolapse reach out to healthcare providers for esthetical concerns. But if the orbital fat prolapse results from the insertion of the orbital septum into the retro or sub orbicularis fat pads, the individuals might experience discomfort with local swelling. In contrast, clinical manifestations of posterior prolapse include optic nerve compression associated with signs like decreased visual acuity, dyschromatopsia (deficiency in color vision), visual field problems, and relative afferent pupillary defect (a condition where the pupils respond to light stimuli in a different way).
How Is Orbital Fat Prolapse Diagnosed?
Healthcare providers or ophthalmologists do clinical examinations to assess the type and severity of the orbital fat prolapse. They might recommend imaging techniques like computerized tomography (CT) scan and magnetic resonance imaging (MRI) as they help provide information on the density and the extension of the lesion. The imaging techniques may or may not be used in the subconjunctival prophase. However, posterior orbital fat prolapse typically requires imaging techniques and a comprehensive investigation.
How Is Orbital Fat Prolapse Managed?
The treatment must be taken into account if the subconjunctival mass causes discomfort or gives an unpleasant esthetic appearance to the individual.
Conservative Approach:
The conservative approach to the discomfort caused by orbital fat prolapse includes artificial tears. This helps with lubrication, relieving eye discomfort.
Surgical Interventions:
The surgical approach for orbital fat prolapse aims to resect or reposition the prolapsed orbital fat tissue.
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Resection: Resection of orbital fat prolapse requires a small or quite large incision at the conjunctival area. This incision consists of a self-healing and suture closure process.
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Reposition: Repositioning orbital fat prolapse is a technique where the fat tissue is posteriorly displaced in conjugation with its conjunctival fixation into the sclera. Two percent lidocaine is first administered to the subconjunctival space. Then, the surgeon passes the traction suture to firmly position the eye. The fat is then repositioned by a blunt object into the posterior position. This process is followed by placing the interrupted suture between the superficial sclera and conjunctiva regions. The reposition of prolapsed orbital fat tissue can also be performed by a small incision at the conjunctival region with fibrin glue closure.
Prognosis:
Orbital fat prolapse mostly requires no medical attention or treatment because many cases are asymptomatic. The prognosis seems favorable and good, with less or no frequent progression of the orbital fat prolapse. Nevertheless, there can be an increased risk of recurrence when resection or repositioning techniques are used. The recurrence of orbital fat prolapse can be managed with appropriate reintervention.
Conclusion:
Orbital fat prolapse is a condition that generally refers to the displacement of herniation of the fat pad tissue that lies within the orbit. Age and certain conditions can contribute to weakening the connective tissue holding the orbital fat in place, causing orbital fat prolapse. It is not associated with serious health issues. In most cases, orbital fat prolapse is more of an esthetic concern than a medical emergency. If one experiences mild discomfort or clinical symptoms of orbital fat prolapse, it is recommended to consult an ophthalmologist for personalized advice and a treatment plan.
