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The purpose of this systematic review is to investigate the most common indications, treatment, and outcomes of computer-assisted surgery (CAS) in ophthalmological practice. CAS has evolved over the years from a neurosurgical tool to maxillofacial as well as an instrument to orbitofacial surgeries. A detailed and organized scrutiny in relevant electronic databases, journals, and bibliographies of the cited articles was carried out. Clinical studies with a minimum of two study cases were included. Navigation surgery, posttraumatic orbital reconstruction, computer-assisted orbital surgery, image-guided orbital decompression, and optic canal decompression (OCD) were the areas of interest. The search generated 42 articles describing the use of navigation in facial surgery: 22 on orbital reconstructions, 5 related to lacrimal sac surgery, 4 on orbital decompression, 2 articles each on intraorbital foreign body and intraorbital tumors, 2 on faciomaxillary surgeries, 3 on cranial surgery, and 2 articles on navigation-guided OCD in traumatic optic neuropathy. In general, CAS is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were related to trauma. Treatment of complex orbital fractures was greatly improved by the use of CAS compared with empirically treated control groups. CAS seems to add a favourable potential to the surgical armamentarium. Planning details of the surgical approach in a three-dimensional virtual environment and execution with real-time guidance can help in considerable enhancement of precision. Financial investments and steep learning curve are the main hindrances to its popularity.

Background and Objectives: Robotic surgery represents one of the most significant innovations in the field of surgery, offering new opportunities for the treatment of complex pathologies that require greater accuracy and precision. It is a technology that has become widely used in general, urologic, gynecologic, and cardio-thoracic surgery, but has a limited evidence in the head and neck region. This review explores the use of robotic surgery in orbital pathology, focusing on its applications, benefits, and limitations. Materials and Methods: A cross-sectional search method was performed in multiple databases to answer the following question: “What are the applications of robotic surgery in the management of orbital pathologies?” Studies were carefully reviewed by two simultaneous researchers, and, in case of disagreement, a third researcher was engaged. Care was taken to identify the surgical hardware (robotic station) used to perform the surgical procedure. Results: Out of 491 records, eight studies met the inclusion criteria. These included cadaveric, preclinical, in vitro, and early clinical investigations assessing robotic approaches for fronto-orbital advancement, tumor resection, orbital decompression, and other surgical procedures such as lacrimal gland dissection and biopsy, medial and lateral orbital wall dissections, enucleation, and lid-sparing orbital exenteration. The robotic systems evaluated included the Da Vinci Xi, Da Vinci SP, Medineering Robotic Endoscope Guiding System, and a modular multi-arm concentric tube robot, each with specific advantages and limitations. Conclusions: Robotic surgery provides significant advantages for orbital pathologies such as improved precision, visualization, and tissue preservation, with reduced complications and faster recovery, although some limitations still exist. Future advancements, such as smaller instruments and AI integration, promise to improve outcomes, making robotic surgery more effective in treating orbital conditions.

ObjectiveTo determine postoperative surgical site infection (SSI) rates in three separate patient groups who underwent orbital surgery without prophylactic systemic antibiotics.Study designSingle-centre retrospective descriptive case series.Study populationWe studied the notes of 639 consecutive patients who had undergone orbital surgery in our hospital from 2009 through 2013. All patients belonged to either of three groups: (1) clean orbital surgery (n=226); (2) clean orbital surgery with implant (n=290); (3) clean-contaminated surgery (n=92). Thirty-one patients were excluded.ResultsOf the total of 608 patients, without systemic antibiotic prophylaxis, only five were diagnosed with SSI 5/608 (0.82%): 1/226 in the ‘clean’ group, 3/290 in the ‘clean-with-implant’ group and 1/92 in the ‘clean-contaminated’ group. All five patients with SSI were effectively treated with antibiotics.ConclusionIn this study ‘clean’, ‘clean-with-implant’ and ‘clean-contaminated’ orbital surgery was safely performed without prophylactic antibiotics. Where postoperative infection did occur, the patients were effectively treated with systemic antibiotics. We suggest to restrict the administration of systemic antibiotic prophylaxis in orbital surgery.

Background Repairing fractures of the orbital wall and floor remains a complex challenge due to the intricate anatomy of the orbit and the limited visibility during surgery. With the advancement of digital technologies, tools such as DICOM (Digital Imaging and Communications in Medicine) now allow the creation of virtual mirrored models of the unaffected orbit, which can greatly assist in surgical planning and reconstruction. This study aimed to evaluate the accuracy of orbital wall reconstruction using patient-specific implants (PSIs) versus prebent titanium mesh. Materials and methods A single-blind randomized controlled clinical trial was carried out on 28 patients with unilateral orbital fractures, who were randomly divided into two equal groups. Group I underwent orbital wall reconstruction using prebent titanium mesh, while Group II received titanium PSIs. Clinical and radiographic evaluations were carried out at 1 week, 1 month, and 3 months postoperatively to evaluate enophthalmos, ocular motility, diplopia, and the precision of orbital volume restoration. Results The mean postoperative orbital volume was 27.48 ± 1.324 cm³ in Group I and 25.62 ± 1.492 cm³ in Group II. The difference in orbital volume between the reconstructed and intact orbit was significantly smaller in the PSI group (0.6543 ± 0.2767 cm³) compared to the pre-bent mesh group (1.666 ± 0.3884 cm³; p  < 0.05). Conclusion Patient-specific titanium implants significantly improved the accuracy of orbital volume restoration, particularly in cases involving large defects. Compared to pre-bent titanium mesh, PSIs reduced the need for revision surgery and offered superior volumetric outcomes. In contrast, prebent titanium mesh still provided satisfactory results for isolated single wall fractures and is likely to be cost-effective. Trial registration This trial was retrospectively registered at ClinicalTrials.gov on March 05, 2024, under the registration number NCT06294535.

Spheno-orbital meningiomas often present with visual deficit due to invasion of the optic canal by the tumor. This study discusses the reasons of visual impairment, the choice of the surgical approach according to the type of optic canal involvement, and the factors correlated to the visual outcome in patients harboring a spheno-orbital meningioma. A surgical series of 60 spheno-orbital meningiomas is reviewed. The preoperative visual symptoms, the involvement of the optic canal in both neuroradiological studies and surgical descriptions, the different surgical approaches are reviewed. These data are correlated with the postoperative visual outcome. The 60 spheno-orbital meningiomas were classified in 4 types according to the intraorbital tumor localization: type I, supero-lateral (18 cases); type II, inferomedial (8 cases); type III, orbital apex (22 cases); type IV, diffuse (12 cases). Thirty-six of the 60 patients (60%) had variable decrease of the visual acuity on the tumor side. Forty-three patients (71.6%) had tumor extension into the optic canal on imaging studies. On the whole, 36 patients among 43 with invasion of the optic canal (83.7%) had preoperative visual dysfunction; on the other hand, none among 17 patients without tumor invasion of the optic canal had visual dysfunction. The surgical approaches according to the tumor location were as follows. A supraorbital-pterional approach was used in the 8 inferomedial tumors, in the 22 orbital apex tumors, and in 9/12 diffuse tumors; these last two types had concentric involvement of the optic canal. Three diffuse tumors with significant extension in the infratemporal fossa were operated on via a frontotemporal-orbitozygomatic approach. A wide decompression of the optic canal was performed in all cases, excepting in two inferomedial tumors without optic canal invasion. The 18 patients with lateral tumors were approached via a lateral orbitocranial approach, including removal of the sphenoid wing and lateral orbital wall without bone flap; the resection of the lateral aspect of the optic canal was performed in the 3 cases with canal invasion. Postoperative improvement of the visual function was observed in 18 of 36 cases with visual dysfunction (50%). The rate of visual improvement was significantly higher in cases with lateral involvement (3/3 or 100%) than in those with concentric involvement of the optic canal (11/27 or 40.7%). The invasion of the optic canal by the tumor is the main reason of visual dysfunction in patients with spheno-orbital meningiomas. A wide opening of the optic canal must be performed routinely in patients with orbital apex and diffuse orbital tumors, where there is concentric invasion of the optic canal wall. In these cases the supraorbital-pterional approach is the technique of choice. In selected cases with lateral intraorbital tumors and invasion of the lateral aspect of the optic canal the complete tumor resection coupled with good decompression of the optic nerve may be achieved via a less invasive lateral orbitocranial approach without craniotomy.

Background: Dermoid cyst, a developmental benign choristoma, is the most common orbital tumor of childhood, arising from ectodermal sequestration along the lines of embryonic fusion of mesodermal processes, lined by keratinized stratified squamous epithelium and expanding slowly due to constant desquamation and dermal glandular elements. Approximately 80% are found in the head and neck region and comprise 3-9% all orbital masses. Purpose: It is mandatory to know about the variable presentations of orbital dermoids and the surgical techniques that can be adopted based on the site, extent, age and aesthetic needs, presence of inflammation and possibility of intraoperative rupture. Synopsis: Orbital dermoids can be classified as juxta-sutural, sutural or soft tissue cysts; superficial or deep; intraosseous or extraosseous, and intraorbital or extraorbital. These smooth, painless, mobile or partially mobile lesions mostly present at the fronto-zygomatic suture with proptosis, displacement, ptosis or diplopia, depending on depth and extent. Therefore, it is important to understand the various presentations and the appropriate surgical techniques. Highlights: We describe the embryological origin, types and clinical features of dermoids in this video and demonstrate the surgical and minimally invasive techniques for their management. Video link: https://youtu.be/-q3xD2igjcQ

Neonatal orbital complications are rare and potentially fatal, demanding prompt diagnosis and adequate treatment. A 25-day-old neonate presented with rapidly progressive orbital complications as evidenced by proptosis, chemosis, lid oedema and restricted eye movements, developing within 3 days. There was no significant medical history or risk factors for developing infection. An initial conservative approach with antimicrobial therapy failed to show any resolve. An MRI brain, orbits and paranasal sinuses demonstrated that there were features suggestive of right orbital cellulitis with possibility of abscess formation with right ethmoidal mucoinflammatory disease and mass effect on the optic nerve causing stretching and compression by the surrounding inflammation. The patient was treated successfully with transnasal endoscopic drainage and decompression. Endoscopic access was challenging owing to the restrictive anatomy. Postoperatively, the patient showed improvement, with gradual decrease in proptosis and resolve in eye movements.

Objective This study compared the impact of gradual oculomotor training (GOT) in blow-out orbital fracture (BOF) reconstruction recovery with the impact of high-intensity trainings. Methods In total, 120 patients with BOF requiring orbital reconstruction surgery were randomly divided into four groups; all groups performed postoperative oculomotor training four times per day. Patients in Groups 1, 2, 3, and 4 performed 10, 20, 30, and 50 sets of all-direction movement per training on the first 3 days, respectively; they performed 10 additional sets per training on the following 4 days. Patients in all groups performed 50 sets per training from 8 days to 3 months postoperatively. Incision healing, pain, and satisfaction rate, as well as degree of diplopia, were recorded during follow-up. Results At 7 days postoperatively, more patients in Group 1 had no/mild swelling and no/mild pain, compared with patients in Group 4. Patients in Groups 1 and 2 had higher satisfaction rates than patients in Group 4. The degree of diplopia did not significantly differ among the groups. Conclusions For patients with BOF, GOT after reconstruction surgery was more beneficial for wound healing, pain relief, and satisfaction; the degree of diplopia did not significantly differ, compared with high-intensity trainings.

To report a retrospective tertiary-center series of unilateral orbital lesions and to illustrate a structured, experience-based multidisciplinary workflow integrating clinical, radiologic, and histopathologic data to support differential diagnosis and management in real-world practice. This retrospective descriptive case-series included 18 patients with biopsy-confirmed unilateral orbital lesions evaluated between January 2021 and March 2025 at the Oculoplastic and Orbital Surgery Unit, Humanitas Research Hospital, Milan. Demographic, clinical, imaging, and histopathologic data were analyzed. Imaging included computed tomography (CT), magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), and functional techniques such as MRA, PET/CT when indicated. Histopathology incorporated immunohistochemistry (IHC) and proliferative indices (Ki-67). Outcomes included final diagnosis, treatment, and early recurrence. 18 patients were included: dermoid cysts (n = 3), vascular malformations (n = 6), neurofibroma (n = 1), idiopathic orbital inflammation (n = 2), meningioma (n = 1), and epithelial malignancies (adenoid cystic carcinoma, basal cell carcinoma, squamous cell carcinoma, mucinous carcinoma, Merkel cell carcinoma; n = 5). Characteristic MRI and IHC patterns enabled accurate subclassification and guided informed-individualized management decisions, ranging from observation or image-guided sclerotherapy to complete surgical excision or multidisciplinary oncologic therapy. No recurrence occurred among benign lesions. Malignant epithelial tumors required adjuvant radiotherapy or systemic therapy according to histologic subtype and TNM stage. A systematic, multidisciplinary approach integrating cross-sectional imaging and histopathologic assessment underpins effective diagnostic and therapeutic decision-making in unilateral orbital disease. The proposed workflow, derived from institutional practice, offers an illustrative and reproducible framework for clinical reasoning and therapeutic decision-making based on real case scenarios. Its adaptability lies in the use of structured clinical-radiologic algorithms, which may help optimize individualized management, facilitate timely referral, and reduce unnecessary invasive procedures, particularly within tertiary referral settings.

Purpose The aim of this study is to assess the efficacy and safety of surgical treatment of orbital cavernomas in terms of clinical and functional results. Methods Twenty consecutive patients underwent surgical removal of a unilateral orbital cavernoma between 1999 and 2009. Indications for surgical treatment were: visual impairment, diplopia due to ocular movement impairment, progressive and disfiguring unilateral proptosis, severe retroorbital pain clearly related to the orbital cavernoma. We used a topographic classification of the lesions within the orbit. The orbit has been divided into an anterior and a posterior compartment on the axial plane and into three sectors on the coronal plane. The proptosis was quantified on MRI scans. Results The location of the cavernoma determined the choice of the surgical approach. We performed eight lateral orbitotomies and 12 fronto-orbito-zygomatic approaches. All the tumors were completely removed as assessed at follow-up MRI. We did not record any intraoperative or major postoperative complication requiring a reoperation. The postoperative visual acuity improved in four of five patients with visual impairment, it worsened in the other case. Proptosis improved in all the patients. Diplopia improved in four patients, and did not recover in another case. Conclusion Surgical treatment of symptomatic orbital cavernomas is safe and effective. Tumor location dictates the choice of surgical approach. Visual function and cosmetic result are the main parameters to evaluate the clinical outcome. Surgical approach and dissection technique are crucial in determining the visual outcome.