Experience & expertise
Mr Uddin specialises in the diagnosis and treatment of orbital disorders, treating a large number of patients both adults and children. He sees patients from all over the UK as well as internationally, accepting referrals from many countries across the globe.
Over the 20 years as a specialist orbital surgeon at Moorfields, he has performed many orbital biopsies and excision of tumours, which require very specialised expertise.
He has performed over 500 orbital decompression procedures, for thyroid eye disease, over the last ten years. He has an extensive thyroid eye disease (TED) practice and runs the TED service at Moorfields.
Mr Uddin has set up the multidisciplinary orbital service at St George’s Hospital Medical School, where he regularly manages orbital trauma, infections, tumours and deformity with an excellent, highly specialised, well-established team including specialists in maxillofacial surgery, ENT, neurosurgery, head & neck oncology, endocrinology, rheumatologist, radiology and pathology.
He has been pivotal in training over 50 specialists who have become consultants in the United Kingdon, Europe, Asia, USA, Canada, Australia, New Zealand and Africa.
“The orbit supports the function and form of eye and eyelids...serving vision and cosmesis. It is a complex structure with a myriad of internal and adjacent structures ..... Any of which can go wrong resulting with problems with eyesight, pain and appearance”
What is the orbit?
The orbit or eye socket is the bony cavity which contains the eyeball and accompanying muscles, soft tissues, blood vessels and nerves. Its purpose is to protect and serve the eye and associated structures. Due to its proximity to the sinuses, brain, and a myriad of other delicate structures, it is vulnerable to many types of inflammation, infection, tumour, injury and deformity.
MDT (multidisciplinary team working)
Many orbital conditions are initially investigated and diagnosed by the orbital, oculoplastic ophthalmologist (who have been specially trained and experienced in this particular field of medicine). Many conditions are managed by the orbital specialist.
However, there are many conditions where the patient is best served with a team. Mr Uddin has developed and worked closely with many world-class teams for the various orbital conditions that he manages regularly.
Imaging is the primary investigation in orbital disease
- CT scans (Computed Tomography) is quick, effective and inexpensive. It gives good definition of bone (esp for trauma) and soft tissue, and is diagnostic for many orbital conditions.
- It is used sparingly with children to reduce radiation dose.
- MRI scans (Magnetic Resonance Imaging) is good for soft tissue of the orbit. It can help identify water content, cellular density, the orbital apex, thrombosis and other positive findings. It takes longer to acquire.
- Colour doppler ultrasound is very useful to look how vascular a lesion is and whether it is high or low flow.
- Blood test can investigate thyroid problems, autoimmune disorders, GPA, sarcoid etc.
- Chest x-ray/CT may be helpful to associated conditions including sarcoid and TB
- Angiography is used for vascular lesions including fistulae.
- PET scans (Positron Emission Tomography) is helpful to look at “active” tissues and local and distant involvement.
Hallmarks of inflammation are pain, redness, and swelling. This is not always apparent if the inflammation is deeper in the orbit. Loss of function of the structures involved indicates which anatomical structures may be involved. For example, weakening orbital muscles can result in double vision, and sight problems may indicate optic nerve involvement
Can tumours form in the orbit?
Although orbital tumours are very rare, Mr Uddin sees over 100 cases each year, due to his referal pattern. These tumours can either be benign (may grow locally and not spread to other tissues) or malignant (cancerous, may invade other tissues or spread to other parts of the body). Sometimes the tumour can be an indication of a cancer that originated from another part of the body (metastasis)
Symptoms of an orbital tumour are similar to many other conditions these include proptosis, pain, double or loss of vision and droopy eyelids. Numbness around the skin is a sinister feature.
It’s important to reach a diagnosis first. Sometimes this can be done with just the clinical finding and imaging in the form of a computed tomography (CT) or magnetic resonance imaging (MRI) scans and ultrasound.
Often a biopsy (to take a piece of tissue and examine under a microscope to make a diagnosis) is required. Sometimes, it is better to removal the whole tumour.
If it turns out to be malignant this may require surgery, MDT work, and treatment including drugs to treat it and/or radiation therapy.
Orbital and facial trauma can result in immediate that need urgent treatment (for example sight loss or entrapment of eye muscles).
There can be many problems that become evident once the trauma has settled. This can be related to visual problems of the optic nerve, eye itself or double vision. Appearance and lid malpositions can be difficult to quantify, such as a sunken eye appearance and droopy eyelids. This will be as a result of underlying bony changes, soft tissue changes and functional changes of eyelid muscles and skin.
These need to be assessed, often in teams including the oculoplastic/orbital surgeon and maxillofacial team.
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