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How is orbital decompression done?

Reviewed on 1/13/2021

The orbit is a solid structure that contains the eyeball, fat, muscles, vessels, and nerves.
The orbit is a solid structure that contains the eyeball, fat, muscles, vessels, and nerves.

The orbit is a solid structure that contains the eyeball, fat, muscles, vessels, and nerves. The maxillary sinus, ethmoid sinus, brain, and eye muscles surround the orbit. Orbital decompression involves removing or thinning of the orbital walls with or without orbital fat removal. This increases the available space for the orbital contents to relieve pressure in the orbit or reduce proptosis (bulging of the eyes).

Why is orbital decompression done?

The main indication for orbital decompression is proptosis (bulging eyes). Proptosis can occur due to thyroid eye disease (Graves’ disease), shallow orbits from birth, orbital tumors, and orbital hemorrhage (bleeding into the orbit). Orbital decompression may be done for optic nerve compression.

What are the signs and symptoms of proptosis?

Proptosis can be subtle without any symptoms. It may present with just bulging of the eyes. Other severe symptoms include:

Can proptosis be treated medically?

Proptosis of the eyes can lead to discomforts of the eyes, such as dry eyes, irritation, and watering of eyes. The doctor would advise eye drops to lubricate the eyes. Other medications may be prescribed to treat the underlying cause of proptosis. Proptosis itself is treated surgically by orbital decompression.

How is orbital decompression done?

Orbital decompression is performed under general anesthesia. It is commonly performed endoscopically. The surgeon uses a thin rigid metal scope (a long tube with light and camera) that is inserted through the nostrils. There are usually no external incisions. Depending on the severity of the proptosis, various amounts of orbital fat and orbital bone are removed. Incisions may be made in the upper eyelid crease or lower eyelid conjunctiva, but these heal without scaring. Usually, one eye is operated at a time and rarely both eyes may be operated at the same time. The surgery is commonly performed by an ENT (ear, nose, and throat) surgeon and ophthalmologist together.

After the procedure:

Most patients can go home on the same day or the day after surgery. There are usually no eyepatches placed. The nose may be packed and dressed for up to 2 days. Patients experience pain, swelling, and bruising for up to 2 weeks after surgery. Painkillers and antibiotics are prescribed.

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What are the complications of orbital decompression?

Some possible risks associated with orbital decompression include:

  • Diplopia (double vision)
  • Asymmetry of the eyes
  • Undercorrection of the problem
  • Overcorrection of the problem
  • Bleeding
  • Infection
  • Reaction of anesthesia

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References
Mercandetti M. Orbital Decompression for Graves Disease. Medscape. https://emedicine.medscape.com/article/878672-overview

McCord CD Jr. Orbital Decompression for Graves' Disease: Exposure Through lateral Canthal and Inferior Fornix Incision. Ophthalmology. June 1, 1981;88(6): 533-541. https://www.aaojournal.org/article/S0161-6420(81)34995-1/fulltext

The University of Mississippi Medical Center. Orbital Decompression Surgery. https://www.umc.edu/Healthcare/ENT/Patient%20Handouts%20-%20ENT/Nose%20and%20Sinus%20Handouts/orbital-decompression-overview-2016.pdf

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