Orbital decompression is a surgical procedure to relieve the eyes from pressure caused by proptosis (abnormal bulge) and which may lead to vision loss. The patient may complain of chronic eye pain, chronic eye irritation, and optic neuropathy (optic nerve damage). The procedure enables the eyes to fit back into their sockets.
It is a delicate surgical technique since it deals with structures and tissues connected to the eye and near the regions of the brain. Causes of proptosis which may necessitate orbital decompression include Graves’ disease, orbital bleeding, relative maxillary hypoplasia (underdevelopment of upper jaw bones), tumors of the orbit, and congenital shallow orbits. Other reasons to perform an orbital decompression include severe eye infection and injury.
The orbit contains the eyeball, muscles, nerves, fat, and vessels. It is surrounded by ethmoid sinus, maxillary sinus, brain, and temporalis muscle. Orbital decompression involves thinning out or removing orbital walls and fat to expand the socket of the eye so that the eyeball can settle down.
Orbital decompression can be cosmetic to remove orbital fat and bone, to reduce the bulge and improve appearance. It can also be done for medical or functional purposes. The procedure creates more orbital space so that the eye can resume its normal position and allow the return of vision, if lost, due to intraorbital pressure.
Preparation & Expectation Before Surgery
The doctor will perform an examination and explain the risks and benefits involved in the operation. Aspirin, aspirin-related medications, or anti-inflammatory medications should not be taken three weeks prior to surgery. Warfarin should not be taken three to four days before surgery. The patient is also advised to avoid food and drink at least six hours before surgery.
Types, Purpose & Procedure
Depending on each situation, this three to four-hour operation is often done as an outpatient surgery. Usually, the procedure is performed on one eye at a time, even though both eyes can be handled simultaneously. General anesthesia is administered to the patient.
The surgeon gently passes an endoscope through the nose and the sinus close to the eyes. This route allows access to the eye socket's bone structure. The surgeon removes bone pieces and some fatty tissue to provide room for the eyes to settle into their sockets. If the purpose is medical, a more significant amount of bone and fat is removed. For the best possible outcome, the surgeon first removes or thins the lateral orbital wall, then the medial wall, and finally the orbital floor. The surgeon hides the incisions in the lower eyelid conjunctiva, caruncle/transcaruncular, and lateral upper eyelid crease. The patient receives a prescription that may consist of oral antibiotics, oral steroid tablets, and eye drops.
Non-endoscopic endonasal procedures can also be performed even though they may have more complications. They involve making incisions and include:
- Lateral wall decompression - The surgeon makes a 10-15 mm long incision in the outer eyelids and removes a part of the bone behind the outer orbital wall. S/he uses a few sutures to close the skin.
- Medial wall decompression - The surgeon makes a fine incision in the conjunctiva behind the eyelid’s inner corner. This action allows the removal of the orbit’s inner wall and the adjacent sinuses. S/he uses fine absorbable stitches to close the conjunctiva without leaving external scars.
- Orbital floor decompression - The surgeon uses lateral wall decompression, followed by removing part of the orbit's floor located below the eyeball.
Risks, Side Effects & Complications
Lateral wall decompression may leave a fine linear scar on the outer corner of the eyelids with swelling on the upper and lower eyelids. Nose-bleeding and double vision may also result.
The upper cheek and upper teeth may suffer from numbness, which will resolve on its own with time.
Generally, orbital compression may present with the following complications:
- Double vision
- Symptomatic sinusitis
- Wasting of the temporal region
- Reduction in visual acuity (rare)
- Permanent hypoesthesia (numbness)
- Intraoperative or postoperative hemorrhage
- Cerebrospinal fluid leakage with cerebral complications
After Care, Recovery & Results
The patient may experience pain on the first day after surgery, which can be managed via pain medications. Swelling and bruising may result and last for two weeks following surgery.
The first follow up visit is scheduled seven days after the surgical procedure. Subsequent visits will follow after a month, and then three months after the procedure.
To aid in healing, the patient is advised to avoid driving, blowing the nose, and limit physical activity.
Orbital decompression often registers a high success rate, and the effects are noticed soon after the procedure. The absence of an eye patch means a patient can see immediately after the surgery.