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Orbital decompression surgery

Orbital decompression surgery is a procedure that provides relief for exophthalmos (a bulging position of the eyeballs) due to Graves’ disease and reduces the amount of pressure within the eye socket (orbital space). The procedure is one step in a series of measures that is used to manage thyroid eye disease (TED). The management of thyroid hormones (before, during and after surgery) and smoking cessation are crucial for the success of the surgery. Steroid treatment is usually necessary to quieten TED activity pre-operatively.

Subsequent surgeries to correct double vision and retracted eyelids may be required after orbital decompression. The timing of the surgery is dependent on many factors and the treatment process is usually long-drawn.

When does one need to consider orbital decompression?

In severe cases of exophthalmos causing:

  • Loss of vision from compressive optic neuropathy
  • Inability to close the eyelids fully, resulting in cornea ulceration (exposure keratopathy)
  • Chronic congestion and eye pain
eye pain

How is endoscopic orbital decompression surgery performed?

The surgery is performed under general anaesthesia and takes place via access through the nostril. Bones are removed from the medial wall and the inferior wall of the orbit. Thereafter, bone and orbital fat are removed to create more room for the swollen orbital tissues to prolapse into the ‘new’ additional compartment. This allows for reduction of intraorbital pressure and relieves pressure on the optic nerve. The previously bulged eyeball would then reverse towards the eye socket into a more normal position.

The advantage of endoscopic decompression surgery is that there is no skin incision or external scar.

When exophthalmos is very severe, additional areas of decompression would then be performed simultaneously. These can be performed via the lateral wall. Lateral wall orbital decompression would require a skin incision.

What to expect after orbital decompression?

  • Excessive swelling and bruising – usually in the first few days after surgery.
  • Double vision – most people already have some degree of double vision prior to the surgery but this may increase. Persistent double vision would require squint surgery correction.
  • Loss of vision in one eye – rare, due to a sudden bleed behind the eyeball during or after surgery.
  • Sinus problems – the bone removed opens up the sinuses next to the nasal cavity, which may cause some sinus fluid or infection.
  • Numbness – cheek area and the upper lip and gums, but usually resolves.
  • Infections

You would be discharged from hospital on the day after surgery and reviewed 1 week later and thereafter reviewed 3 weeks later.

Lubricating eyedrops will be prescribed. Ointment to apply on the eyelid wound if any and anti-swelling medication will also be prescribed.

Further assessment would be done to ascertain the need for subsequent surgeries (squint and corrective eyelid surgeries).