Orbital decompression is a surgical procedure that creates additional space within the orbit, the bony socket housing the eye and its structures. The objective is to alleviate pressure that has built up behind the eye, affecting the eyeball and the optic nerve. By expanding the eye socket’s volume, the surgery allows the eye to settle back into a more natural position, relieving compression on these structures.
Medical Conditions Requiring Surgery
The most frequent reason for orbital decompression is Thyroid Eye Disease (TED), also known as Graves’ ophthalmopathy. TED is an autoimmune disorder where the immune system attacks the tissues surrounding the eyes. This response causes the fatty tissue and extraocular muscles to become swollen and inflamed. The swelling increases tissue volume within the bony orbit, pushing the eyeball forward in a condition called proptosis, or bulging eyes.
This forward displacement can prevent the eyelids from closing completely, leading to severe dry eye and corneal damage. In advanced cases, the enlarged muscles can press on the optic nerve. This compression interferes with the nerve’s function, leading to vision loss that can become permanent if the pressure is not relieved. The goal of surgery in these cases is to prevent irreversible blindness.
While TED is the principal cause, other conditions can also necessitate orbital decompression. The growth of benign or malignant tumors within the eye socket can increase pressure and displace the eye. Severe inflammation or significant facial trauma that results in bleeding behind the eye can also create a dangerous buildup of pressure requiring surgical intervention.
The Surgical Procedure
Orbital decompression surgery is performed under general anesthesia and takes between two and three hours to complete. The goal is to increase the internal volume of the eye socket. Surgeons achieve this through two primary methods, often used in combination: the removal of sections of the bony walls of the orbit and the removal of excess orbital fat.
The orbit is a pear-shaped structure with four bony walls. To create more space, surgeons remove portions of one, two, or sometimes three of these walls. The targeted walls are often the medial wall, separating the eye socket from the nasal sinuses, and the orbital floor above the maxillary sinus. Removing bone here allows the orbital contents to expand into the sinus cavities, reducing pressure.
To access these structures, surgeons make precise incisions in natural skin folds, like the upper eyelid crease, or inside the eyelid to minimize scarring. Through these openings, specialized instruments are used to remove small sections of bone or excise precise amounts of orbital fat. The amount of bone and fat removed is tailored to the patient’s anatomy and condition severity.
Recovery and Healing Process
Following surgery, patients may stay overnight in the hospital for observation. The operated eye is covered with a dressing that is removed the next morning, and patients are instructed to apply ice packs for the first 48 hours to manage swelling. A course of steroids may be prescribed to control inflammation, along with antibiotics to prevent infection and eye lubricants.
In the first one to two weeks, significant bruising and swelling around the eyes are normal. Patients are advised to avoid strenuous activities, bending, and heavy lifting to prevent increased pressure at the surgical sites. Sleeping with the head elevated can also reduce swelling. Normal, non-strenuous daily activities can be resumed within seven to ten days.
The complete healing process takes several months. While initial bruising and swelling subside within a few weeks, the final results become apparent as residual inflammation resolves. Follow-up appointments are scheduled to monitor healing, remove sutures, and assess the functional and cosmetic outcomes.
Surgical Outcomes and Potential Complications
The outcomes of orbital decompression are both functional and aesthetic. A successful procedure reduces proptosis, which alleviates corneal exposure, reduces eye irritation, and improves the ability to close the eyelids completely. For patients with vision loss from optic nerve compression, the surgery can halt further damage and sometimes lead to improved eyesight.
Despite its benefits, the surgery carries risks. The most common complication is diplopia, or double vision, which can occur if the eye’s repositioning alters muscle alignment. This double vision may be temporary, resolving as swelling subsides, or it can be a persistent issue that may require subsequent eye muscle surgery to correct.
Other less frequent complications include infection and bleeding. Some patients may experience numbness in the cheek, upper lip, or gum area if nerves along the orbital floor are disturbed during the operation; this numbness is often temporary but can last for several months. Rare but serious complications include leakage of cerebrospinal fluid and severe bleeding that could lead to vision loss.