Definition & Overview
An orbital decompression is a surgical procedure that involves removing a portion of, or the entire wall of the eye socket. It is performed to relieve pressure on the eye’s orbit caused by Grave’s disease. In the past, the procedure was performed through open surgery. However, with the advances in surgical technology, specifically endoscopy, orbital decompression is now performed using minimally invasive techniques, which result in less trauma to surrounding areas.
Grave’s disease is a relatively common autoimmune disorder affecting 1 in 200 people. The disease is more prevalent in women and is one of the primary causes of hyperthyroidism. The disease primarily affects the thyroid gland and causes an overproduction of the thyroid hormone.
Some people with the disease are also affected by a condition called thyroid-associated orbitopathy (TAO), also referred to as Grave’s orbitopathy. TAO results in the overgrowth of muscles, tissue, and fat surrounding the eye’s orbit. As a result, pressure develops in the area, which leads to the development of various symptoms including protrusion of the eyeball and reduced sense of sight.
Severe cases of TAO can lead to significant facial disfigurement and even blindness. It is important to understand that there is no cure for this condition. However, with surgical treatment, such as orbital decompression, the patient experience symptoms relief. To relieve pressure on the eye’s orbit, one or more of the four walls of the eye socket are removed. These walls are the lateral, superior, medial, and inferior walls.
Endoscopic orbital decompression is the preferred method of surgery today. It is not only highly effective, but also results in less damage to the surrounding tissues, including skin and muscle.
Who Should Undergo & Expected Results
Orbital decompression is the primary form of surgical treatment for thyroid-associated orbitopathy. Patients with this condition display symptoms associated with severe corneal exposure (protruding eyeball), compressive optic neuropathy (injury to the optic nerve caused by compressive force), and cosmetic deformity (distorted facial appearance).
As mentioned earlier, the cure for this condition is yet to be discovered. However, surgical treatment can reduce the symptoms and even slightly improve the patient’s facial appearance.
It is also important to note that orbital decompression is mostly recommended for patients with severe cases of the condition. Such patients typically display the following symptoms:
- Vision loss
- Loss of the ability to distinguish colours
- Swelling of the optic disc
- Retraction of the eyelid
In terms of expectations after the procedure, most patients will notice significant improvement almost immediately. They can also expect shorter recovery period, as endoscopic orbital decompression is a minimally invasive form of surgery.
However, like any other form of surgery, there are risks associated with the procedure. Moreover, there is a possibility that complications could develop.
How is the Procedure Performed?
Orbital decompression is performed under general anaesthesia, which means that the patient is fully asleep throughout the procedure.
The surgeon will make use of an endoscope, a device that is fitted with miniature surgical instruments, a video camera, and a light source. The instruments are inserted through the nostrils and guided to the sinuses.
The first part of the surgery involves the opening of the sinuses, which are located directly beside the eyes, to expose the bone of the eye socket. After exposing the bone of the eye socket, the surgeon will carefully remove it. Doing so will expose a lining called the periorbita. This lining holds in the fat and other tissue besides the eyeball. The surgeon will create an incision in this lining allowing fat and a small amount of tissue to protrude into sinuses. This is done to relieve pressure (decompress) on the eye.
No further treatment is usually required after the procedure. The patient can be transferred to a recovery area for close observation and then to a ward when fully stabilised. Patients usually only need to stay in the hospital overnight. They can be discharged the following day as long as no complications arise.
Possible Risks & Complications
Endoscopic orbital decompression may be minimally invasive but there are still significant risks involved. One of the most serious is vision loss. Other risks and complications include, but not limited to, bleeding around the eye, numbness of the cheeks, leakage of cerebrospinal fluid, injury to other components of the eye and sinuses, infection, and meningitis.
Rootman J, Stewart B, Goldberg RA. Orbital Surgery A Conceptual Approach. Philadelphia Pa: Lippincott-Raven Publishers; 1995. 353-384.
Ing E, Bednarczuk T. Thyroid Ophthalmopathy. Medscape Reference. Ophthalmology:[Full Text].
Phillips PH. Newmann, NJ editor. The Orbit. in Ophthalmology Clinics of North America. Philadelphia PA: W.B. Saunders Company; Mar 2001. 14:1: 109-127.