Orbital Decompression Surgery

If you have bulging or protruding eyes, medically known as exophthalmos, you may have an underlying condition called Graves’ ophthalmopathy that puts pressure on your eye socket. If the orbital pressure around your eyes becomes too high, it may even lead to vision loss. Orbital decompression is the surgical removal of the bones and sometimes the fat in the orbit of the eye (eye socket), performed to relieve exophthalmos.

1. Improve vision when the optic nerve has been depressed by the orbital muscles
2. To improve appearance in case of Grave's Ophthalmology
3. To relieve symptoms of dry eyes, bulging eyes and any discomfort of the eyes.

Orbital decompression surgery is performed to treat Graves’ ophthalmopathy, which results from a buildup of certain carbohydrates in the muscles and tissues behind your eye. It can treat the following symptoms of Graves’ ophthalmopathy:-

1. Bulging of the eyes
2. Dry eye
3. Inability to close the eyes completely
4. Double vision
5. Swelling of eyelids
6. Increased orbital pressure
7. Chronic pain in the eyes
8. Headache

Orbital decompression surgery is generally performed under general anaesthesia. The procedure involves:-

Step 1: Making an incision: The surgeon usually makes an incision through your upper eyelid crease or caruncle (medial inner corner of the eye). 

Step 2: Removal of bone: He/she then carefully removes a part of the bone between your eye and your nose and a part of the bone that forms the outer layer of the orbit. The surgeon may also remove a part of the bone under your eye. 

Step 3: Removal of fat: Once the surgeon removes the bone, periorbita (a thin lining covering the eye) gets exposed. He/she will make small cuts in the lining and allow the muscle and fat surrounding the eye to expand. Your surgeon will then carefully remove some of the fat. 

Step 4: Closing the incision: The surgeon will close the skin with sutures and apply a bandage to the wound. 

The types of orbital decompression surgery include:-

Lateral wall decompression: The surgeon makes a 10-15 mm long incision in the crease of your outer eyelids and removes a section of bone behind the outer wall of the orbit. The skin is closed by stitches which are removed after two weeks. 

Medial wall decompression: The surgeon makes an incision in the conjunctiva behind the inner corner of the eyelid and removes the ethmoid air cells, also known as sinuses. He/she uses absorbable stitches to close the conjunctiva. There are no visible scars in the procedure. 

Orbital floor decompression: It is similar to lateral wall decompression in which the surgeon removes a part of the floor of the orbit underneath the eyeball. 

1. Before the surgery, the doctor will advise you for a pre-anaesthetic checkup. 
2. The doctor will ask you about your medical history and perform imaging tests to ensure that you are fit for the surgery. 
3. The doctor will ask you to stop taking blood thinners like aspirin and anti-inflammatory medicines at least three weeks before the surgery. 
4. He/she will instruct you to stop smoking two weeks before and after the surgery. 
5. You will be asked to not eat or drink anything after midnight the night before the surgery. 
6. He/she will then briefly explain the procedure, hospital stay, estimated cost, and insurance formalities

1. You will be informed to arrive a few hours before the surgery begins.
2. The hospital staff will ask you to sign consent formalities before admitting you to the hospital.
3. They will inform you about the change of clothes and removal of all jewellery pieces. 
4. The doctor will record your last meal and monitor your vitals, including blood pressure, heart rate, and breathing. 
5. After your vitals are monitored, the team will shift you to the OT room.

1. In the OT room, you will be made to relax on the operating table. 
2. The team will administer an IV line in your arms or hands for fluids. 
3. The anaesthesiologist will administer general anaesthesia to put you to sleep throughout the surgery. 
4. Someone from the team will constantly monitor your vitals. 
5. Finally, the surgeon will make the required incisions and perform the surgery. 
6. After the surgery is done, he/she will close the incision with sutures.

Recovery in Hospital:-

1. After the surgery, the team will shift you to the recovery room to monitor your vitals and the effect of anaesthesia. 
2. You may feel extremely tired after the surgery. The doctor may prescribe a pain medication to manage the pain. 
3. Orbital decompression is performed as an outpatient procedure, i.e., you will be able to go home the same day. However, sometimes you may need to spend one night in the hospital under observation.
4. Ask a friend or family member to drive you home. 

Recovery at Home:-

1. There is some bruising or swelling around the eye that can last up to two weeks. 
2. Your doctor may prescribe corticosteroids and antibiotics to help reduce swelling and prevent infections. 
3. You should remain active after the surgery but avoid engaging in strenuous activities for 10-14 days. 
4. Avoid lifting heavy objects or bending in the first week after the surgery. 
5. Do not blow your nose for the first few days after the surgery. 
6. The doctor may also advise using cold compresses to help relieve pain and swelling. 

First Follow-Up Appointment

The first follow-up appointment is typically scheduled one to two weeks after the surgery. During the visit, the doctor will remove your sutures and examine the healing of your eye. The doctor does not need to remove sutures in medial wall decompression surgery. He/she will also provide other home care and follow-up instructions.

Like any other surgery, orbital decompression has some risks. The potential risks of orbital decompression include:-

1. Diplopia (double vision)
2. Scarring
3. Optic nerve injury
4. Epiphora (excessive tearing)
5. Retinal detachment
6. Bleeding in the nose or around the eye
7. Vision loss
8. Eye or sinus infection
9. Blocked tear duct
10. Eyelid malposition
11. Cerebrospinal fluid leakage
12. Scratch on the cornea
13. Swelling of the conjunctiva
14. Pain in the eye
15. Numbness around the eye

Call your healthcare professional immediately if you experience:-

1. Vision loss
2. Increase in pain, redness, or swelling
3. Vomiting and nausea
4. Drainage of pus or blood from the incision