Orbital decompression
This operation is performed to create more room in the eye socket and is usually performed as part of the management of thyroid eye disease. There are a number of indications that will point to the need for this surgery:
The optic nerve is compressed by swollen muscles at the apex of the orbit where there is a confined space. An orbital decompression may be considered as the main management of this problem or it may be used for patients in whom alternative treatments e.g. steroids, radiotherapy have failed or have caused intolerable side effects.
A situation where the cornea is exposed due to severe proptosis (protrusion of the eye) with poor closure of the eye resulting in drying of the cornea and even ulceration in advanced cases.
Constant aching orbital pain due to congestion of the orbital tissues which can be relieved by a decompression procedure.
The distressing situation where the eyes are so protrusive that they may prolapse out of the orbit especially on attempting to look up. The eyelids may close behind the eye.
In some patients whose eyes are quite protrusive, the eyes may become more protrusive following eye muscle surgery to improve double vision. In such patients a decompression operation may be considered desirable prior to such eye muscle surgery.
In some patients, a satisfactory result cannot be obtained by eyelid lengthening procedures alone as extreme protrusion of the eyes is the main cause of the lid retraction. Such patients require an orbital decompression.
Decompressive surgery is also being requested more and more frequently to improve the cosmetic appearance of patients as the surgical results and safety of the surgery have improved considerably over recent years. Most orbital surgeons would regard such surgery as rehabilitative (as opposed to “cosmetic”) with an attempt being made to restore a patient’s appearance to that which existed prior to the onset of this disease process. However, such goals are rarely achieved completely.
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