Orbital Decompression Surgery

Orbital decompression surgery removes bone and/or fat from the eye socket to create more space. It's used primarily for thyroid eye disease to treat proptosis (bulging eyes) or optic nerve compression.

Why It's Done

Urgent (Vision-Threatening)

• Optic nerve compression from thyroid disease
• Not responding to steroids
• Prevents permanent vision loss

Elective

• Cosmetic improvement of proptosis
• Exposure keratopathy (cornea drying)
• Quality of life improvement

Types of Decompression

Bone Removal (Wall Decompression)

• Removes parts of orbital bones
• Medial wall (toward nose)
• Floor (toward sinus)
• Lateral wall (toward temple)
• Creates space for expanded tissue

Fat Removal

• Removes orbital fat
• May be combined with bone removal
• Less effect on eye position

What to Expect

Before Surgery

• Thyroid disease should be controlled
• Ideally in stable (inactive) phase
• CT scan for planning
• Stop smoking

Surgery

• General anesthesia
• 1-3 hours depending on approach
• May be done through eyelid or through sinuses

After Surgery

• Significant swelling and bruising
• Hospital stay often needed
• Ice packs, head elevation
• Recovery over weeks to months

Possible Complications

• New or worsened double vision (common)
• Numbness of cheek or teeth
• Infection
• Bleeding
• CSF leak (rare)
• May need strabismus surgery later

Staged Approach

Often done in sequence:

1. Decompression (if needed)
2. Strabismus surgery (if needed)
3. Eyelid surgery