Exophthalmos is the bulging or protrusion of the eyeballs from their sockets, which may lead to loss of vision. It is a condition associated with Graves’ disease, which is an immune system disorder resulting in the overproduction of thyroid hormones (Hyperthyroidism). Orbital decompression surgery is performed to relieve this exophthalmos.
Why is an orbital decompression performed?
Typically, patients elect to undergo this procedure when the exophthalmos becomes severe. Some of the symptoms at this stage may include:
- Chronic eye irritation causing scar tissue over the cornea (keratitis)
- Chronic eye pain or headaches
- Damage to the optic nerve (optic neuropathy) and loss of vision
The main aim of orbital decompression surgery is to make more space in bones around the eye (orbit), allowing the eye to return to a more normal position.
How is an endoscopic orbital decompression surgery performed?
The patient is first induced under general anaesthesia. The entire surgery is performed endoscopically through the nostrils, which means there is no incision made through the skin. This ensures no external bruising or swelling around the surgical site or eyes.
During surgery, the central (medial), and at times the inferior (lower) parts of the orbit are removed. It creates more room around the eyeball, allowing it to return to a normal position.
However, for cases with severe exophthalmos, doctors may decide to remove part of the lateral (side) wall of the orbit as well. Here, incisions are required through the skin and may cause external bruising or swelling.
Recovery from Endoscopic Orbital Decompression
Usually, the surgery is performed one eye at a time, although both eyes could be done together if required. Since there are no eye patches, the patient can see immediately after surgery. Patients may experience some pain or discomfort, which is controlled with medications. Patients are usually kept under observation overnight, mainly to monitor the patient’s vision. If the patient is in good condition, he/ she may go home the day after surgery. The effect of orbital decompression is noted soon after surgery with a high success rate.
The patient is asked to limit physical activity for around 10 days and not to blow their nose. Regular follow-ups are required to monitor the recovery of the patient.
Risks of Endoscopic Orbital Decompression
Generally, an endoscopic orbital decompression is a safe procedure, but like with any surgery, it carries a risk of complications like double vision, asymmetry, under-correction, over-correction, bleeding and infection. However, these risks are minimised by doctors, ensuring that complications are prevented/ minimised during the procedure.