Orbital Decompression Surgery

Some patients with Graves Disease (an autoimmune disorder causing an overactive thyroid gland) may develop Thyroid Eye Disease (also known as dysthyroid orbitopathy, thyroid ophthalmopathy, Graves’ ophthalmopathy, or Graves orbitopathy). In this condition, a patient’s antibodies bind to the tissues in the eye sockets and cause them to swell. The swelling of the muscles and fat within the eye socket can cause the eyes to bulge out (proptosis) and the extra volume in the eye socket can put pressure on the nerve leading to the retina in the eye itself (optic nerve). This can lead to vision loss and blindness if left untreated. The primary treatment of thyroid eye disease involves medicines designed to slow down or reverse the process causing the swollen tissues.

Working with an endocrinologist to maintain a normal thyroid hormone level is essential. Oral and IV corticosteroids are the most effective medications available to control the orbital tissue swelling and decrease pressure on the optic nerve. Oral and IV corticosteroids are commonly given for short durations (days to weeks) for this condition. If the signs and symptoms of the orbital compression from thyroid eye disease continue or return after initial steroid treatment, surgery may be indicated. Your ophthalmologist and ENT doctor will discuss when surgery is indicated in your case. Endoscopic orbital decompression is performed with the patient asleep (general anesthesia). The procedure is performed through the nostrils with endoscopes and specialized angled and curved instruments. The paranasal sinuses are opened and the thin bony wall between the orbit and ethmoid sinuses is removed. Incisions are made in the soft tissue envelope separating the orbital fat and contents from the sinuses. This allows the fat to herniate or bulge into the open sinus cavity and thus relieves the pressure in the orbit. The eye subsequently resumes a more normal position in the orbit, minimizing the proptosis (eye bulging).

Patients typically stay one night in the hospital unless there are other medical problems. A post-operative course of corticosteroids and antibiotics are prescribed to minimize swelling and prevent infection. Frequent follow up appointments with both the ophthalmologist and ENT specialist are required. Additional surgery may be required by the ophthalmologist or oculoplastic surgeon depending on the amount of decompression achieved.