It is an operation on the eye socket (orbit) that reduces the protrusion, or bulging, of the eye that can occur due to multiple diseases like:

• Thyroid Eye Disease (TED)

• Graves Eye Disease - Hyperthyroidism

• Trauma / Facial Injuries - especially if there is bleeding behind or under the eye

• Eye socket infections

• Tumours (like neuroblastoma and soft-tissue sarcoma)

The surgery can be performed on one, or both of the eyes (bilateral) at the same time.

Orbital decompression is just one part in the management of patient’s with TED, as management occurs in conjunction with your endocrinologist.

Decompression surgery may also be required for patients experiencing double vision, and for staring or retracted and puffy or swollen eye-lids.

The aim of an orbital decompression surgery is to relive the pressure on your optic nerve by making more room for the swollen fatty tissue, and the muscles behind your eyes, that cause the eyes to bulge.

More room is created by removing bone from the walls of the bony eye socket (the orbit) to make the orbit bigger, allowing the eye to settle back in. Amount of bone removed will depend on the severity of the condition and your surgeons will be guided by advanced imaging to ensure the best outcomes.

Before you have an orbital decompression, your doctor will want to make sure you are a good candidate for the procedure.

Your surgeon will order a CT scan to have a picture of the areas that will be operated on during surgery. The doctor will use the image to check several factors such as the thickness of the bones around your eye socket.

As the surgeon evaluates you before surgery, he/she will also discuss the risks and benefits of the surgery.

The potential benefits for undergoing an Orbital Decompression include:

• Reduction in protrusion (bulging) of the eye an restoration of normal appearance

• Improved vision by relieving vision off the optic nerve, that may be causing visual defects (symptoms)

• Improved comfort: patients with TED or trauma may experience aching or sensation of pressure behind the eye

• Reduced staring appearance of the eyes: there is often a small reduction in the gap between the upper and lower eye lids, however, some patients may require an additional procedure to to correct their eyelids after a decompression.

For external orbital decompression, the only externally visible scar will be a short scar that runs down at an angle from the outer corner of the eye, in one of the eye “smile-lines”.

This scar is expected to heal well and should no longer be visible in a few months. Your surgeon will be able to better advise you of this, during your consultation.

You will be expected to stay in the hospital, for at least one night after your surgery, and sometime two or more nights, depending on your individual case.

• Excessive swelling or bruising: Normal in the first few days . Sometimes the thin skin on the surface of the eye, the conjunctiva, can appear swollen and look like a blister.

• Double Vision: Often present before surgery, but can also present after surgery. If it does occur, is often temporary and nearly always can be treated

• Numbness: around the eye, on the cheek and rarely at the tip of the nose

• Loss of vision in one eye: this is a very serious problem, but extremely rare. Can occur if there is a bleed in or behind th eye during, of after surgery, however the risk is 1 in hundreds.

• Sinus problems: as some of the bone that is removed opens up some of the sinuses next to the oral cavity, it can lead to sinuses becoming blocked or filled with fluid. This is rare and can be treated.

• Infection: a risk in all surgeries, and often rare.

• CSF leak: very rarely, damage to the covering over the brain during bone removal can lead to CSF leak. Even if it does occur, it can be dealt with during the surgery, without complications or symptoms.