Endoscopic Orbital Decompression

What is orbital decompression surgery?

Orbital decompression surgery is performed to relieve exophthalmos, a condition associated with Graves' disease, which causes the eyes to bulge and may lead to loss of vision.

Why is an orbital decompression performed?

Patients typically elect to undergo this procedure when the symptoms of exophthalmos become severe. This stage of the disease may include:

Chronic eye pain or headaches
Chronic eye irritation causing scar tissue over the cornea (keratitis)
Optic neuropathy and loss of vision

The primary goal of an orbital decompression surgery is to create more space in the orbit (bones around the eye) to allow the eye to return to a more normal position.

How is an endoscopic orbital decompression surgery performed?

With the patient under general anesthesia, a surgeon works endoscopically through the nose. Endoscopic orbital decompression surgery does not require cutting the skin — it is performed entirely through the nostrils. Therefore, there is usually no external bruising or swelling.

During the procedure, surgeons remove the bones of the medial, and sometimes the inferior, orbit. When the exophthalmos is very pronounced, incisions through the skin may be required to remove the bone of the lateral orbit. This procedure is performed by an eye surgeon, either simultaneously with endoscopic surgery or at a later date.

Unlike endoscopic orbital decompression surgery, a lateral orbital decompression requires cutting the skin and can cause external bruising or swelling.