Orbital Decompression: Graded Surgical Approach

Abstract

Orbital decompression is an effective surgical intervention for the treatment of thyroid eye disease and other conditions causing expansion of orbital soft tissue volume. Indications for surgery include disfiguring proptosis, compressive optic neuropathy, exposure keratopathy, orbital congestion, and reduction of proptosis in preparation for strabismus surgery. The primary goals of orbital decompression are to expand orbital capacity through bony decompression and reduce orbital soft tissue volume through orbital fat decompression. The amount of decompression performed should be tailored to the individual patient based on the severity of proptosis, with the goal of returning the patient to their pre-disease state. Our preferred progression for graded proptosis reduction is fat decompression, followed by lateral wall, then medial wall, then orbital floor, and then lateral orbital rim removal, as needed. However, in cases of optic neuropathy, maximal apical expansion is created with medial, floor, and lateral decompression. Careful patient selection and improved surgical technique have led to a broadening of the indications for this traditionally rare operation.