Orbital Decompression Surgery for Thyroid Eye Disease

Thyroid eye disease (TED) is a chronic (long-term) disease that can lead to progressive damage to the tissues in and around the eyes. TED progresses in phases, with an inflammatory active phase and an inactive phase.^1,2

Surgery is sometimes used to correct the damage that TED can cause. There are different types of surgery used to treat and repair the damage caused by TED. Orbital decompression surgery is 1 procedure that might be performed in the inactive phase of the disease.³

What is orbital decompression surgery?

Orbital decompression is performed to relieve proptosis (prop-toe-sis), or eye bulging. In TED, the body mistakes healthy tissue in and around the eye as harmful, attacking and damaging the eye’s muscles, fat, and tissue.³

This damage causes swelling, leading to eye bulging and, in some cases, squeezes the eye’s optic nerve. Because the optic nerve is the vision highway to the brain, problems with this nerve can lead to severe problems, including threatening your vision.³

Orbital decompression surgery is performed under general anesthesia. The goal of orbital decompression is to open up the bony socket of your eye to reduce pressure inside the eye socket.⁴

Types of orbital decompression

Some orbital decompression surgeries are performed endoscopically. The surgeon goes through the nose using a long, flexible tube with a camera (endoscope). Some endoscopic procedures do not require an incision on the skin.⁴

However, depending on your symptoms and the severity of the swelling, your TED specialist may need to decompress the outside wall of your eye as well. This is done with a small incision on the side of your eye.⁴

With surgical decompression, the surgeon usually cuts through the upper eyelid. They then carefully remove part of the bone between the eye and nose, along with part of the bone that forms the outer wall of your eye socket. In some cases, the surgeon also has to remove some of the bone from under the eye.⁵

After removing some bone, the doctor will make small cuts to the lining over the muscle and fat behind the eye. This allows the fat and muscle to expand and decompress into the space created by the bone removal. Some of the fat might be removed too.⁵

What are the possible side effects?

All medical procedures have risks of side effects. As with any surgery, side effects can include:⁵

• Infection
• Swelling
• Scarring
• Pain

Orbital decompression may cause rare side effects, which include:⁵

• Post-operative double vision (diplopia, dip-low-pee-uh)
• Bleeding in the nose or around your eye
• Excessive tearing
• Vision loss
• Numbness around the eye or face
• Nerve injury
• Eyelid malposition
• Sinus infection
• Blocked tear duct
• Cerebrospinal fluid (CSF) leak
• Injury to the eye

Because endoscopic orbital decompression does not involve cutting through the skin, there is usually minimal bruising or swelling.

These are not all the possible side effects of orbital decompression surgery. Talk to your doctor about what to expect with orbital decompression. You also should call your doctor if you have any changes that concern you after the surgery.

Other things to know

You will likely stay overnight in the hospital to monitor your vision, pain, and swelling.⁵

Intravenous (IV) antibiotics, steroids, painkillers, and anti-nausea drugs are given after surgery as needed.⁵

Ice packs and rest are generally recommended for the first week after surgery. Additional aftercare instructions might include:⁵

• Avoid strain, heavy lifting, or nose blowing for the first 1 to 4 weeks after surgery.
• Sleep with your head slightly elevated for 2 to 3 days.
• Monitor for excessive bleeding from the nose. Mild bloody discharge is normal, but if it gets worse or persists, contact your doctor.
• Your doctor may instruct you to use salt water (saline) nasal spray to keep your nose moist after the surgery.
• Monitor your temperature for the first few days after surgery. If you develop a fever over 100 degrees, contact your surgeon.
• Make sure to keep your follow-up appointments, and do not use any treatments that your surgeon has not instructed you to use.

If you think you may be a candidate for orbital decompression surgery, talk to your TED specialist. All procedures have their risks and benefits, and your doctor will be able to answer any questions you might have.