Orbital Decompression Surgery
As one of the most difficult surgical procedures that very few surgeons perform, Dr. Murdock is a specialized orbital surgeon who has particular expertise in the treatment of autoimmune orbital disease, such as Thyroid Eye Disease, and the surgical treatment of proptosis (bulgy eyes). An orbital decompression is a complex procedure that involves manipulating the bony orbit and soft tissues around the eye so that the eye can sit in a natural position within the skull. While an orbital decompression may sound daunting, it can be a comfortable experience in the hands of a board-certified orbital surgeon, Dr. Jennifer Murdock.
Why would I need an orbital decompression?
Different conditions can affect the orbital tissues, or tissues around the eyes, that can include the fat, muscles, vessels, and bones. The orbit is essentially a fixed box, or cone of bone, meant to protect the eye and the delicate structures around the eye. Exophthalmos, proptosis, or bulgy eyes can be treated with a surgical orbital decompression. However, the underlying condition must first be controlled and stable before any surgical intervention may take place. The most common condition that affects the orbit are inflammatory disease, such as Thyroid Eye Disease.
Thyroid Eye Disease is an autoimmune disorder that causes inflammation around the eyes in the orbit, leading to bulgy eyes, pain, double vision, and often even vision loss. Orbital decompression surgery may be performed emergently if there is sudden vision loss due to compression of the optic nerve. Usually, it is preferred to treat the inflammation first, and continue with orbital decompression when the inflammation is stable and in a state of remission.
Thyroid Eye Disease is an autoimmune disorder that causes inflammation around the eyes in the orbit, leading to bulgy eyes, pain, double vision, and often even vision loss. Orbital decompression surgery may be performed emergently if there is sudden vision loss due to compression of the optic nerve. Usually, it is preferred to treat the inflammation first, and continue with orbital decompression when the inflammation is stable and in a state of remission.
Other inflammatory causes, such as sarcoidosis or idiopathic orbital inflammation (previously known as pseudotumor), can also cause bulging eyes, double vision, and orbital pain. Different tumors can also affect the orbit, causing proptosis. Dr. Murdock will complete a thorough evaluation during your consultation that includes different measurements in the office and often a CT or MRI, for a deeper look at the orbital tissues. Sometimes, a biopsy is needed to determine the definitive diagnosis before considering any orbital decompression.
What is an orbital decompression?
An orbital decompression is a surgery for bulgy eyes with the goal of moving the eyes back into a normal position within the skull. This helps to relieve pressure on the optic nerve, gives the muscles that move the eyes in different direction more space, and improve eyelid closure. Additionally, there is a cosmetic benefit because an orbital decompression can make give bulgy eyes a more natural look. Removing tissue around and behind the eyes help to achieve this goal. This can be done in multiple different ways:
Orbital fat decompression- Our eyes are cushioned within the orbit by fat. This fat can be affected by different inflammatory disorders that makes the fat become larger (hypertrophy) and expand. By removing the excess fat, specifically the intraconal fat, that sits behind the eye, the eye can shift backwards into a more natural position. Alone or combined with a bony decompression, the eye can move up to 6mm backwards in the skull, in a more natural position. Dr. Murdock often utilizes this orbital fat decompression technique to achieve symmetric and optimal results after medical management of proptosis, such as with teprotumumab.
Single wall orbital decompression- Often combined with a fat decompression or performed endoscopically (with a camera inside the nose), removing bone from one wall can provide a small change in proptosis. However, this technique can be beneficial in severe vision loss where the optic nerve needs to be decompressed.
Single wall orbital decompression- Often combined with a fat decompression or performed endoscopically (with a camera inside the nose), removing bone from one wall can provide a small change in proptosis. However, this technique can be beneficial in severe vision loss where the optic nerve needs to be decompressed.
2-wall orbital decompression and balanced orbital decompression- In moderate to severe cases, a more robust reduction in proptosis is necessary to obtain the best results. This can be achieved by removing bone from 2 walls. If bone is removed from the medial wall and the orbital floor posteriorly in the back of the orbit, this can significantly decompress the orbital apex, which, in turn, can relieve pressure off of the optic nerve and restore vision. If the bone is removed from both the medial and lateral walls of the orbit, this results in a balanced orbital decompression, shifting the eye backwards in more of a straight and controlled manner and limiting the post operative side effects of double vision or globe displacement.
3-wall orbital decompression- During this type of procedure, Dr. Murdock will remove both bone and fat from the orbit. The bone will be removed from 3 different areas: the lateral wall, the orbital floor, and the medial wall of the orbit. Intraconal fat excision also takes place. On the lateral wall, sometimes a burr is used to thin this very thick bone in the orbit. Alternatively, a bone window may be necessary to achieve the maximum bone removal in this area for a significant orbital decompression. This technique can treat between 3 and 6mm of proptosis, depending on how much bone is removed. This also includes removal of bone from the medial wall and floor as well as fat removal, as previously described.
Maximum orbital decompression- In very severe and refractory cases, the orbital roof may be the final option for bone removal in addition to the previously described 3-wall and fat decompression. Dr. Murdock will work with a neurosurgeon to achieve this manipulation of the skull base.
What can I expect after an orbital decompression?
Dr. Murdock and her team will prepare you for all aspects of your surgical procedure and ensure a smooth healing phase after surgery. However, it is important to know of some specifics relating to orbital decompression surgery. First, Dr. Murdock does not remove your eye during the procedure. This is actually one of the most asked questions during the initial surgical consultation. As a specialized orbital surgeon, Dr. Murdock uses precise techniques to work around and behind the eye, while keep the eye intact and unharmed.
Next, it is important to understand that there are certain side effects that are more common with orbital decompression procedures than other surgical interventions. These include:
- Double vision that is usually temporary for the first couple of weeks but may be permanent and require additional surgery to correct. Double vision is expected temporarily in cases when Dr. Murdock operates on one eye at a time, separating the orbital decompression procedures by a couple of weeks.
- Numbness of the same side of the nose, cheek, lip, and teeth. This can last for a couple of days after surgery to 1 year after surgery.
- Vision changes
- Bleeding
- Pain, discomfort, or headache
- Sinus issues
The long term effects of orbital decompression are usually very positive. Most patients experience improvement of their symptoms and overall quality of lift. However, it’s crucial for individuals to have realistic expectations and understand that every surgery has its risks of complications.
Trust Your Orbital Surgeon
Few physicians are credentialed, trained, and experienced with this very delicate type of orbital surgery. Dr. Murdock has spent years perfecting her surgical techniques so that she may offer the best orbital decompression surgeries in Miami and South Florida. Schedule a consultation today with Jennifer Murdock, MD to find out how to achieve your successful outcomes with an orbital decompression.
