Orbital decompression surgery is a surgical procedure used to increase the volume of the orbit to relieve proptosis (exophthalmos) and optic nerve compression. This surgery primarily targets patients with pathological conditions that lead to insufficient orbital space, such as severe proptosis or vision-threatening conditions caused by Graves' orbitopathy (thyroid eye disease).
The principle involves removing part of the orbital bony wall or fat tissue to allow the eyeball to retreat to a normal position, thereby reducing pressure on the optic nerve. This treatment can prevent permanent vision loss and improve the patient's appearance and ocular function.
Based on the surgical approach, there are three types:
The main mechanism involves reducing intraorbital pressure distribution, allowing the eyeball to return to a normal position. For patients with thyroid eye disease, this surgery effectively prevents complications such as optic atrophy and corneal exposure.
Mainly suitable for:
Requires joint assessment by ophthalmologists and endocrinologists to confirm that the disease has stabilized before surgery to ensure effective and stable results.
The surgery is usually performed under general anesthesia, lasting approximately 2-4 hours. The surgeon accesses the orbit via conjunctival or skin incisions, choosing to remove bone or fat based on the condition. Postoperative care includes antibiotics eye drops and corticosteroids to control swelling.
Unilateral or bilateral surgery depends on the severity of the condition; bilateral procedures may be staged. Regular follow-up is necessary to monitor visual acuity and intraocular pressure, along with head elevation to reduce swelling.
Main benefits include:
Compared to medication, surgery directly addresses structural issues and provides more immediate results in severe cases. However, it is a permanent procedure and should be considered when other treatments are ineffective.
Possible complications include:
Severe risks: Intraorbital hemorrhage may lead to acute optic nerve compression, requiring immediate medical attention. Postoperative permanent asymmetry of the eyeball position may occur and should be evaluated for risk-benefit by the physician.
Contraindications include:
Preoperative detailed assessment of thyroid function, optic nerve function, and orbital structure is necessary. Postoperative strict adherence to care instructions is required, avoiding heavy lifting or vigorous exercise for at least six weeks.
Often combined with medication therapy, such as preoperative use of immunosuppressants or corticosteroids to control inflammation. Radiation therapy may affect tissue healing and should be spaced at least 6 months before surgery.
Use of anticoagulants (e.g., warfarin) should be adjusted to reduce intraoperative bleeding risk. A multidisciplinary team should collaboratively develop the treatment plan.
Clinical studies show that surgery can improve vision in 70-90% of patients, with an average reduction of 3-5mm in proptosis. Long-term follow-up indicates a reduction in the risk of optic atrophy by over 60%.
In cases with threatening vision, surgery can restore vision completely in up to 85% of cases. However, the degree of aesthetic improvement varies among individuals, and patient expectations should be thoroughly discussed.
Non-surgical options include:
Observation and waiting strategies are only suitable for mild symptoms with stable disease course. Alternative treatments should be selected based on disease stage and overall patient health.
What preparations are needed before surgery?
Patients should first undergo detailed ocular imaging examinations (such as CT or MRI) to assess orbital structure and lesion extent. Physicians will evaluate overall health and explain surgical risks and potential complications. Discontinuation of anticoagulants 3 to 7 days before surgery is necessary, along with managing underlying conditions like blood sugar or blood pressure as advised.
How long does swelling last after surgery, and how can it be alleviated?
Postoperative eyelid swelling typically lasts 1 to 2 weeks, possibly extending up to a month in severe cases. Ice packs within 24 hours after surgery can reduce swelling, and maintaining an elevated head position during rest is recommended. Immediate medical attention should be sought if severe pain or sudden vision loss occurs.
When can normal activities resume after surgery, and what precautions should be taken?
Mild activities like walking can usually resume after 1 week, but heavy lifting or vigorous exercise should be avoided for at least 3 weeks. Patients should avoid rubbing the eyes, swimming, or exposure to irritating odors to prevent infection or wound dehiscence. Full visual and aesthetic recovery typically takes 3 to 6 months.
What are the main factors affecting the success rate of the surgery?
The success rate is highly related to the severity of the condition, choice of surgical method, and precision of execution. Early treatment and limited disease extent yield better outcomes. The surgeon’s experience and accurate preoperative assessment of orbital structure are also crucial for reducing complications and enhancing efficacy.
Why is regular imaging follow-up necessary after surgery?
Postoperative imaging follow-up (such as MRI or CT) is used to evaluate the recovery of orbital structure and monitor for recurrence of lesions. For patients with underlying diseases like thyroid eye disease, regular follow-up helps adjust immunotherapy or radiation therapy strategies.
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