Orbital Decompression Surgery

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Orbital Decompression Surgery (Bulging Eye Surgery)

Eyes can bulge for a few different reasons, though the most common cause is Thyroid Eye Disease. In specific conditions, such as Graves’ Disease, the tissues around the eyes can swell. This can encompass the fat or the muscles around the eyes. In these cases, the eyes may have a variety of side effects caused by the bulging, including irritation of the eyes, double vision, eyelid retraction, and even vision loss. In order to make the eyes more comfortable and treat some of these effects, decompression surgery can be performed to help the eyes return to a more normal position.
eyelid surgery

My eyes are red and irritated all the time. Is this from bulging?

Bulging of the eyes causes them to be more exposed to the air and environment. The eyelids also don’t do as good a job lubricating the surface of the eyes when the eyes bulge. As a result, dry eye-type symptoms such as redness, irritation and blurring of vision are quite common. As a first step, Dr. Dewan recommends treating these symptoms with artificial tears and other lubricants, but decompression surgery may be the ultimate solution.

How does this surgery work?

Orbital decompression surgery is specifically designed to help with bulging eyes. In Thyroid Eye Disease, bulging is caused by the swelling of the fat and muscle that surround the eyes. Because the eye is in an inflexible bony eye socket, the swelling causes the eye to push forward, resulting in a bulging eye. Decompression surgery works by expanding the area of the eye socket by removing sections of the eye socket bone. This allows the swollen tissue to fall into the expanded areas, giving space for the eye to fall back into a more normal position.

What are the side effects of surgery?

Decompression surgery can have some side effects associated with it. First, there are nerves that travel through the eye socket bones in the areas that the bone is being removed. As a result, some patients may have numbness of the cheek and midface area for some time after the surgery. Numbness can last several weeks but typically does resolve on its own. Patients can also have double vision associated with surgery. Many patients have double vision because of the bulging of the eyes even before surgery, and the plan is often to have the double vision corrected surgically after decompression surgery. Patients who develop double vision after decompression can have the same double vision surgery after healing from decompression.
Located in the Twin Cities

What is the surgical experience for decompression?

Orbital decompression surgery is performed in the operating room with you completely asleep. Surgery is performed through an incision on the backside of the lower eyelid and is carried into the skin on the outside corner of the eye. From here, bone is removed from underneath the eye and from the middle wall of the eye socket. Sutures are then placed in the outer corner of the eye to close the incision. If surgery is necessary for both eyes, it is often performed on both sides together. Patients may stay in observation overnight, though some may go home after surgery.

What is the post-operative experience?

Patients are quite swollen and bruised following this surgery. Lots of ice packs and rest are essential. Dr. Dewan typically prescribes a small amount of pain medicine and antibiotic ointment for you to use for the first few days. You may also have a prescription for oral steroids and antibiotics. Your vision may be slightly blurry following surgery, and swelling can cause mild double vision. After 1 week, most of these symptoms are greatly improved and you can return to normal activity.

What if my bulging is being caused by swollen eyelids?

While most patients have bulging caused by Thyroid Eye Disease resulting in the description above, some patients have swelling primarily in the upper eyelids. These patients may not need a full orbital decompression, but rather a fat decompression. This is a type of decompression where fat is removed from the eyelids and from around the eye without the need for bone decompression. Dr. Dewan will evaluate your eyelids and eyes and can provide you with a customized treatment plan.
Located in the Twin Cities

How is double vision fixed?

If you have double vision due to Thyroid Eye Disease, Dr. Dewan will make a recommendation on a specialist to see. In many cases, double vision can be corrected with glasses. In other cases, surgical correction will be recommended. This type of surgery, called strabismus surgery, typically takes place several weeks to a few months after decompression surgery.

My eyes are really widely opened because of eye bulging. Can this be fixed?

When the eye bulges, the eyelids get pulled away from their normal position over the eyes. This is a condition called eyelid retraction and is a common occurrence in Thyroid Eye Disease. This is a correctable condition that Dr. Dewan specializes in. This is a surgery typically performed after decompression surgery and strabismus surgery if those are necessary. In order to return your eyelid to a normal position, Dr. Dewan makes an incision in the upper eyelid crease and then loosens the lifting muscle to lower the eyelid position. For the lower eyelid, a special eyelid spacer tissue may be necessary to raise the eyelid to a more normal position.

My eyes are bulging and I’d like to talk to someone. What’s the next step?

Bulging eyes are a complex problem with multiple potential ways to improve them. Dr. Dewan is happy to help you achieve your goals. During your consultation, he will take a thorough history and perform a comprehensive exam to determine the best way to help you. He may recommend additional tests including blood tests and CT scans prior to recommending surgery to ensure you have the best outcome possible. If interested, schedule a consultation today.
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