The orbital socket is made up of seven different bones which make the roof, the floor and two side walls of the socket. Inside this orbital structure, all the ocular components like the eye, the muscles, nerves etc. are present. Sometimes, to reduce the increased pressure inside the orbital area, some part of the orbital wall or the orbital fat is removed. This surgery is known as orbital decompression and is done as a treatment for bulging eyes. This surgery is performed for restoring the balance between the volume of the soft tissues of the orbit and bone volume. Orbital decompression treatment does not necessarily involve complete removal of the orbital wall. The orbital wall may just be thinned by the surgery for orbital decompression. Orbital decompression treatment is done to allow the eye to move back comfortably in the orbit and also to achieve good cosmetic outcome.
Main objectives of an orbital decompression surgery:-
- Relieve intraorbital pressure
- Reduce the bulging of the eyes
- Reduction in corneal exposure
- Management of compressive optic neuropathy
What are surgical indications for orbital decompression surgery?
- Inflammation in the orbit
- Acute pain experienced by the patient
- Optic nerve compression
- Progressive proptosis
- Optic neuropathy
Any condition which can increase the size of the eye can cause severe problems in the vision of the patient. The most common condition for which an orbital decompression surgery is performed is the Grave’s disease. Grave’s disease is a condition in which the eyes and the thyroid gland of the patient are affected. The Grave’s disease is an autoimmune disorder which causes the orbital fat inside the socket and the extraocular muscles to expand. This disease can have an active or an inactive phase. This increases the pressure behind the eyes causing the eyes to bulge forwards. It can occur at any age but is generally found in older people past the age of 50. Since the eye begins to protrude, the eyelids are not able to function properly. Due to inadequate lubrication on top the white portion of the eye begins to dry up and the chances of injury to the eye also increases. Because of the bulging of the eyes double vision may also be experienced. As the eye begins to get squeezed inside the orbital area, the pressure on the optical nerve increases which can cause major orbital damage like complete vision loss. If the patient is experiencing a mild form of Grave’s disease, then medication may be enough for treatment. The aim of medical therapy is to minimize the active phase of the Grave’s disease. In chronic phase medical therapy is aimed at reducing the disfigurement associated with the chronic phase of the Grave’s disease. However, if the patient is experiencing symptoms like pain, double vision, severe irritation in the eye, then orbital decompression surgery may be necessary. Before the orbital decompression surgery is perform test to ensure that the patient is stable endrocrinologically. The sign and symptoms of the Grave’s diseases could range from mild to severe. Because of Grave’s disease, asymmetry could be present in the ocular area. Imaging tests like MRI and CT scan are used as the main diagnostic tools.
Purpose of an orbital decompression surgery:-
Orbital decompression is performed for both functional as well as cosmetic reasons. If the orbital decompression surgery is being performed for cosmetic reasons then small amount of fat and small piece of the orbital wall are removed. But if the orbital decompression surgery is being done to restore the proper function of the eyes, then more removal of orbital wall and orbital fat may be required.
Apart from Grave’s disease, orbital decompression surgery is also performed in cases where the pressure inside the orbital area increases. It can happen due to orbital tumors, accumulation of blood behind the eyes and orbital trauma.
Traditionally, surgical decompression has been performed by using a transantral approach. In this procedure, the inferior and medial orbital walls are removed. But this procedure has its limitations. Because of limited access to posterior laminar papyracea it may not be removed completely. The oblique approach to fovea ethmoidalis also makes it more susceptible to injuries. In case the orbital floor is removed completely, inferior displacement of globe is also common.
In endoscopic decompression, when the medial wall and the floor are removed, the posterior half of the floor laying medial to the infra orbital nerve is also removed. In this process, there is not significant displacement of the globe because a large amount of anterior buttress remains. The decompression of the lateral floor and wall along with anterior orbital floor can be achieved through a subconjunctival incision.
How is an orbital decompression surgery performed in India?
The orbital decompression surgery is performed in India with general anesthesia. Now, the orbital decompression surgery is performed endoscopically in India by most of the top hospitals. The surgeon enters the nose for the orbital decompression surgery and then removes a part of the orbital wall and in some cases part of the orbital floor also. During the orbital decompression surgery, orbital fat is also removed. Since, by orbital decompression surgery the surgeon has been able to clear up some space inside the orbit, the eye can now fit properly inside the socket. Endoscopic orbital decompressions surgery is performed in India for debulking the orbital areas in case of infection and orbital tumors. After the orbital decompression surgery has been performed, generally the eye will not be covered. But the orbital area may have swelling and bruising. Use of endoscopes has improved the outcome of the orbital decompression surgery. But for patients whose visions has been compromised or are affected by acute proptosis, only surgery provides complete resolution. Reduced morbidity is achieved by endoscopic technique because the bone which is located posteriorly to the apex can be removed to a very large extent. Endoscopic intervention can be used by itself or as an auxiliary tool during surgery for complete treatment of proptosis. An endoscopic approach can help a surgeon carry out posterior decompression and decompress the optic nerve also, if required, by providing an endoscopic view of sphenoid sinuses and ethmoidal sinuses.
An orbital decompression surgery may also be performed in India with the help of open technique which involves the incisions of the surgery to be made inside the eyelids. The best technique that the surgeon adopts will vary on case to case basis. After the orbital decompression surgery in India the first step of the treatment is pain medication. Patients of orbital decompression surgery in India do not remain hospitalized. The treatment for orbital decompression does not involve the patient to wear eye patches.
Orbital decompression surgery by Dr. Debraj Shome:-
The best treatment and surgery for orbital decompression is performed in Mumbai by Dr. Debraj Shome. He has his own chain of best cosmetic clinics in Mumbai. Dr. Shome is the top expert in performing orbital decompression surgery and treatment and wants the people of India to know about some of the top risks associated with the treatment and surgery of orbital decompression. In India, still a large number of patients hesitate in asking information about orbital decompression before they are given treatment. But knowledge of the best approach for the surgery and the top risks of the treatment are imperative for the best outcome. Dr. Shome performs orbital decompression surgery with both the endoscopic and open technique in Mumbai. Depending upon the type of outcome which is expected from orbital decompression surgery, the best suited treatment plan is made for his patients in Mumbai. When the surgery and treatment for orbital decompression is done for cosmetic reasons, the patient heals quickly after the surgery. At The Esthetic Clinics in Mumbai, the best orbital decompression treatment is available. Before you start your treatment with Dr. Shome in Mumbai, you can clear all your doubts regarding your treatment. You are unlikely to find this open approach and transparency in treatment anywhere else in India except at The Esthetic Clinics in Mumbai. All the branches of The Esthetic Clinics in Mumbai are achieving significant milestones in the field of cosmetic and facial plastic surgery. So, be it patients’ satisfaction or the induction of latest medical equipment, The Esthetic Clinics in Mumbai are always at the top. You can find the latest technology in the field of cosmetic and facial plastic medicine only at The Esthetic Clinics in Mumbai before anywhere else in India. The Esthetic Clinics are on the road to become one of the most successful and best chains of cosmetic clinics in India and it has been made possible by Dr. Debraj Shome.