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Orbital Decompression: Graded Surgical Approach

  • Kyle J. Godfrey
  • Christine C. Annunziata
  • Bobby S. Korn
  • Don O. Kikkawa
Chapter

Abstract

Orbital decompression is an effective surgical intervention for the treatment of thyroid eye disease and other conditions causing expansion of orbital soft tissue volume. Indications for surgery include disfiguring proptosis, compressive optic neuropathy, exposure keratopathy, orbital congestion, and reduction of proptosis in preparation for strabismus surgery. The primary goals of orbital decompression are to expand orbital capacity through bony decompression and reduce orbital soft tissue volume through orbital fat decompression. The amount of decompression performed should be tailored to the individual patient based on the severity of proptosis, with the goal of returning the patient to their pre-disease state. Our preferred progression for graded proptosis reduction is fat decompression, followed by lateral wall, then medial wall, then orbital floor, and then lateral orbital rim removal, as needed. However, in cases of optic neuropathy, maximal apical expansion is created with medial, floor, and lateral decompression. Careful patient selection and improved surgical technique have led to a broadening of the indications for this traditionally rare operation.

Keywords

Orbitopathy Exophthalmos Proptosis Thyroid eye disease Graves’ disease Orbital decompression 

Supplementary material

419986_5_En_50_MOESM1_ESM.mp4 (214.9 mb)
Video 50.1 Left lateral orbital decompression. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/left-lateral-orbit-decompress.htm (MP4 220034 kb)
419986_5_En_50_MOESM2_ESM.mp4 (163.7 mb)
Video 50.2 Right lateral orbital decompression. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/rt-lateral-orbit-decompress.htm (MP4 167671 kb)
419986_5_En_50_MOESM3_ESM.mp4 (168.3 mb)
Video 50.3 Left medial orbital decompression. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/left-medial-orbit-decompress.htm (MP4 172301 kb)
419986_5_En_50_MOESM4_ESM.mp4 (48.8 mb)
Video 50.4 Right medial orbital decompression. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/rt-medial-orbit-decompress.htm (MP4 49980 kb)
419986_5_En_50_MOESM5_ESM.mp4 (81.6 mb)
Video 50.5 Right orbital floor decompression. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/rt-orbit-floor-decompress.htm (MP4 83600 kb)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Kyle J. Godfrey
    • 1
  • Christine C. Annunziata
    • 2
  • Bobby S. Korn
    • 3
  • Don O. Kikkawa
    • 3
  1. 1.Department of OphthalmologyUC San Diego, Shiley Eye InstituteLa JollaUSA
  2. 2.Metrolina Eye AssociatesMatthewsUSA
  3. 3.Department of Ophthalmology, Division of Oculofacial Plastic Surgery and Department of Surgery, Division of Plastic SurgeryUC San Diego and the Shiley Eye InstituteLa JollaUSA

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