Chronic immune system-mediated inflammation can lead to an increased amount of connective tissue forming behind the eye, which pushes the eyeball forward – and severely limits its mobility. These changes also cause the eye muscles to swell.
In active endocrine orbitopathy, treatment usually comprised of medical therapy (with certain drugs) and/or surgical treatment of the thyroid. Orbital decompression surgery, to relieve these issues, only becomes an option once the diseases has stopped progressing for a period of at least one year.
Orbital decompression surgery involves removes bone from the eye socket so that the swollen eye muscles have more space to reside, and no longer push the eye forward. Clearly, this does not treat the underlying disease, but rather, but it can greatly improve a patient’s quality of life, as it ensures normal eyelid closure and also helps restore the patient’s own self-image: looking in the mirror and seeing a reflection of themselves with bulging eyes can be difficult to bear.
There are a number of surgical techniques that can be used to achieve orbital decompression, performed by various specialists, including facial surgeons, ear, nose and throat surgeons and orbital surgeons. The latter are highly specialized eye surgeons who treat all diseases around the bony eye socket.
There are several techniques that can be used to perform this surgery – and they differ in both approach and result.
Most facial surgeons prefer “transantral” approach, in which the facial skin is released at the top of the skull and “folded” down, so that the eye socket is freely accessible. You can appreciate why we chose not to show illustrations of this approach on the website.
Most orbital surgeons, including Dr. Dr. Paridaens, prefer access via the lower eyelid with a ~3 mm-long, hidden, cut. This has the benefit of much easier and faster wound healing, as the incision is far smaller than the transantral approach. Below are illustrations (© Dr. Dr. Paridaens) that show the different stages of orbital decompression surgery using his preferred approach via the lower eyelid.