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  • Chris Thiagarajah MD

What an orbital decompression will and won’t do for you in Graves disease



There seems to be a lot of confusion surrounding orbital decompression and graves disease. An orbital decompression is a procedure that is performed in Graves disease for very specific reasons. They are

  1. Optic nerve compression from muscle and fat swelling

  2. Bulging of the eye (proptosis) causing the eye to dry out

  3. Bulging of the eye causing the eye to cosmetically appear different than the other eye

This procedure consists of breaking the bones of the eye socket to allow the eye to sink back further into the eye socket. A couple things about a decompression and its risks:

  1. New onset double vision

  2. Worsening double vision

  3. 1/1000 risk of vision loss or blindness

As can be seen orbital decompression has some serious risks. A cosmetic decompression can improve the bulging of the eyes and recently Mayran Taban MD has presented 26 cases of patients undergoing orbital decompression cosmetically for many reasons without worsening diplopia. 2 of his patients complained of sunken eyes after surgery.

Eyelid retraction occurs when the eyelid is raised in a higher position in the upper eyelid. In the lower eyelid, it occurs when the eyelid sits lower. In both cases, the white of the eyes can be visible above the iris. Dan Rootman MD recently reviewed eye muscle and eyelid position changes after decompression. In his study he found that the eye muscle position changes so the eye movement decreases, upper eyelid retraction does NOT improve at all and lower eyelid retraction can improve by 50%.

Dan’s study showed that improving upper eyelid retraction should not be a goal of orbital decompression and diplopia can definitely worsen.

These are some things to consider when getting orbital decompression for Graves disease. Knowing the risks of any procedure offered to you along with the indications is critical to determining whether a procedure is right for you.


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