Orbital decompression surgery for proptosis Procedure information Information for patients Ophthalmology (Ocular Plastics) Large Print
This leaflet explains about the problem you have and how surgery can be used to treat it. What is proptosis? Proptosis is when the eyeballs are pushed forward by the surrounding swollen muscles, fat and soft tissues contained within the bony eye socket (orbit). What causes proptosis? There may be many reasons; however a common one is as a result of thyroid eye disease. What are the symptoms of proptosis? Proptosis causes a cosmetic change to your appearance which may cause distress or embarrassment. Inability to close your eyelids at night can cause sore, red and dry eyes with possible ulceration to the front part of the eyeball (cornea), caused by increased eye exposure. Other common symptoms are light sensitivity (photophobia) or a sensation of pressure within the eyes. page 2 of 12
How can it be treated? You may have taken prescribed medication to help reduce the inflammation in your orbits. You may have been advised to have orbital decompression surgery now that your inflammation is under control and your proptosis is stable. What is orbital decompression surgery? The bony socket is made up of 4 walls. Usually bone from 1 wall (lateral wall) is removed. Sometimes bone from 2 or 3 walls, or fat from the orbit, is removed. This creates extra volume to allow your eyeball(s) to fall back into place. Left Eye socket Right page 3 of 12
What will the surgery involve? An assessment of your health will be needed to check if you are fit to have your surgery. Your operation will be done whilst you are asleep (general anaesthetic). The bone will be removed from your orbits through an incision made into the side of your eyelids, inner corner of your eye and into your socket. Your surgeon will explain your operation to you in more detail. What are the benefits of having the surgery? Typically your cosmetic appearance should improve, although the swelling and bruising commonly caused by surgery may take a few weeks or months to settle. Symptoms of dry eyes, redness, soreness and light sensitivity should improve due to your ability to blink and close your eyelids more easily. The pressure sensation should also improve. Will I need further surgery? You will be advised of the benefits of further surgery if required. You may be offered further surgery to correct a squint or upper/lower eyelid surgery for either lid retraction or excessive fatty tissue. In rare cases you may be page 4 of 12
advised to have further orbital decompression surgery. What are the risks of having orbital decompression surgery? General risks Minor problems that may be encountered which settle gradually: Bleeding from the wound - sitting up and applying pressure to the wound will usually help to control minor episodes of bleeding. This normally settles within a few hours. Bruising and swelling - normally settles within a few days. Ice packs held onto the area 3-4 times daily for a week is advised. Wound scar - usually fades within a few weeks. Infection - always a risk after surgery but to help reduce this risk you will be given antibiotic medicines. page 5 of 12
Specific risks Although rare, a collection of blood (haematoma) within the eye socket may cause pressure on the optic nerve at the back of your eye. This may lead to pain and a reduction in your eyesight or, in extreme and very rare cases, a complete loss of eyesight. Therefore surgery would be required to remove the blood clots. Symptoms of double vision may appear worse after your operation. Management of this problem will be discussed, although it usually settles after 3-6 months. Temporary numbness to the area around your socket, cheek, nose and upper mouth may be felt. This is caused by interruption to the nerves within the bony area of the orbit during surgery. The numbness should improve within 3-6 months but, in rare cases, can be permanent if the nerves do not recover. There is a chance that your eyes may sink inwards a little more than originally planned. There may also be asymmetry between both eyes / eyelids requiring further surgery. page 6 of 12
What happens before my surgery? You will be invited to attend a pre-operative assessment to discuss your surgery and anaesthetic with a fully trained nurse. You will have the opportunity to discuss any fears or anxieties regarding your operation. Medical problems and medications will be noted by the nurse and you will be instructed what to do if you take certain medication that help to thin your blood. These may need to be stopped temporarily to make sure your surgery is done safely. In some cases, you may be required to undergo a few tests such as blood checks, chest X-ray and heart tracing (ECG). How long does the surgery take? Between 1-4 hours, as both eyes may be operated on at the same time. page 7 of 12
What happens after my surgery? You will need to stay in hospital for at least 1 or 2 days and nursed in a semi-upright position. You will have a dressing and eyepad covering your eye(s) until the following morning. A nurse or doctor will check you and your dressing for signs of bleeding, swelling and pain and you will be given regular painkillers to keep you comfortable. You may want to bring music or talking books with earphones into hospital with you. The eyeball and eyelid may appear worse following your surgery. This is normal and it may take several days or weeks for the bruising and swelling to settle. Regular use of ice-packs will help and regular non-steroidal anti-inflammatory painkillers is all that should be required. Will I need to take any medication when I leave hospital? Normally you are required to take a short course of steroid tablets to reduce swelling. The doctor may also give you a short course of antibiotic tablets and eye drops / ointment to guard against infection. page 8 of 12
Is there any general advice for when I leave hospital? Before you go home you will be given instructions on how to care for your wound. You will have stitches that stay in place for up to two weeks and will be removed on an arranged visit to the Eye Clinic. To help reduce the risk of further swelling it is recommended that you: sleep in an upright position for 3 nights after leaving hospital. continue to use ice-packs regularly to reduce swelling. generally rest and take things easy for 7-10 days after your surgery. avoid driving until symptoms of double vision have settled. Advice about going back to work or sporting activities should be discussed with your doctor. This will vary depending on your job or chosen sport. Please ensure that you attend your follow-up hospital appointments to the outpatient department to allow your doctor to check your wound and vision. page 9 of 12
Is there anything to look out for when I go home? Please look out for: Sudden onset pain Swelling around the operation site Loss of vision Who should I contact if I have any concerns? Emergency Eye Centre 0114 271 2726 Monday to Friday, 8.00am - 4.30pm Outside of these hours please contact: Ward I1 0114 271 2504 page 10 of 12
What happens if I decide not to have surgery? Your doctor will need to discuss alternative options with you. You may be required to take further medications which help to reduce inflammation. You will need to have your vision tested regularly and you may be asked to visit the hospital for blood tests and/or a head scan. This will allow the doctor to observe your orbits for signs of further swelling or abnormalities. For further advice before or after your surgery please contact: Linzi McLean - Secretary to oculoplastic consultants: 0114 271 3829 page 11 of 12
For further support contact: Thyroid Eye Disease charitable trust (TEDct) PO Box 1928 Bristol BS37 0AX 0844 8008 133 British Thyroid Foundation PO Box 97 Clifford Wetherby West Yorkshire LS23 6XD 01423 709 707 Changing Faces The Squire Centre 33-37 University Street London 0845 4500 275 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD6444-PIL2484LP v4 Issue Date: May 2018. Review Date: May 2021