Patients with thyroid eye disease often require orbital decompression to give more room around the boney socket for the eyes to move. Prior to consideration for surgery Dr. McHenry will review a CT scan of your orbits. This will help guide his surgical approach. He will have also done a visual field test to document your optic nerve function. As the muscles enlarge, they can compress the optic nerve.
There are several approaches to orbital decompression. The approach depends on which muscle is being restricted the most. The most common approach is external ethmoidectomy and medial orbitotomy. Removing the ethmoid sinuses and medial wall of the eye socket provides the greatest amount of decompression. This can significantly change the amount of double vision and alignment of the eyes.
Transconjunctival inferior orbitotomy is best when the inferior rectus muscle is enlarged or there is vertical double vision. There is virtually no scarring. In this procedure the eye is lifted up and the inferior wall of the orbit is removed.
These procedures take less than an hour to perform. In some cases, a patient requires a lateral orbitotomy. This is a more extensive procedure and allows for the least amount of decompression. Often it is combined with the other two procedures.
No matter the particular procedure the surgery is performed under general anesthesia. You will be asleep. After Dr. McHenry and his anesthesiologist have spoken with you in pre-op, you will be given some sedation and then brought to the operating room. You will wake up in the recovery room with a patch on your eye. We usually monitor patients overnight for pain and bleeding, and then Dr. McHenry sees you the next day. We will remove the patch in the morning. You may have some short-term double vision in the immediate post-operative period until the eyes get used to working together again.
We only perform surgery on one side at a time to keep you from being incapacitated. We start you on some steroids to keep the swelling down. When you are stable, we will consider the other eye if necessary.