Name of the Procedure:

Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of bone for decompression

Summary

Orbitotomy without a bone flap is a surgery where a small incision is made near or within the eye socket to access the orbit (the bony cavity containing the eye). This approach can be frontal (through the forehead) or transconjunctival (through the lining of the lower eyelid) and involves removing some bone around the eye to relieve pressure.

Purpose

This procedure is performed to alleviate pressure within the eye socket, which can result from conditions such as thyroid eye disease or orbital tumors. By removing bone around the eye, the surgery aims to prevent vision loss, alleviate pain, and improve the appearance and function of the eye.

Indications

• Persistent pressure or pain in the orbit that is not alleviated by conservative treatments
• Bulging eyes (proptosis) typically caused by thyroid eye disease
• Orbital tumors causing pressure on ocular structures or nerves
• Vision changes due to compression of the optic nerve

Preparation

• Pre-procedure fasting as directed by the healthcare provider
• Adjustment of medications, including stopping certain blood thinners
• Comprehensive eye and orbital imaging studies (CT or MRI scans)
• Preoperative consultation with the surgeon and anesthesiologist
• Blood tests and a complete medical history review

Procedure Description

1. The patient is given either local anesthesia with sedation or general anesthesia.
2. An incision is made either through the frontal approach (above the eye) or transconjunctival approach (through the lower eyelid).
3. The surgeon carefully navigates to the orbit without removing large sections of bone (avoiding a bone flap).
4. Specific bones around the eye socket are removed to decompress and relieve pressure.
5. The incision is closed with sutures, and a sterile dressing is applied.

Tools and equipment used include specialized surgical instruments such as orbital retractors and bone rongeurs.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and the approach used.

Setting

This surgery is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Ophthalmic surgeon or oculoplastic surgeon
• Anesthesiologist
• Surgical nurses
• Possible involvement of a radiologic technologist

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Double vision (diplopia)
• Temporary or permanent vision changes
• Scarring or poor wound healing
• Damage to surrounding eye structures
• Anesthetic complications

Benefits

• Relief from eye pressure and associated pain
• Improved eye appearance and function
• Prevention of further vision loss or restoration of vision

Recovery

• Post-procedure monitoring in a recovery room
• Prescription pain medications and antibiotics
• Instructions for home care, including keeping the surgical site clean and dry
• Follow-up appointments to monitor healing and function
• Recovery time varies; initial healing occurs within 1-2 weeks, while complete recovery may take several months

Alternatives

• Conservative treatments like corticosteroids or radiation therapy
• Less invasive decompression techniques
• Observation and regular monitoring if symptoms are mild

Pros and cons of alternatives should be discussed with the healthcare provider to determine the best approach based on the patient's specific condition.

Patient Experience

Patients may experience swelling and bruising around the eye, which typically subsides within a few weeks. Pain is manageable with prescribed medications. Vision may be blurred initially but should improve as healing progresses. The surgeon and care team will provide detailed instructions and support throughout the recovery process to ensure comfort and successful outcomes.