Orbital Decompression
What is Orbital Decompression?
Orbital decompression is a surgical procedure to relieve pressure within the orbit (eye socket) by removing bone and/or fat, typically to treat severe proptosis (bulging eyes) or optic nerve compression in conditions like thyroid eye disease (Graves’ orbitopathy). It aims to improve eye function, appearance, and comfort. In India, orbital decompression is performed in ophthalmology or oculoplastic surgery departments at hospitals like Apollo, Fortis, Medanta, and AIIMS, often at affordable costs. Since we’ve discussed related eye surgeries like LASIK and enucleation, this overview complements that context. Understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for patients in India to make informed decisions.
Why do you need Orbital Decompression?
Orbital decompression is indicated for:
- Thyroid eye disease (Graves’ orbitopathy):
- Severe proptosis: Bulging eyes causing exposure keratopathy (corneal dryness), pain, or cosmetic concerns.
- Optic neuropathy: Compression of the optic nerve leading to vision loss (urgent indication).
- Orbital tumors:
- Benign or malignant tumors causing proptosis or nerve compression; decompression may be combined with tumor removal.
- Trauma:
- Orbital fractures with entrapment or severe swelling causing pressure on the optic nerve.
- Other conditions:
- Idiopathic orbital inflammation (orbital pseudotumor) unresponsive to steroids.
- Severe orbital infection (e.g., orbital cellulitis) with abscess formation (rare).
The procedure aims to create more space in the orbit by removing bone from the orbital walls and/or fat, allowing the eye to sit back (reducing proptosis) and relieving pressure on the optic nerve.
Why Do Orbital Decompression Costs Vary in India?
Costs range from ₹80,000 to ₹2.5 lakh :
- Procedure Extent: One-wall decompression (₹80,000–₹1.2 lakh); two- or three-wall (₹1.5–2.5 lakh).
- Hospital/Location: Higher in metro cities (Apollo, Fortis); lower in government hospitals (AIIMS, ₹20,000–₹50,000; often subsidized under schemes like Ayushman Bharat).
- Surgeon’s Expertise: Experienced oculoplastic surgeons charge more.
- Additional Costs: Anesthesia (₹10,000–₹20,000), hospital stay (₹5,000–₹15,000/day), pre-op imaging (₹5,000–₹10,000), medications (₹2,000–₹5,000).
- Insurance: Covered for medical necessity (e.g., optic neuropathy, severe proptosis); confirm with your provider.
Orbital Decompression Procedure
- Before Surgery Evaluation:
- Diagnosis:
- CT/MRI scan: Assesses orbital anatomy, bone structure, and soft tissue (e.g., muscle enlargement, fat volume).
- Visual acuity test: Checks for vision loss (esp. optic neuropathy).
- Hertel exophthalmometry: Measures proptosis (normal: 15–17 mm; severe: >20 mm).
- Visual field test: Detects optic nerve compression.
- Blood tests: Thyroid function (TSH, T3, T4 for Graves’), blood sugar, clotting profile.
- Medications: Stop blood thinners (e.g., aspirin) 5–7 days prior if safe; steroids (e.g., prednisolone) may be continued for Graves’ disease.
- Consent: Risks, including double vision, are explained.
- Diagnosis:
- Surgical Techniques:
- Orbital Decompression:
- Performed under general anesthesia, lasting 2–4 hours (depending on extent).
- Approaches vary based on severity and surgeon preference:
- Medial wall decompression: Removes bone from the medial orbital wall (near the nose) via an endoscopic transnasal approach; often combined with ENT surgeon.
- Lateral wall decompression: Removes bone from the lateral orbital wall (temple side) via an external incision (e.g., eyelid crease or coronal approach).
- Inferior wall decompression: Removes bone from the orbital floor (via transconjunctival or subciliary incision); avoids maxillary sinus if possible.
- Fat decompression: Removes orbital fat (often combined with bone removal) to reduce volume.
- Two-wall (medial + inferior) or three-wall (medial + inferior + lateral) decompression may be done for severe cases.
- Incisions are closed with sutures (external approaches); endoscopic approaches leave no visible scar.
- Intraoperative Tools:
- Endoscope: For transnasal medial wall approach.
- Bone rongeurs/drills: Remove bone.
- Operating microscope: Enhances precision.
- Orbital Decompression:
- After Surgery:
- Hospital stay: 1–3 days.
- Pain management: IV analgesics (e.g., morphine) for 1 day, then oral (e.g., ibuprofen) for 3–5 days.
- Eye care: Antibiotic/steroid drops (e.g., tobramycin-dexamethasone) for 2–4 weeks; artificial tears for dryness.
- Nasal care (if endoscopic): Saline spray to prevent crusting; avoid nose blowing for 2 weeks.
- Instructions: Avoid heavy lifting or strenuous activity for 4–6 weeks; sleep with head elevated.
Recovery After Orbital Decompression
- Hospital Stay: 1–3 days.
- Post-Surgery Care:
- Swelling/Bruising: Around the eyes for 2–3 weeks; cold compresses for 48 hours, then warm compresses help.
- Pain: Moderate for 3–5 days, managed with analgesics; orbital discomfort may persist for 1–2 weeks.
- Eye care: Antibiotic/steroid drops for 2–4 weeks; artificial tears for 1–2 months (dryness common).
- Activity: Avoid heavy lifting, bending, or strenuous activity for 4–6 weeks; normal activities (e.g., reading) in 1–2 weeks.
- Vision: May be blurry for 1–2 weeks due to swelling; optic neuropathy improvement (if present) seen in 4–6 weeks.
- Proptosis: Reduced by 3–6 mm (varies by extent of decompression); final results at 3–6 months.
- Follow-Up:
- Visits at 1 week, 1 month, and 3–6 months to monitor healing, proptosis, and vision.
- Visual field test: At 1–3 months to confirm optic nerve recovery (if indicated).
Most resume normal activities in 2–4 weeks; full recovery takes 3–6 months. Success rate: 85–90% achieve reduced proptosis and symptom relief; 70–80% with optic neuropathy show vision improvement.
Risks and Complications
- Surgical Risks:
- Bleeding (2–5%): Orbital hematoma; may need drainage if severe.
- Infection (1–3%): Orbital cellulitis; treated with antibiotics, may require drainage.
- Cerebrospinal fluid (CSF) leak (<1%): Rare, during medial wall decompression; may need repair.
- Post-Surgery:
- Double vision (10–30%): Due to muscle imbalance post-decompression; often temporary (resolves in 3–6 months); persistent cases may need strabismus surgery.
- Numbness (5–10%): Infraorbital nerve (cheek/lip) after inferior wall decompression; usually temporary.
- Sinus issues (2–5%): Sinusitis or nasal crusting (endoscopic approach); managed with saline spray or antibiotics.
- Scarring (1–3%): Minimal with endoscopic or transconjunctival approaches; visible scar possible with external incisions.
- Long-Term:
- Recurrence of proptosis (5–10%): If thyroid eye disease reactivates; may need repeat surgery.
- Dry eyes (5–10%): Due to increased exposure; managed with artificial tears.
- Sunken eye (enophthalmos, 1–3%): Over-decompression; may need fat grafting.
Report sudden vision loss, severe pain, fever, or nasal leakage (possible CSF leak) promptly.
Frequently Asked Questions (FAQs)
What causes the need for orbital decompression?
Thyroid eye disease (most common), orbital tumors, trauma, or severe infections causing proptosis or optic nerve compression.
Can I avoid orbital decompression?
Yes, if mild: Steroids, radiation, or observation for Graves’ disease; surgery is for severe proptosis, optic neuropathy, or cosmetic concerns.
Is orbital decompression painful?
No, performed under anesthesia; moderate pain post-surgery for 3–5 days, managed with medication.
How soon can I resume activities?
Light activities in 1–2 weeks; normal routines in 2–4 weeks; full recovery in 3–6 months.
Is orbital decompression covered by insurance in India?
Yes, for medical necessity (e.g., optic neuropathy, severe proptosis); confirm with your provider.
Signs of complications?
Sudden vision loss, severe pain, fever, or nasal leakage (possible CSF leak).
Will my eyes look normal after surgery?
Proptosis reduces by 3–6 mm; 85–90% achieve improved appearance, though some asymmetry may persist.
Lifestyle changes post-surgery?
Avoid heavy lifting for 4–6 weeks, use prescribed drops, manage thyroid condition, wear sunglasses for UV protection, and attend follow-ups.
Conclusion
Orbital decompression is an effective procedure to manage severe proptosis or optic nerve compression, improving function and appearance with a good success rate. India’s top hospitals (Apollo, Fortis, AIIMS) provide affordable, expert care, often covered by insurance for medical necessity. Understanding the procedure, costs, recovery, risks, and FAQs helps patients approach surgery confidently. Consult an oculoplastic surgeon for personalized guidance and optimal outcomes.
Looking for Best Hospitals for Orbital Decompression
Note: we are not promoting any hospitals
we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₹) | Maximum Price (₹) |
|---|---|---|
Agra |
2,00,000 |
4,50,000 |
Ahmedabad |
2,25,000 |
5,00,000 |
Ajmer |
2,00,000 |
4,50,000 |
Aligarh |
2,00,000 |
4,50,000 |
Allahabad |
2,00,000 |
4,50,000 |
Amritsar |
2,10,000 |
4,75,000 |
Aurangabad |
2,10,000 |
4,75,000 |
Bangalore |
2,25,000 |
5,00,000 |
Bareilly |
2,00,000 |
4,50,000 |
Belgaum |
2,10,000 |
4,75,000 |
Bhopal |
2,10,000 |
4,75,000 |
Bhubaneswar |
2,10,000 |
4,75,000 |
Bikaner |
2,00,000 |
4,50,000 |
Chandigarh |
2,25,000 |
5,00,000 |
Chennai |
2,25,000 |
5,00,000 |
Coimbatore |
2,25,000 |
5,00,000 |
Dehradun |
2,10,000 |
4,75,000 |
Delhi |
2,25,000 |
5,00,000 |
Dhanbad |
2,00,000 |
4,50,000 |
Durgapur |
2,00,000 |
4,50,000 |
Faridabad |
2,25,000 |
5,00,000 |
Ghaziabad |
2,25,000 |
5,00,000 |
Gorakhpur |
2,00,000 |
4,50,000 |
Guntur |
2,10,000 |
4,75,000 |
Gurgaon |
l2,25,000 |
5,00,000 |
Guwahati |
2,10,000 |
4,75,000 |
Gwalior |
2,00,000 |
4,50,000 |
Hyderabad |
2,25,000 |
5,00,000 |
Indore |
2,10,000 |
4,75,000 |
Jabalpur |
2,00,000 |
4,50,000 |
Jaipur |
2,25,000 |
5,00,000 |
Jalandhar |
2,10,000 |
4,75,000 |
Jamshedpur |
2,10,000 |
4,75,000 |
Jodhpur |
2,00,000 |
4,50,000 |
Kanpur |
2,00,000 |
4,50,000 |
Kochi |
2,25,000 |
5,00,000 |
Kolkata |
2,25,000 |
5,00,000 |
Kollam |
2,10,000 |
4,75,000 |
Lucknow |
2,10,000 |
4,75,000 |
Ludhiana |
2,25,000 |
5,00,000 |
Madurai |
2,10,000 |
4,75,000 |
Mangalore |
2,10,000 |
4,75,000 |
Meerut |
2,00,000 |
4,50,000 |
Moradabad |
2,00,000 |
4,50,000 |
Mumbai |
2,25,000 |
5,00,000 |
Mysore |
2,25,000 |
5,00,000 |
Nagpur |
2,10,000 |
4,75,000 |
Nashik |
2,10,000 |
4,75,000 |
Navi Mumbai |
2,25,000 |
5,00,000 |
Noida |
2,25,000 |
5,00,000 |
Patna |
2,00,000 |
4,50,000 |
Pune |
2,25,000 |
5,00,000 |
Raipur |
2,10,000 |
4,75,000 |
Rajkot |
2,10,000 |
4,75,000 |
Ranchi |
2,00,000 |
4,50,000 |
Surat |
2,25,000 |
5,00,000 |
Thane |
2,25,000 |
5,00,000 |
Vadodara |
2,10,000 |
4,75,000 |
Varanasi |
2,00,000 |
4,50,000 |
Visakhapatnam |
2,10,000 |
4,75,000 |
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.