Principles of Protection of the Eye and Vision in Orbital Surgery

Abstract

Orbital surgery can result in damage to ocular and orbital structures, leading to a range of structural and visual sequelae, including corneal abrasions, globe malposition, diplopia, and blindness. Vision loss in particular is the most feared and devastating complication, occurs with an overall incidence of 0.84%, and can occur secondary to direct injury, optic nerve compression, or ischemic events. Different types of orbital surgery and surgical approaches carry their own hazards, and it is important to be mindful of these risks in addition to having a thorough understanding of individual risk factors and anatomical variations for each patient. Although universal guidelines for preserving vision in orbital surgery do not yet exist, there are concrete steps that every surgeon can take at the preoperative, intraoperative, and postoperative stages to minimize the risk of injury and maximize the likelihood of preserving the eye and visual function.

The Changes in Optic Nerve after Orbital Decompression Surgery for Thyroid Eye Disease and Case Reports of Ischemic Optic Neuropathy

“…Other studies regarding the outcomes of orbital decompression surgery also reported very few cases with postoperative vision loss [ 8 , 12 , 25 ]. The possible etiologies of vision loss included surgical manipulation, thermal and electrical injury, compression from bony fragments, vasospasm due to inflammation, and elevated intraorbital pressure due to tissue swelling, retrobulbar hemorrhage, and tight pressure patching [ 10 , 11 ]. Ischemic events included AION, PION, posterior ciliary artery occlusion, central retinal artery occlusion, or ophthalmic artery occlusion could occur [ 10 , 11 ].…”

“…Vision loss is a very rare but devastating complication after orbital surgery [6][7][8][9][10][11]. The prevalence of vision loss after TED decompression surgery ranges from 0.09 to 0.52% [8,11,12].…”