Orbital decompression for non-Graves' orbitopathy: a consideration of extended indications for decompression

Orbital decompression is typically indicated for Graves' orbitopathy. Other causes of proptosis can also be safely and effectively addressed surgically with orbital decompression. Patients with prominent globes can have significant discomfort related to exposure keratopathy, lagophthalmos, and inefficient function of the globe-eyelid interface. We present six cases of non-Graves' proptosis that were addressed with orbital decompression. Indications for surgery included hypoplastic malar eminence with scleral show, enlarged globes, and congenital shallow orbits. Successful reduction of proptosis was achieved by orbital decompression with subsequent relief of presenting symptoms. Graded balanced orbital decompression was used to minimize shifts of the muscle cone. In some cases osteotomies and advancement of the lateral wall and malar region were also employed. Complications included transient esotropia, esotropia requiring surgery, and microplate granuloma. Orbital decompression should be considered for patients with relative proptosis and related eyelid malpositions regardless of the underlying etiology.