This retrospective review assessed the risk of severe vision loss after orbital surgery.

Study design

The authors reviewed records from 1,665 patients who underwent orbital surgery at 2 academic centers between 1994 and 2014. The analysis found 14 patients (0.84%) with a baseline vision 20/200 or better that declined to 20/400 or worse after surgery.

Outcomes

The causes of vision loss included retrobulbar hemorrhage, malpositioned implant, optic nerve ischemia, and direct optic nerve insult. The risk of vision loss was greater for patients undergoing orbital floor repair in the setting of multiple facial fractures (6.45%), bony decompression of the optic canal (15.6%), or intracranial approach to the orbital roof (18.2%). Administration of IV corticosteroids did not significantly influence visual acuity outcomes.

Limitations

The study is retrospective and involved multiple surgeons. As the authors note, not all orbital surgeries are equal, but some do pose a higher risk than others of visual loss. The heterogeneity of patients undergoing orbital surgery, even within subgroups, makes this type of study difficult to control. In addition, one could argue that an academic practice might see a more complicated mix of cases than community practices.

Clinical significance

These findings can help clinicians counsel patients about the risks of orbital surgery. Overall, fewer than 1% of patients will experience severe visual loss after this procedure. However, some procedures appear to carry a higher risk of visual loss, and this should be noted by both the surgeon and patient.