Orbital Decompression as an Alternative Management Strategy for Patients with Benign Tumors Located at the Orbital Apex

PurposeTumors located in the intraconal portion of the orbital apex, especially those inferior to the optic nerve, can be difficult to access surgically, carrying a significant risk of ocular morbidity. The purpose of this study was to investigate outcomes in 5 patients with benign-appearing but symptomatic tumors located in the intraconal portion of the orbital apex in which orbital decompression was performed as an alternative management strategy to resection.DesignRetrospective interventional case series.ParticipantsFive patients were diagnosed with a compressive optic neuropathy secondary to a benign-appearing tumor at the orbital apex.InterventionEach patient underwent surgical decompression of the affected orbit. None of the patients had the tumor biopsied or resected.Main Outcome MeasuresBest-corrected visual acuity (VA), pupillary responses, visual fields (VFs), color vision, and orbital imaging.ResultsEach of the patients demonstrated improvement in visual function, as measured by VA, VFs, and, in some cases, color vision. One patient required a second orbital decompression for recurrent optic neuropathy 4 years after the initial decompression. Complications included ptosis and enophthalmos in 2 patients and diplopia in the extreme right gaze in 1 patient.ConclusionsOrbital decompression is a therapeutic option for patients with compressive optic neuropathies from benign orbital apex tumors, offering potential improvement in optic nerve function while sparing morbidity from attempts at surgical resection.