[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
March 1987

Optic Nerve Sheath DecompressionReview of 17 Cases

Author Affiliations

From the Department of Surgery, Division of Ophthalmology, University of South Alabama College of Medicine, Mobile (Dr Hupp); and the Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine (Dr Glaser and Ms Byrne).

Arch Ophthalmol. 1987;105(3):386-389. doi:10.1001/archopht.1987.01060030106037

• Seventeen patients (19 eyes) with progressive visual loss associated with retrobulbar optic nerve and/or sheath enlargement were treated by surgical nerve sheath decompression at the Bascom Palmer Eye Institute, Miami, from 1969 through 1984. A decision to intervene was based on progressive visual loss unresponsive to other modes of therapy and accompanied by retrobulbar optic nerve sheath enlargement as determined by computed tomography, contrast orbitography, or orbital echography. Follow-up ranged from three months to nine years, with an average of 17 months. Visual function improvement was noted within one month after operation in seven of 19 eyes. The other 12 eyes showed no improvement or continued to worsen. Postoperative complications were infrequent, with motility disturbances being the most common. Optic nerve sheath decompression via the medial orbital approach has a low operative morbidity and may improve visual function in patients with progressive visual loss associated with the accumulation of compressible fluids in the retro-orbital optic nerve sheaths. This relatively safe surgical approach to the retrobulbar optic nerve may also be of future use in the retrieval of optic nerve tissue and fluid for chemical and cytologic analysis.

Billson FA, Hudson RL:  Surgical treatment of chronic papilloedema in children . Br J Ophthalmol 1975;59:92-95.Article
Burde RM, Karp JS, Miller RN:  Reversal of visual deficit with optic nerve decompression in long-standing pseudotumor cerebri . Am J Ophthalmol 1974;77:770-772.
Davies G, Zilkha KJ:  Decompression of the optic nerve in benign intracranial hypertension . Trans Ophthalmol Soc UK 1976;96:427-429.
Galbraith JEK, Sullivan JH:  Decompression of the perioptic meninges for relief of papilledema . Am J Ophthalmol 1973;76:687-692.
Kaye AH, Galbraith JEK, King J:  Intracranial pressure following optic nerve decompression for benign intracranial hypertension . J Neurosurg 1981;55:453-456.Article
Kilpatrick CJ, Kaufman DV, Galbraith JEK, et al:  Optic nerve decompression in benign intracranial hypertension . Clin Exp Neurol 1981;18:161-168.
De Wecker L:  On incision of the optic nerve in cases of neuroretinitis . Rep Int Ophthalmol Congr 1872 . 1878;4:11-14.
Carter RB:  On retrobulbar incision of the optic nerve in cases of swollen discs . Brain 1887;10:199-209.Article
Hayreh SS:  Pathogenesis of oedema of the optic discs . Br J Ophthalmol 1964;48:522-542.Article
Smith JL, Hoyt WF, Newton TH:  Optic nerve sheath decompression for relief of chronic monocular choked discs . Am J Ophthalmol 1969;68:633-639.
Davidson SI:  A surgical approach to plerocephalic disc oedema . Trans Ophthalmol Soc UK 1969;89:669-690.
Hagg JR, Smith JL, Susac JO, et al:  Optic atrophy following jejunoileal bypass . J Clin Neuro Ophthalmol 1985;5:9-15.Article
Hupp SL, Buckley EG, Byrne SF, et al:  Posttraumatic venous obstructive retinopathy associated with enlarged optic nerve sheath . Arch Ophthalmol 1984;102:254-256.Article
Conn H, Tenzel RR, Smith JL:  Optic disc changes with intracranial subarachnoid cysts . J Clin Neuro Ophthalmol 1982;2:183-192.Article
Byrne SF, Glaser JS:  Orbital tissue differentiation with standardized echography . Ophthalmology 1983;90:1071-1090.Article
Kushner B:  Optic nerve decompression . Arch Ophthalmol 1979;97:1459-1461.Article
Keltner J, Albert DM, Lubow M, et al:  Optic nerve decompression . Arch Ophthalmol 1977;95:97-104.Article
Davidson SI:  The surgical relief of papilloedema , in Cant JS (ed): The Optic Nerve. London , Henry Kimpton, 1972, pp 174-179.
Maroon JC, Kennerdell JS:  Surgical approaches to the orbit . J Neurosurg 1984;60:1226-1235.Article