Orbital decompression as an alternative management strategy for patients with benign tumors located at the orbital apex

Purpose: Tumors 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. Design: Retrospective interventional case series. Participants: Five patients were diagnosed with a compressive optic neuropathy secondary to a benign-appearing tumor at the orbital apex. Intervention: Each patient underwent surgical decompression of the affected orbit. None of the patients had the tumor biopsied or resected. Main Outcome Measures: Best-corrected visual acuity (VA), pupillary responses, visual fields (VFs), color vision, and orbital imaging. Results: Each 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. Conclusions: Orbital 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.