About the Procedure
The eye socket (orbit) shares thin bony walls with the nose and sinuses. This close relationship makes it possible, in selected cases, to reach parts of the orbit through the nostrils using endoscopes, without an external incision. Endoscopic orbital surgery is a group of techniques that use this endonasal route to decompress the orbit, drain an infection, take a biopsy, or remove certain lesions located along the inner part of the orbit or its apex.
Not every orbital problem can be reached this way. The endonasal route is best suited to areas along the medial wall and floor of the orbit and toward the back of the socket. Lesions on the outer side of the orbit or wrapped around the eye often need an external or combined approach, and some are better managed without surgery.
At Norelle Health, endoscopic orbital surgery is performed in close partnership with ophthalmology and, when the skull base is involved, neurosurgery. Careful evaluation determines whether an endonasal route is appropriate and what the realistic goals and risks are.
Conditions that may use an endonasal orbital route
An endoscopic endonasal route may be used in selected cases for:
- Decompression of the orbit, most often for thyroid eye disease
- Drainage of an orbital or subperiosteal abscess related to sinus infection
- Biopsy of an orbital lesion to establish a diagnosis
- Removal of certain tumors along the medial wall or orbital apex
Whether this route is suitable depends on the exact location of the problem and its relationship to the eye, the optic nerve, and the sinuses.
Eye and neurologic warning signs
Some orbital problems are urgent. Warning signs that need prompt evaluation include sudden or worsening loss of vision, double vision, a rapidly bulging or very painful eye, an eye that cannot move normally, or redness and swelling with fever.
These symptoms can indicate an infection spreading into the orbit, pressure on the optic nerve, or another process that may need emergency care. They should be treated as an emergency rather than waiting for a routine appointment.
Considering endoscopic orbital surgery? The next step is a quiet, unhurried conversation.
CT/MRI and ophthalmic testing
Imaging is central to planning. CT shows the bony walls and sinuses and is helpful for infection and trauma, while MRI gives more detail of soft tissue and the optic nerve. Together they show the location of the problem and whether an endonasal route can reach it safely.
Ophthalmic testing, including vision and color vision, eye movement, pupil responses, and measurement of eye protrusion, establishes a baseline and helps judge urgency and the goals of surgery.
Roles of ENT and ophthalmology
Endoscopic orbital surgery is a shared effort. The ENT (rhinology) surgeon provides safe endonasal access through the nose and sinuses and works along the orbital wall, while ophthalmology evaluates and manages the eye itself and its function.
When the problem extends to the skull base, neurosurgery is also involved. This team approach helps protect vision and address the underlying condition together rather than in isolation.
Endoscopic, external and combined approaches
The endonasal endoscopic route avoids an external incision and is well suited to the inner wall, floor, and back of the orbit. An external approach, through the eyelid or skin, may be needed for the outer orbit or areas the endoscope cannot reach. Some operations combine both routes.
The approach is selected to match the location of the problem while protecting the optic nerve, the eye muscles, and surrounding structures. The plan, including its limits, is discussed before surgery.
Considering endoscopic orbital surgery? The next step is a quiet, unhurried conversation.
Visual-risk counseling and follow-up
Because surgery is performed close to the eye and optic nerve, there are uncommon but serious risks to vision and eye movement, including double vision. These risks, and the realistic goals of the operation, are reviewed in detail beforehand.
After surgery, vision, eye position, and movement are monitored closely, and nasal healing is supported with saline rinses and follow-up endoscopy. Care is coordinated between the surgical team and ophthalmology.
Clinical references
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. Sudden vision loss, a rapidly bulging or very painful eye, double vision, or eye redness and swelling with fever should be treated as an emergency, and you should seek immediate medical care.
Considering endoscopic orbital surgery? The next step is a quiet, unhurried conversation.
Candidacy & Evaluation
Recovery & Aftercare
Specialists who perform endoscopic orbital surgery
Dr. Adrian Ong
MD
Board-Certified Facial Plastic & Reconstructive and Head & Neck Surgeon
Dr. Adrian Ong is a board-certified surgeon who practices exclusively on the face, head, and neck, with expertise spanning rhinoplasty, sinus surgery, facial trauma, reconstruction, and sleep surgery.
- Functional and aesthetic rhinoplasty (including revision)
- Sinus surgery and complex revision sinus surgery
- Facial trauma and nasal fractures
- Head and neck cancer surgery and microvascular reconstruction
Also caring for this area
Not sure who to see? Our patient coordination team can help match you with the right specialist.
(212) 444-8006Frequently Asked Questions
Related Conditions
1 of 2 · Skull Base Tumors
Related Procedures
1 of 3 · Orbital Decompression
Request a consultation about endoscopic orbital surgery
Schedule a consultation with our team to discuss whether this procedure is the right option for you.