The swelling of the muscles can become so severe that the blood flow to the optic nerve is strangled, resulting in slow loss of vision. Double vision can also result. Surgical rehabilitation is usually reserved after the eyelid abnormalities have stabilized for at least four months. Acute surgery may be needed to prevent loss of vision from swelling around the optic nerve. Other modalities tried first are Prednisone, Cyclosporin or x-ray therapy.
Surgical rehabilitation needs to be individualized and performed in stages.
The most common method of orbital expansion to relieve compression of the optic nerve is a two wall decompression which involves removing the bone of the floor of the orbit. When the inferior, orbital rim is struck with any object, the floor is deformed with resultant fracture with entrapment of tissue. This entrapment of tissue can include eye muscles which results in double vision. Also, with fractures of the floor, the volume of the orbit can expand and the eye can sink back also. This can be corrected by repairing the fracture and placing an implant on the floor of the fracture to reapproximate the floor.