A 59-year-old man with a history of chronic hydrocephalus and lifelong poor vision was referred to the oculoplastic surgery service for the management of symptomatic proptosis and intermittent globe subluxation of his OD. Imaging studies of his orbits revealed massively enlarged and calcified optic nerve sheaths. Neurosurgical consultation recommended against violation of the cerebrospinal fluid space given the chronic compensated hydrocephalus. Three-wall bony orbital decompression was therefore performed without complication and resulted in improved symptomatic and cosmetic outcomes.
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