The surgical management of Graves' ophthalmopathy

The underlying cause of Graves' ophthalmopathy is unknown and therefore all treatment is palliative rather than preventive. The proximate cause of the retrobulbar swelling is an accumulation of glycosaminoglycans with subsequent water binding. Treatment, in a general sense, either attempts to shrink swollen tissues or to expand orbital volume. Expanding the orbital volume by decompression can be accomplished by many different techniques. Removal of bone is central to this theme. Another type of "decompression" removes orbital fat without any bone removal. This review highlights results of decompression by the antral-ethmoidal (transantral and anterior), transfrontal, endoscopic, and orbital defatting techniques. Diplopia can be a major source of morbidity. From a surgical perspective recessions are the most frequently performed procedure. The results of adjustable versus nonadjustable sutures are compared in one report. Various methods of performing eyelid surgery including a technique to harvest hard palate mucosa are also briefly discussed.