Endoscopic orbital decompression for thyroid eye disease

Thyroid eye disease is a disorder of immune function resulting in extraocular myopathy and an increase in retrobulbar fat. These changes lead to the clinical features found in thyroid eye disease including proptosis, eyelid retraction, restrictive myopathy and sometimes compressive optic neuropathy. Orbital decompression is undertaken for optic nerve compression, exposure keratopathy or cosmesis. Previously this involved an external approach with the removal of the medial orbital wall along with the floor. An intranasal endoscopic approach with the removal of the medial orbital wall and part of the floor has recently been advocated as an alternative procedure.

We present the results of 7 patients who underwent endoscopic orbital decompression. The effects on optic nerve function, proptosis and ocular motility were assessed. Symptoms before and after surgery were monitored.

The surgery was found to be successful in all cases with a reduction in proptosis and minimal effect on ocular motility. The surgery was also associated with a low post-operative morbidity.

We suggest endoscopic orbital decompression is an effective and safe treatment for dysthyroid eye disease.