Microsurgical endonasal decompression in dysthyroid orbitopathy

Area of Science:

• Ophthalmology
• Endocrinology
• Otorhinolaryngology

Background:

• Thyroid eye disease (TED) diagnosis is based on clinical signs and autoimmune thyroid disease findings.
• Treatment options for TED are limited and depend on disease stage and activity.
• Surgical decompression is indicated when conservative therapies fail, particularly for vision loss or severe ocular complications.

Purpose of the Study:

• To evaluate the efficacy and safety of endonasal microsurgery for orbital decompression in patients with thyroid eye disease.
• To compare endonasal microsurgery outcomes with traditional external surgical approaches.

Main Methods:

• A retrospective analysis of 27 orbital decompressions performed via endonasal microsurgery and 3 via external approach.
• Detailed description of the endonasal microsurgical technique, emphasizing bimanual operation and stereomicroscopic visualization.
• Assessment of outcomes including proptosis reduction and visual acuity improvement.

Main Results:

• Endonasal microsurgery achieved a mean proptosis reduction of 4.1 mm, comparable to the 4.7 mm from the external approach.
• Both methods resulted in a mean visual acuity improvement of 0.2.
• The endonasal approach avoided external scars, neural pain, and reduced diplopia and trauma to nasolacrimal/nasofrontal ducts.

Conclusions:

• Endonasal microsurgery is a viable and effective technique for orbital decompression in thyroid eye disease.
• This minimally invasive approach offers comparable efficacy to external methods with significant advantages in terms of patient recovery and complication avoidance.
• The technique allows for simultaneous decompression of medial and inferior orbital walls and effective relief at the orbital apex.