Surgical treatment for malignant exophthalmos of endocrine origin

Endocrine exophthalmos is a poorly understood disease process thought to be related to a dysfunction of the thyroid-pituitary axis. Initial therapy for symptomatic endocrine exophthalmos is medical. Failure to respond to medical management is heralded by progressive exophthalmos, exposure keratitis, and decreasing visual acuity. The pathophysiologic processes involved and an historical review of the various surgical procedures used are discussed. The results of 28 patients surgically decompressed by a transantral transethmoid approach are presented. Preservation or improvement in visual acuities were observed in all but one patient. Diplopia was generally not improved and may be worsened in some patients.