Decompression for dysthyroid ophthalmopathy via the orbital rim approach. Technical note

A technique is described wherein the approach to the orbital cavity, with resection of its roof and lateral wall, is facilitated by a single burr hole and local en bloc removal of the lateral and supraorbital margins. A satisfactory decompression with reduction of proptosis of the orbital contents and a good cosmetic result is achieved without the need for a large dural exposure. The approach may be combined with removal of the anterior wall of the frontal sinus in cases where the lateral aspect extends appreciably laterally. Access to the orbital roof and lateral wall is straightforward and can be coupled with further removal of the floor lateral to the infraorbital nerve and medial wall. Advancement of the orbital rim upon bone replacement adds to orbital volume, creating better mechanical advantage for eyelid closure.