Orbital Decompression in Graves' Disease

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Abstract
Objective: The authors' experience with surgical decompression of the orbits in patients with Graves' orbitopathy is reviewed. Design: One hundred twenty-six consecutive primary orbital decompressions were retrospectively studied. Setting: Tertiary care university hospitals. Patients: All patients were referred by ophthalmologists for surgical decompression after failure of a trial of oral steroid therapy, and many had had orbital irradiation. Intervention: Antral-ethmoidal or transconjunctival surgical decompression was accomplished in all. Main Outcomes: Measurements of visual acuity, ocular motility, and proptosis were accomplished preoperatively and a minimum of 3 months postoperatively. Surgical complications were tallied. Results: Mean reduction of proptosis by antralethmoidal decompression was 5.3 mm, and 3.6 mm by the transconjunctival appproach. Visual acuity improved in 34 orbits, was unchanged in 91 orbits, and decreased in one orbit. In a subgroup of 30 patients in whom ocular motility was quantified by prism cover test preoperatively, motility was unchanged or improved in 21 and was decreased in nine. Complications were infrequent. Conclusion: The antral-ethmoidal and transconjunctival approaches to orbital decompression are safe and effective. (Arch Otolaryngol Head Neck Surg. 1994;120:831-834)