Selection of patients and choice of operation for orbital decompression in graves' ophthalmopathy

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Abstract
Until the fundamental cause of the orbital problem associated with Graves' disease is better understood and can be prevented or reversed, some patients will need palliative orbital decompression. Of the available methods of orbital enlargement, the transantral ethmoidal decompression and the transfrontal operation seem most useful because of the amount of bone that can be removed by either approach.Transantral decompression is an appropriate operation for those patients with serious bilateral disease who would otherwise be treated systemically with corticosteroids. It also is of value as a preliminary step to extraocular muscle surgery after the orbital process has stabilized in those patients with exophthalmos and extraocular muscle myopathy and diplopia. Cosmetic decompression by this route is practical but total rehabilitation may also require upper lid and rectus muscle surgery.Forty patients with Graves' ophthalmopathy were treated by transantral decompression in the period July, 1969, to July, 1972. Seventeen of these had optic nerve dysfunction and visual field defects, papilledema, or choroidal folding. Fourteen patients had proptosis without optic neuropathy and six of these had corneal ulceration. Five patients had decompression specifically as a preliminary to eye muscle surgery and four patients had decompression for purely cosmetic reasons.The transfrontal decompression is ideal for patients with unilateral exophthalmos and when orbital exploration is needed. The transfrontal operation can salvage vision in the occasional patient with serious disease that is not palliated by transantral decompression.Orbital decompression is a more conservative approach to palliation than is high‐dose long‐term systemic steroid therapy. Orbital decompression has effectively controlled the optic neuropathy of Graves' disease without serious complications from the operation and without risking the potential side‐effects of long‐term high‐dose steroid therapy.

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