Combined endoscopic medial and external lateral orbital decompression

Abstract

Objectives: To compare the efficacy of endoscopic medial and external lateral orbital wall surgery to 3-wall decompression in patients with progressive thyroid eye disease. Methods: Patients underwent either endoscopic medial and external lateral orbital wall decompression or 3-wall decompression (including the orbital floor). This was performed in 32 orbits of 17 patients and 15 orbits of 8 patients, respectively. Patients diagnosed with thyroid eye disease demonstrating severe proptosis, exposure keratitis, or compressive optic neuropathy were included. Results: Mean reduction in proptosis as evaluated by Hertel exophthalmometry was 4.37 mm OU (range, 0.58 mm) in the 2-wall approach and 4.59 (range, 1–8 mm) in the 3-wall group. Seventy-five percent of patients in the 2-wall group demonstrated improved visual acquity, while 50% improved after surgical decompression in the 3-wall group. Palpebral fissures decreased by an average of 2.50 mm (range, 07 mm) in the 2-wall group and by 2.03 mm (range, 0–3mm) in the 3-wall group. New onset diplopia was seen in 2 of 17 patients (11.8 %) in the 2-wall group and 1 of 8 (12.5%) patients following 3-wall orbital decompression. The mean time from diagnosis to intervention was 5.9 years in the 2-wall group and 19 years in the 3-wall group. Conclusions: This study supports the use of combined endoscopic medial with external lateral orbital wall decompression for patients with thyroid eye disease. Results compared favorably to those of 3-wall decompression. Additionally, the time interval from diagnosis to surgical intervention does not appear to predict the degree of improvement in patients with thyroid eye disease.