Abstract
Orbital decompression may be required for patients with thyroid eye disease (TED) who have not responded to medical therapy. The endoscopic transnasal approach to the medial and inferior orbital walls is an excellent surgical option for the vast majority of patients. This article will cover the latest developments in endoscopic management of thyroid eye disease while reviewing the pathophysiology of the disease, patient selection, proper surgical technique, postoperative outcomes, and complications. Endoscopic surgeons have modified the technique over the past several years in order to reduce the incidence of certain complications, in particular diplopia. The implementation of “balanced” decompression, along with preservation of orbital struts and/or periorbital slings, has improved postoperative outcomes. Endoscopic orbital decompression remains a safe and effective surgical option for TED best applied in conjunction with inferior and lateral approaches. Working closely with the oculoplastics team to effect a balanced decompression most often yields the best outcomes.
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