Combined-approach orbital decompression for thyroid-related orbitopathy

Surgical treatment of thyroid-related orbitopathy can be accomplished by tr ansorbital or endoscopic techniques. Transorbital surgery has advantages in the orbital floor and lateral wall, and endoscopic decompression is best s uited to the medial orbital wall. We describe a retrospective review of 16 orbits (10 patients) treated with surgery, combining endoscopic decompressi on of the medial wall and a transorbital approach to the floor and lateral wall. Follow-up averaged 20.8 months. Vision and field defects improved dra matically in compressive optic neuropathy cases. Hertel measurements improv ed, on average, 4.9 mm. Two patients with severe preoperative diplopia requ ired strabismus surgery after decompression. Combined-approach decompressio n is a safe and efficacious operation with conceptual advantages over curre nt surgical techniques.