Modified orbital decompression for dysthyroid orbitopathy

Purpose: The transantral approach to orbital decompression remains useful f or the management of exophthalmos associated with dysthyroid orbitopathy. H owever, the risk of postoperative diplopia is a concern. Preservation of th e anterior periorbita may help support the orbital contents and decrease th e incidence of diplodia. Methods: The medical records were reviewed of 15 consecutive patients who u nderwent 30 transantral orbital decompressions for proptosis associated wit h dysthyroid orbitopathy. The procedures were completed in standard fashion , including, removal of the inferomedial bony strut between the medial orbi tal wall and the floor. However, stripping of the periorbita was only done posteriorly; the anterior 10 to 15 mm of periorbita were left intact. Results: Six patients had preoperative diplopia that persisted after decomp ression. Of the nine patients without diplopia preoperatively, none develop ed diplopia. Proptosis was reduced a mean of 3.5 +/- 2.6 mm. Conclusions: Preservation of the anterior periorbita during transantral orb ital decompression reduces the risk of postoperative diplopia. An adequate reduction in proptosis is also achieved.