Indication and technique of transnasal microscopic orbital decompression for endocrine ophthalmopathy

If endocrine ophthalmopathy progresses despite conservative treatment then indications for surgical decompression are: loss of visual acuity, increasi ng strabism, and severe keratopathy. Endonasal microsurgery ensures a binoc ular view onto the intranasal landmarks of the orbital walls and allows sim ultaneous decompression of the medial and inferior wall as well as a good r elief of pressure at the orbital apex. Surgical decompressions were perform ed on 29 orbits in 19 patients, 16 by using the endonasal microsurgical, 3 via external approach. The microscopic approach was entirely comparable wit h regard to the reduction of proptosis with a mean improvement of 4.2 mm ag ainst a mean of 4.7 mm by external approach and a mean 0.2 of better visual acuity in both procedures. The microsurgical technique is considered super ior to an external approach avoiding external scars, neural pain, and repor tedly less diplopia. The healing phase and the hospitalization time are sho rter. Copyright (C) 2000 S. Karger AG,Basel.