Ancillary procedures in microscopic endonasal orbital decompression for thyroid-associated ophthalmopathy

In 35 patients with thyroid-associated orbitopathy, nonresponsive to conser vative treatment, an endonasal microscopic approach with bimural osteotomy was performed for decompression in two ways. While in group A the periorbit a was resected, and fat septa were cut, in group B periorbital strips were left, and fat septa were respected. In accordance with other authors, resec tion of the periorbital and cutting fat septa will improve vision and propt osis, but in up to 30% of the patients de novo diplopia occurs. Our data fa vor the assumption that a more conservative endonasal microscopic decompres sion of the orbita leaving periorbital strips and fat septa achieves simila r good results for reduction of proptosis and visual gain but creates less often de novo diplopia in primary gaze. Based on our experience, rehabilita tion for thyroid-associated arbitopathy comprises as a first step orbital e ndonasal decompression with cooperation of the ophthalmologist, then if nec essary as a second step strabismus surgery, and thirdly eyelid repair for s cleral show. Copyright (C) 2001 S. Karger AG, Basel.