Endoscopic Orbital Decompression in HD

Indications:

• Graves’ orbitopathy

Highlights:

• Surgery begins with a sphenoethmoidectomy
• The lamina papyracea is opened with a spoon curette
• Fragments of lamina are elevated and removed with a Blakesley forceps
• The medial floor of the orbit is down-fractured and removed
• The underlying periorbita is incised in a posterior-to-anterior direction allowing for orbital fat to herniate into the ethmoid and maxillary sinuses with a reduction in proptosis

Keep in mind:

• In most cases, a 10 mm wide strip of periorbita is preserved overlying the medial rectus muscle.
• This “orbital sling” prevents prolapse of the muscle and decreases the incidence of postoperative diplopia
• In patients with severe proptosis or optic neuropathy, instead of the orbital sling technique, the entire periorbita in incised and removed

Reference: 2008-86 Endoscopic Orbital Decompression.pdf