Endoscopic Orbital Decompression in HD

Survey

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