Endoscopic transnasal orbital decompression for thyrotoxic orbitopathy

Abstract

Objective: To evaluate the efficacy of endoscopic transnasal orbital decompression alone for thyrotoxic orbitopathy.

Design: Retrospective review of consecutive procedures.

Setting: Tertiary referral otorhinolaryngology centre.

Patients: Twenty-three eyes of 14 patients.

Intervention: Endoscopic transnasal orbital decompression.

Main outcome measures: Proptosis reduction, intra-ocular pressure reduction, exposure keratitis reduction, visual acuity improvement, and complication rate.

Results: There were no surgical complications for the 23 orbital decompressions. Proptosis reduction was achieved in 22 (96%) eyes. The mean proptosis reduction was 4.6 mm (median, 5.0 mm; range, 1.0-8.0 mm). The postoperative intra-ocular pressure decreased after surgical decompression in 20 (87%) eyes with a mean reduction of 11 mm Hg (median, 6 mm Hg; range, 1-35 mm Hg). Of the 15 eyes with incomplete closure of the eyelid before the operation, 11 (73%) had complete eyelid closure after surgical decompression. Of the other four eyes that had incomplete closure, the gaps were reduced. The visual acuity was improved for 16 (70%) eyes with a median improvement of 3 Snellen lines (range, 1-8 lines).

Conclusion: Endoscopic transnasal medio-inferior orbital wall decompression is a safe and adequate treatment for thyrotoxic orbitopathy with proptosis, exposure keratitis, and visual loss.