[Skip to Content]
[Skip to Content Landing]
Article
May 1985

An Individualized Approach to Orbital Decompression in Graves' Orbitopathy

Author Affiliations

From the Departments of Ophthalmology (Dr Hurwitz) and Otolaryngology (Dr Birt), Sunnybrook Hospital, University of Toronto.

Arch Ophthalmol. 1985;103(5):660-665. doi:10.1001/archopht.1985.01050050052016
Abstract

• With better understanding of the various techniques available for orbital decompression, the indications for surgical decompression in Graves' orbitopathy are now less rigid. Decompressions may be performed for (1) prolonged orbital congestion and pain, (2) orbital problems resistant to steroid treatment, (3) orbital problems where there have been steroid complications, (4) severe corneal exposure that cannot be treated with lidlengthening surgery, and (5) the standard indication—Graves' optic neuropathy. Assessment of muscle size by computed tomographic scanning and ultrasound, as well as the measurement of orbital pressure, are important advances in the assessment of these patients. The lateral approach produces less strabismus and allows for exophthalmos reduction, especially if fascia temporalis is incised and if part of that muscle is removed. The inferomedial approach is advisable in patients with severe posterior optic neuropathy caused by apical crowding of the enlarged muscles, particularly the medial rectus. The two approaches may be combined in severe cases.

References
1.
Hurwitz JJ, Rodgers KJA:  Presentation and management of post-operative lateral upper lid retraction in Graves' disease . Can J Ophthalmol 1983;18:329-332.
2.
Anderson RL, Linberg JV:  Transorbital approach to decompression in Graves' disease . Arch Ophthalmol 1981;99:120-124.Article
3.
Trobe JD, Glaser JS, Laflamme P:  Dysthyroid optic neuropathy: Clinical profile and rationale for management . Arch Ophthalmol 1978; 96:1199-1209.Article
4.
Kronlein RU:  Zur patholgie und operatuen Behandlung der Dermoid cystem der orbita . Beitr Klin Chir 1931;4:149-163.
5.
Naffziger HC:  Progressive exophthalmus following thyroidectomy: Its pathology and treatment . Ann Surg 1931;94:582-586.Article
6.
Sewall EC:  Operative control of progressive exophthalmos . Arch Otolaryngol 1936;24:621-624.Article
7.
Ogura JH, Walsh TE:  The trans-antral orbital decompression operation for progressive exophthalmos . Laryngoscope 1962;72:1078-1097.Article
8.
De Santo LW, Gorman CAS:  Orbital decompression in Graves' ophthalmopathy . Laryngoscope 1974;84:637.Article
9.
Kennerdell JS, Maroon JC:  An orbital decompression for severe thyroid exophthalmos . Ophthalmology 1982;89:467-472.Article
10.
Hurwitz JJ:  Tests of thyroid function important to the ophthalmologist . Can J Ophthalmol 1982;17:49-52.
11.
Shammas HJF, Minckler DS, Ogden C:  Ultrasound in early thyroid ophthalmopathy . Arch Ophthalmol 1980;98:277-279.Article
12.
Trokel SL, Jacobiec FA:  Correlation of CT scanning and pathological features of ophthalmic Graves' disease . Ophthalmology 1981;88:553-564.Article
13.
McGowan H, Hurwitz JJ, Gentles W:  Orbitotonography, the dynamic assessment of orbital tension: I. Results in subjects without known orbital disease . Can J Ophthalmol 1984;19:122-125.
14.
Trobe JD:  Optic nerve involvement in dysthyroidism . Ophthalmology 1981;88:488-492.Article
×