title: Surgical treatment of dysthyroid orbitopathy.
abstract: OBJECTIVE
  Orbital decompression for dysthyroid orbitopathy may be performed by open or transnasal endoscopic approaches; however, criteria for the selection of the appropriate surgical technique have not been well-defined. Our goal was to compare the surgical outcomes of orbital decompression techniques employed by the otolaryngology and ophthalmology services at a single institution, so as to clarify the indications and develop a rationale for optimal management.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care academic medical center.
  
  
  METHODS
  Orbital decompressions on 112 orbits of 69 patients from 2001 to 2008 at a tertiary care academic medical center.
  
  
  RESULTS
  The majority (83%) of orbital decompressions were performed primarily for proptosis, whereas the remainder was indicated for dysthyroid optic neuropathy. Maximum reduction of proptosis was achieved with an endoscopic medial and inferior orbital wall decompression combined with a lateral orbitotomy with fat removal. The average reduction in proptosis was 7.4 mm+/-2.3 mm (primary surgery for proptosis). The endoscopic approach alone provided the least average proptosis reduction but was highly successful in the treatment of dysthyroid optic neuropathy.
  
  
  CONCLUSIONS
  A three-wall decompression using a combined endoscopic and external approach provides the greatest amount of decompression. The endoscopic approach as a single modality is best suited for patients with mild proptosis and for patients with dysthyroid optic neuropathy. Cooperation between otolaryngology and ophthalmology achieves the best care for patients with thyroid eye disease who require surgical treatment.
authors: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD 21287-0910, USA.
authors: Eugene A
authors: EA
authors: Chu
authors: Neil R
authors: NR
authors: Miller
authors: Michael P
authors: MP
authors: Grant
authors: Shannath
authors: S
authors: Merbs
authors: Ralph P
authors: RP
authors: Tufano
authors: Andrew P
authors: AP
authors: Lane
mesh_terms: D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome