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Jeffrey J. Hurwitz, MD, FRCS(C); Derek Birt, FRCS(C)

Arch Ophthalmol. 1985;103(5):660-665.

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.

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

Footnotes
Accepted for publication Dec 11, 1984.

Reprint requests to the Department of Ophthalmology, Sunnybrook Medical Centre, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5 (Dr Hurwitz).

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