An individualized approach to orbital decompression in Graves' orbitopathy
J. J. Hurwitz and D. Birt
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
lid-lengthening 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.
