Endoscopic orbital decompression in dysthyroid orbitopathy

Abstract

Purpose: To evaluate the results of endoscopic orbital decompression and to make a technical description of the technique as well as comments on its possible complications.
Material and methods: Retrospective clinical study of all cases that underwent endoscopic orbital decompression for dysthyroid orbitopathy —as a main inclusion criterion— at Hospital José de San Martín of La Plata and Instituto Diagnóstico of La Plata from May to October 2018.
Results and discussion: Eight orbits from four patients were included. Three patients underwent surgery during the inactive stage and the remaining one, during the active stage, with compressive optic neuropathy and preoperative diplopia. Upon preoperative examination, all of them evidenced proptosis, three of them, bilateral exposure keratitis, and two, bilateral compressive optic neuropathy. Pre-and postoperative visual acuity remained unchanged in all cases, while the visual field defect improved in that who suffered from compressive optic neuropathy and color vision improved in all cases. The intraoperative complication reported was cerebrospinal fluid loss in one patient, whereas postoperative complications were the following: one case of spontaneously resolved lower nasolacrimal duct obstruction and two cases of sinusitis that also resolved spontaneously. With the nasal endoscopic approach there is no need for incisions in the conjunctiva that would generate more inflammation in active orbits.
Conclusion: Endoscopic orbital decompression can be performed with safety in active dysthyroid orbits and it is recommended in cases of compressive optic neuropathy since it allows for posterior access and, therefore, also for the subsequent decompression of the optic nerve.