Endoscopic transnasal orbital decompression for thyrotoxic orbitopathy

APW Yuen, KYW Kwan, E Chan, AWC Kung, KSL Lam
Division of Otorhinolaryngology, Department of Surgery, Queen Mary Hospital

OBJECTIVE. To evaluate the efficacy of endoscopic transnasal orbital decompression alone for thyrotoxic orbitopathy.

DESIGN. Retrospective review of consecutive procedures.

SETTING. Tertiary referral otorhinolaryngology centre.

PATIENTS. Twenty-three eyes of 14 patients.

INTERVENTION. Endoscopic transnasal orbital decompression.

MAIN OUTCOME MEASURES. Proptosis reduction, intra-ocular pressure reduction, exposure keratitis reduction, visual acuity improvement, and complication rate.

RESULTS. There were no surgical complications for the 23 orbital decompressions.Proptosis reduction was achieved in 22 (96%) eyes. The mean proptosis reduction was 4.6 mm (median, 5.0 mm; range, 1.0-8.0 mm). The postoperative intra-ocular pressure decreased after surgical decompression in 20 (87%) eyes with a mean reduction of 11 mm Hg (median, 6 mm Hg; range, 1-35 mm Hg). Of the 15 eyes with incomplete closure of the eyelid before the operation, 11 (73%) had complete eyelid closure after surgical decompression. Of the other four eyes that had incomplete closure, the gaps were reduced. The visual acuity was improved for 16 (70%) eyes with a median improvement of 3 Snellen lines (range, 1-8 lines).

CONCLUSION. Endoscopic transnasal medio-inferior orbital wall decompression is a safe and adequate treatment for thyrotoxic orbitopathy with proptosis, exposure keratitis, and visual loss.

Hong Kong Med J 2002;8:406-10

Key words: Endoscopes; Exophthalmos; Keratitis; Orbital diseases; Thyrotoxicosis