Abstract
Surgical decompression of the orbit may be necessary in dysthyroid patients with compressive optic neuropathy. Two-wall decompression with a trans-antral or a trans-conjunctival approach is commonly used. However, in some patients the initial improvement following this surgical procedure is not maintained. Although this may be due to disease progression, a variant of orbital anatomy can contribute to sub-optimal decompression. We report three cases in which recurrence of compressive optic neuropathy occurred following two-wall decompression. The sphenoidal sinus was placed anteriorly in these patients. Further decompression which included the lateral wall of the sphenoidal sinus resulted in improvement. An endoscopic approach provides superior access and visibility for decompression of the optic nerve into the sphenoidal sinus, and this approach may be the surgical treatment of choice in these cases.
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Neigel JM, Rootman J, Belkin RI, et al. Dysthyroid optic neuropathy: the crowded orbital apex syndrome. Ophthalmology 1988;95:1515–21.
Char DH . Thyroid eye disease, 1st ed. Baltimore: Williams and Wilkins, 1985.
Trobe JD . Optic nerve involvement in dysthyroidism. Ophthalmology 1981;88:488–92.
Anderson RL, Linberg JV . Transorbital approach to decompression in Graves disease. Arch Ophthalmol 1981;99:120–4.
Rootman J . Graves' orbitopathy. In: Diseases of the orbit. New York: JB Lippincott, 1988:265.
Fujii K, Chambers SM, Rhoton AL . Neurovascular relationships of the sphenoid sinus: a microsurgical study. J Neurosurg 1979;50:31–9.
Walsh TE, Ogura JH . Transnasal orbital decompression for malignant exophthalmos. Laryngoscope 1957;67:544–9.
Fatourechi V, Garrity JA, Bartley GB, Bergstralh EJ, DeSanto LW, Gorman CA . Graves' ophthalmopathy: results of transantral orbital decompression performed primarily for cosmetic indications. Ophthalmology 1994;101:938–42.
Garrity JA, Fatourechi V, Bergstrahl EJ, Bartley GB, Beatty CW, DeSanto LW, Gorman CA . Results of transantral orbital decompression in 428 patients with severe Graves' ophthalmopathy. Am J Ophthalmol 1993;116:533–47.
Warren JD, Spector JG, Burde R . Long term follow up and recent observations on 305 cases of orbital decompression for dysthyroid orbitopathy. Laryngoscope 1989;99:35–40.
Desanto LW . The total rehabilitation of Graves' ophthalmopathy. Laryngoscope 1986;90:1652–78.
Khan JA, Wagner DV, Tiojanco JK, Hoover LA . Combined transconjunctival and external approach for endoscopic orbital apex decompression in Graves' disease. Laryngoscope 1995;105:203–6.
Kennedy DW, Goodstein ML, Miller NR, Zinreich SJ . Endoscopic transnasal orbital decompression. Arch Otolaryngol Head Neck Surg 1990;116:275–82.
Mann W, Kahaly G, Lieb W, Rothoff T, Springhorn S . Orbital decompression for endocrine ophthalmopathy: the endonasal approach. Dev Ophthalmol 1993;25:142–50.
Neugebauer A, Nishino K, Neugebauer P, Konen W, Michel O . Effects of bilateral orbital decompression by an endoscopic endonasal approach in dysthyroid orbitopathy. Br J Ophthalmol 1996;80:58–62.
McCord CD Jr. Current trends in orbital decompression. Ophthalmology 1985;92:21–33.
Buus RB, Tse DT, Farris BK . Ophthalmic complications of sinus surgery. Ophthalmology 1990;97:612–8.
Stankiewicz JA . Complications in endoscopic intrana-sal ethmoidectomy: an update. Laryngoscope 1989;99:686–90.
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Gormley, P., Bowyer, J., Jones, N. et al. The sphenoidal sinus in optic nerve decompression. Eye 11, 723–726 (1997). https://doi.org/10.1038/eye.1997.184
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DOI: https://doi.org/10.1038/eye.1997.184
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