“Balanced” Orbital Decompression for Severe Graves' Orbitopathy: Technique with Treatment Algorithm

BACKGROUNDGraves' orbitopathy can produce proptosis, compressive optic neuropathy, and extraocular motility abnormalities; symptoms result from an increase in orbital volume due to expansion of intraorbital fat, with or without extraocular muscle involvement.STUDY DESIGNWe conducted a chart review of patients who underwent orbital decompression to treat Graves' orbitopathy. Twenty‐two orbits (13 patients) underwent orbital bone decompression, of which 17 orbits (9 patients) underwent the combined medial and lateral “balanced” decompression.RESULTSAll patients had significant improvement with an average decrease in proptosis of 5.9 mm in the balanced decompression group. Restoration of normal optic nerve function was achieved in all patients with compressive optic neuropathy. Diplopia was noted in 4 patients (30.7%) preoperatively. Two patients had new postoperative diplopia (15.35%).CONCLUSIONIn our experience, “balanced” decompression results in a reduction of proptosis and improved optic nerve function and has a low incidence of complications.