Endonasal methods of correction in the treatment of endocrine ophthalmopathy

Endocrine ophthalmopathy is a severe complication of thyrotoxicosis that significantly reduces patients’ quality of life and may lead to persistent visual function impairment. Objective — to scientifically substantiate, analyze, and summarize modern endonasal correction methods in the treatment of endocrine ophthalmopathy, assessing their effectiveness, safety, and prospects for implementation in clinical practice. Materials and methods. The study included 60 patients with confirmed endocrine ophthalmopathy aged 12 to 64 years (36 women — 60%, 24 men — 40%), with a mean age of 42.7±10.8 years. Inclusion criteria were diagnosed ophthalmopathy with disease activity CAS ≥ 3, exophthalmos ranging from mild to severe, ineffectiveness of previous therapy, or the necessity of surgical correction. Exclusion criteria included acute infections, uncontrolled diabetes mellitus, severe cardiovascular pathology, coagulopathies, and pregnancy. The applied correction methods included endoscopic transnasal orbital decompression, medial and extended endonasal decompression, minimally invasive approaches, endonasal drug delivery, and balloon decompression. All patients underwent comprehensive clinical and instrumental examination, including Hertel exophthalmometry, CAS evaluation, ophthalmoscopy, perimetry, and computed tomography. Statistical analysis was performed using SPSS 26.0 and Statistica 10.0 software with χ2, Student’s t-test, Mann–Whitney test, and Pearson’s and Spearman’s correlation methods. Results. It was found that the choice of endonasal correction method depends on the severity of exophthalmos, disease activity, and the presence of optic nerve compression. The highest efficacy in severe cases was demonstrated by endoscopic transnasal orbital decompression and its modifications, while in milder forms, endonasal steroid delivery or balloon decompression proved more appropriate. All methods showed statistically significant improvement (p < 0.05), confirming the feasibility of using endonasal technologies in the comprehensive treatment of endocrine ophthalmopathy. Conclusions. The choice of endonasal correction method for EO directly depends on the severity of exophthalmos, the presence of optic nerve compression, disease activity, and the effectiveness of previous therapy. The most common indication — severe exophthalmos and optic nerve compression — requires the use of endoscopic transnasal decompression, especially if drug therapy has been ineffective.