Surgical Advances in Orbital Decompression Orbital Fat Decompression - Endoscopic Medial Decompression Internal Orbital Contouring

Treatment of proptosis in the stable phase of Graves’ orbitopathy differs significantly from that in the acute inflammatory phase. The treatment paradigm employed at the Harkness Eye Institute, reserves surgical decompression in the acute phase for those cases of optic neuropathy that fail to respond to orbital radiotherapy or when radiotherapy is contraindicated. Owing to the 90% success rate of orbital radiotherapy, stable phase orbital decompressions are most commonly performed to relieve exposure keratitis, spontaneous globe prolapse and disfigurement. As a consequence, our tolerance for adverse effects resulting from the surgery is low. In an effort to limit the surgical complications, we have adopted a graded approach to orbital decompression. The approach tailors the decompressive procedure to the clinical findings and radiographic analysis of the orbital anatomy. Tailoring surgery to the individual patient’s orbital anatomy rather than performing a uniform operation on all patients we believe results in more consistent outcomes. To understand how this approach fits into the evolution of orbital decompressive surgery it is valuable to review the interval milestones upon which it is based.