The total rehabilitation of Graves' ophthalmopathy.

The concept of enlarging the orbital space in some patients with Graves' ophthalmopathy is usually acceptable. Controversial, however, are 1. the indications for enlarging the space, 2. the sequence of therapy that is most successful in restoring the eyes to near normal, and 3. the value of enlarging the orbital space and its relationship to non-surgical alternatives. Since 1669 a personal experience with more than 600 eyes in over 300 patients using the transantral route to orbital decompression has accumulated. From the surgical experience plus exposure to other non-surgically treated patients, a concept of total management of Graves' ophthalmopathy has evolved. The technical aspects of decompression through the sinuses are straight forward. The key to a satisfactory operation is a complete transantral ethmoidectomy; a less than complete ethmoidectomy will eliminate a predictable result. Transantral decompresssion as a single procedure will not successfully palliate all aspects of Graves' ophthalmopathy. Eye muscles and lid procedures in a timely sequence may be needed to complete rehabilitation. Perfect eyes are seldom obtained but the goal of satisfied patients is realistic. This essay will emphasize technical aspects, theoretical advantages, as well as pitfalls and limitations of the transantral orbital decompression.