Radical orbital decompression for severe dysthyroid exophthalmos.

A surgical technique is described for radical decompression of the orbit for dysthyroid exophthalmopathy. The operation should be considered in a patient with proptosis greater than 30 mm bilaterally or one with unilateral proptosis of 10 mm or more greater than the opposite eye. Such exophthalmos is frequently associated wih corneal exposure and ulceration, extreme cosmetic disfigurement, and optic neuropathy. The surgical procedure is performed through a 35-mm lateral skin incision and a lateral canthotomy with subconjunctival dissection. All four walls of the orbit are partially removed. This panorbital decompression procedure has been performed on five patients, with reduction of preoperative proptosis by as much as 17 mm. Complications were minimal. A review of the effectiveness of other orbital decompressive procedures is presented. It appears that the four-wall decompressive procedure offers the maximum degree of orbital reduction.