Skip to main content

Outcomes of endoscopic orbital decompression for graves’ ophthalmopathy



We assess outcomes of endoscopic orbital decompression for Graves’ ophthalmopathy.


A review of endoscopic orbital decompressions of the medial and partial inferior wall between July 2004 and July 2017 was carried out. Outcome was assessed by comparing pre- and post-operative measurements of exophthalmometry and visual acuity. Results were evaluated by repeated measures analysis of variance.


A total of 41 orbits in 25 patients underwent endoscopic orbital decompression for Graves’ ophthalmopathy in the time period; however, six orbits in three patients had insufficient data for inclusion. Eleven patients required concurrent septoplasty to allow access. Measurements were taken at a mean of 11 days, 32 days, and 95 days post-operatively. Reduction in mean proptosis was 2.81 mm at 1-month post-decompression and 3.26 mm at 3 months. There was no significant difference between those treated for compressive optic neuropathy compared with those treated for cosmetic reasons. Colour vision by Ishihara plate improved significantly by a mean score of 2.67 post-operatively. Using LogMAR conversion for visual acuity, measured by a best-corrected Snellen chart, improvement of 0.18 was achieved at 1-month post-decompression, equivalent to approximately two lines on the Snellen chart. There was minimal (0.04) further improvement at 3 months. The improvement in visual acuity was greater in cases treated for compressive optic neuropathy than cosmesis, but this did not reach statistical significance (p = 0.06). Three cases required revision surgery. Diplopia disimproved or developed in four cases and squint surgery was required in three cases.


Endoscopic orbital decompression offers an effective, safe and minimally invasive treatment for Graves’ ophthalmopathy. There is a trend towards continued improvement in outcomes over the course of 3 months post-operatively.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Graves R (1835) Newly observed affection of the thyroid: clinical lectures. Lond Med Surg J 7:516–517

    Google Scholar 

  2. Brent GA (2008) Clinical practice. Graves’ disease The New England journal of medicine 358:2594–2605.

    CAS  Article  PubMed  Google Scholar 

  3. Boboridis KG, Bunce C (2011) Surgical orbital decompression for thyroid eye disease. The Cochrane database of systematic reviews, p CD007630.

    Book  Google Scholar 

  4. Wiersinga WM, Bartalena L (2002) Epidemiology and prevention of Graves’ ophthalmopathy. Thyroid 12:855–860.

    Article  PubMed  Google Scholar 

  5. Lazarus JH (2012) Epidemiology of Graves’ orbitopathy (GO) and relationship with thyroid disease. Best Pract Res Clin Endocrinol Metab 26:273–279.

    Article  PubMed  Google Scholar 

  6. Bartalena L, Baldeschi L, Dickinson AJ et al (2008) Consensus statement of the European group on Graves’ orbitopathy (EUGOGO) on management of Graves’ orbitopathy. Thyroid 18:333–346.

    Article  PubMed  Google Scholar 

  7. Wiersinga WM (2017) Advances in treatment of active, moderate-to-severe Graves’ ophthalmopathy. Lancet Diabetes Endocrinol 5:134–142.

    CAS  Article  PubMed  Google Scholar 

  8. Barrio-Barrio J, Sabater AL, Bonet-Farriol E et al (2015) Graves’ ophthalmopathy: VISA versus EUGOGO classification, assessment, and management. J Ophthalmol 2015:249125.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Boboridis KG, Gogakos A, Krassas GE (2010) Orbital fat decompression for Graves’ orbitopathy: a literature review. Pediatric Endocr Rev 7(Suppl 2):222–226

    Google Scholar 

  10. Kennedy DW, Goodstein ML, Miller NR et al (1990) Endoscopic transnasal orbital decompression. Archives Otolaryngology--Head & Neck Surg 116:275–282

    CAS  Article  Google Scholar 

  11. Gulati S, Ueland HO, Haugen OH et al (2015) Long-term follow-up of patients with thyroid eye disease treated with endoscopic orbital decompression. Acta Ophthalmol 93:178–183.

    Article  PubMed  Google Scholar 

  12. Jernfors M, Valimaki MJ, Setala K et al (2007) Efficacy and safety of orbital decompression in treatment of thyroid-associated ophthalmopathy: long-term follow-up of 78 patients. Clin Endocrinol 67:101–107.

    Article  Google Scholar 

  13. Malik R, Cormack G, MacEwen C et al (2008) Endoscopic orbital decompression for dyscosmetic thyroid eye disease. J Laryngol Otol 122:593–597.

    CAS  Article  PubMed  Google Scholar 

  14. Hernandez-Garcia E, San-Roman JJ, Gonzalez R et al (2017) Balanced (endoscopic medial and transcutaneous lateral) orbital decompression in Graves’ orbitopathy. Acta Otolaryngol 137:1183–1187.

    Article  PubMed  Google Scholar 

  15. Leong SC, White PS (2010) Outcomes following surgical decompression for dysthyroid orbitopathy (Graves’ disease). Curr Opin Otolaryngo Head Neck Surg 18:37–43.

    Article  Google Scholar 

  16. Leong SC, Karkos PD, Macewen CJ et al (2009) A systematic review of outcomes following surgical decompression for dysthyroid orbitopathy. Laryngoscope 119:1106–1115.

    Article  PubMed  Google Scholar 

  17. Borumandi F, Hammer B, Kamer L et al (2011) How predictable is exophthalmos reduction in Graves’ orbitopathy? A review of the literature. Br J Ophthalmol 95:1625–1630.

    Article  PubMed  Google Scholar 

  18. Rootman DB (2018) Orbital decompression for thyroid eye disease. Surv Ophthalmol 63:86–104.

    Article  PubMed  Google Scholar 

  19. Cheng AM, Wei YH, Tighe S et al (2018) Long-term outcomes of orbital fat decompression in Graves’ orbitopathy. Br J Ophthalmol 102:69–73.

    Article  PubMed  Google Scholar 

  20. Chang M, Baek S, Lee TS (2013) Long-term outcomes of unilateral orbital fat decompression for thyroid eye disease. Graefe’s archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle. Ophthalmologie 251:935–939.

    Article  Google Scholar 

  21. Ulualp SO, Massaro BM, Toohill RJ (1999) Course of proptosis in patients with Graves’ disease after endoscopic orbital decompression. Laryngoscope 109:1217–1222.

    CAS  Article  PubMed  Google Scholar 

  22. Kingdom TT, Davies BW, Durairaj VD (2015) Orbital decompression for the management of thyroid eye disease: an analysis of outcomes and complications. Laryngoscope 125:2034–2040.

    Article  PubMed  Google Scholar 

  23. Unal M, Leri F, Konuk O et al (2003) Balanced orbital decompression combined with fat removal in Graves ophthalmopathy: do we really need to remove the third wall? Ophthalmic Plast Reconstr Surg 19:112–118.

    Article  PubMed  Google Scholar 

  24. Graham SM, Brown CL, Carter KD et al (2003) Medial and lateral orbital wall surgery for balanced decompression in thyroid eye disease. Laryngoscope 113:1206–1209.

    Article  PubMed  Google Scholar 

  25. Sellari-Franceschini S, Dallan I, Bajraktari A et al (2016) Surgical complications in orbital decompression for Graves’ orbitopathy. Acta Otorhinolaryngologica Italica : Organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale 36:265–274.

    CAS  Article  Google Scholar 

  26. Wu CY, Niziol LM, Musch DC et al (2017) Thyroid-related orbital decompression surgery: a multivariate analysis of risk factors and outcomes. Ophthal Plast Reconstr Surg 33:189–195.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wu W, Selva D, Bian Y et al (2015) Endoscopic medial orbital fat decompression for proptosis in type 1 graves orbitopathy. Am J Ophthalmol 159:277–284.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Robbie S. R. Woods.

Ethics declarations

This study was approved by the Royal Victoria Eye and Ear Hospital Clinical Audit Committee. All patient data were kept anonymous and encrypted throughout.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Woods, R.S.R., Pilson, Q., Kharytaniuk, N. et al. Outcomes of endoscopic orbital decompression for graves’ ophthalmopathy. Ir J Med Sci 189, 177–183 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Cosmesis
  • Endoscopic surgery
  • Graves’ ophthalmopathy
  • Optic nerve
  • Orbital decompression