Orbital Decompression: Transnasal and Transethmoid Endoscopic Approaches

  • Howard L. LevineEmail author


Graves’ ophthalmopathy can be caused by excessive periorbital fat that puts pressure on the globe and adjacent structures resulting in proptosis, diplopia, and visual loss. The air-filled ethmoid and maxillary sinuses are adjacent to the bony orbit. Upon removal of the common walls between the orbit and these sinuses, there is a space provided into which the periorbital fat can prolapse relieving the intraorbital pressure. Performing the orbital decompression endoscopically through the ethmoid and maxillary sinuses permits a delicate and thorough procedure minimizing risk to important structures within the orbit.


Graves’ disease Thyroid ophthalmopathy Endoscopic orbital decompression 

Supplementary material

419986_5_En_51_MOESM1_ESM.mp4 (133.3 mb)
Video 51.1 MicroFrance®—Levine orbital decompression instrument set. Courtesy of Howard Levine and Integra MicroFrance Instruments, Cincinnati, Ohio (MP4 136500 kb)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cleveland Nasal Sinus & Sleep CenterClevelandUSA
  2. 2.Department of OtolaryngologyCleveland Clinic HillcrestClevelandUSA

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