“Balanced” Orbital Decompression for Severe Graves' Orbitopathy: Technique with Treatment Algorithm

BACKGROUND: Graves' orbitopathy can produce proptosis, compressive optic neuropathy, and extraocular motility abnormalities; symptoms result from an increase in orbital volume due to expansion of intraorbital fat, with or without extraocular muscle involvement. STUDY DESIGN: We conducted a chart review of patients who underwent orbital decompression to treat Graves' orbitopathy. Twenty-two orbits (13 patients) underwent orbital bone decompression, of which 17 orbits (9 patients) underwent the combined medial and lateral “balanced” decompression. RESULTS: All patients had significant improvement with an average decrease in proptosis of 5.9 mm in the balanced decompression group. Restoration of normal optic nerve function was achieved in all patients with compressive optic neuropathy. Diplopia was noted in 4 patients (30.7%) preoperatively. Two patients had new postoperative diplopia (15.35%). CONCLUSION: In our experience, “balanced” decompression results in a reduction of proptosis and improved optic nerve function and has a low incidence of complications.

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Orbital Volumetry in Graves' Orbitopathy: Muscle and Fat Involvement in relation to Dysthyroid Optic Neuropathy

ISRN Ophthalmology ◽

10.1155/2014/435276 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Moug Al-Bakri ◽

Åse Krogh Rasmussen ◽

Carsten Thomsen ◽

Peter Bjerre Toft

Keyword(s):

Optic Nerve ◽

Optic Neuropathy ◽

Ct Scans ◽

Orbital Decompression ◽

Orbital Fractures ◽

Relative Significance ◽

Dysthyroid Optic Neuropathy ◽

Orbital Fat ◽

Graves Orbitopathy ◽

Fat Volume

Purpose. We wanted to investigate the relative significance of fat and muscle enlargement in the development of dysthyroid optic neuropathy (DON) in Graves’ orbitopathy (GO). Methods. Preoperative coronal CT scans of 13 patients with and without DON who subsequently underwent orbital decompression were retrospectively analyzed. Thirteen patients imaged for unilateral orbital fractures served as controls. Results. The retrobulbar muscle volume was 2.1 ± 0.5 cm3 (mean ± SD) in controls, 4.3 ± 1.5 cm3 in GO without DON, and 4.7 ± 1.7 cm3 in GO with DON. The retrobulbar fat volume was 5.4 ± 1.6 cm3 in controls, 8.7 ± 8.0 cm3 in GO without DON, and 9.4 ± 3.1 cm3 in GO with DON. The muscle and fat volumes were higher in patients with GO than in controls (P<0.001), but the volumes in orbits with and without DON were not significantly different. The volume of the optic nerve were similar in the 3 groups. The number of apical, coronal 2 mm thick slices with no fat was 2.9 ± 0.9 in normal orbits, it was 4.1 ± 1.0 in GO orbits without DON and 5.3 ± 0.8 in GO orbits with DON (P=0.007). Conclusion. Apical muscle enlargement may be more important than orbital fat enlargement in the development of DON. However, the fact that apical crowding and muscle enlargement also occur in orbits without DON suggests that other factors also play a role in the development of DON.

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Transcranial Orbital Decompression for Progressive Compressive Optic Neuropathy After 3-Wall Decompression in Severe Graves’ Orbitopathy.

Ophthalmic Plastic and Reconstructive Surgery ◽

10.1097/iop.0000000000000052 ◽

2014 ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Chad M. Bingham ◽

Matheson A. Harris ◽

Ira A. Vidor ◽

Charles L. Rosen ◽

John V. Linberg ◽

...

Keyword(s):

Optic Neuropathy ◽

Orbital Decompression ◽

Compressive Optic Neuropathy ◽

Graves Orbitopathy

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Compressive Optic Neuropathy Caused by Orbital Non-Hodgkin's Lymphoma

Case Reports in Ophthalmological Medicine ◽

10.1155/2012/894062 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3

Author(s):

Mohammed M. Ziaei ◽

Hadi Ziaei

Keyword(s):

Optic Nerve ◽

Paranasal Sinus ◽

Optic Neuropathy ◽

Hodgkin’S Lymphoma ◽

Visual Loss ◽

Hodgkin's Lymphoma ◽

Compressive Optic Neuropathy ◽

Acute Visual Loss ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma

Purpose. To present a unique case of Non-Hodgkin’s-Lymphoma- (NHL) associated compressive optic neuropathy.Method. An 89-year-old male presenting with acute unilateral visual loss and headache.Results. Patient was initially diagnosed with occult giant cell arteritis; however after visual acuity deteriorated despite normal inflammatory markers, an urgent MRI scan revealed an extensive paranasal sinus mass compressing the optic nerve.Conclusion. Paranasal sinus malignancies occasionally present to the ophthalmologist with signs of optic nerve compression and must be included in the differential diagnosis of acute visual loss.

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Compressive Optic Neuropathy

Neuro-Ophthalmology ◽

10.1093/med/9780195390841.003.0004 ◽

2011 ◽

pp. 21-24

Author(s):

Matthew J. Thurtell ◽

Robert L. Tomsak ◽

Robert B. Daroff

Keyword(s):

Optic Nerve ◽

Optic Neuropathy ◽

Vision Loss ◽

Clinical Signs ◽

Monocular Vision ◽

Compressive Optic Neuropathy ◽

Imaging Characteristics ◽

Optic Nerve Sheath Meningioma ◽

Common Causes ◽

Optic Nerve Compression

Optic nerve compression results in progressive, and often painless, monocular vision loss. In this chapter, we review the clinical signs and common causes of compressive optic neuropathy. We discuss in more detail the imaging characteristics and management of optic nerve sheath meningioma.

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Comparison of Optic Disc Morphology of Optic Nerve Atrophy between Compressive Optic Neuropathy and Glaucomatous Optic Neuropathy

PLoS ONE ◽

10.1371/journal.pone.0112403 ◽

2014 ◽

Vol 9 (11) ◽

pp. e112403 ◽

Cited By ~ 8

Author(s):

Masayuki Hata ◽

Kazuaki Miyamoto ◽

Akio Oishi ◽

Yukiko Makiyama ◽

Norimoto Gotoh ◽

...

Keyword(s):

Optic Nerve ◽

Optic Disc ◽

Optic Neuropathy ◽

Glaucomatous Optic Neuropathy ◽

Optic Nerve Atrophy ◽

Compressive Optic Neuropathy

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Compressive Optic Neuropathy and Repeat Orbital Decompression

Ophthalmic Plastic and Reconstructive Surgery ◽

10.1097/iop.0000000000000356 ◽

2015 ◽

Vol 31 (5) ◽

pp. 385-390 ◽

Cited By ~ 18

Author(s):

Courtney Y. Kauh ◽

Shivani Gupta ◽

Raymond S. Douglas ◽

Victor M. Elner ◽

Christine C. Nelson ◽

...

Keyword(s):

Optic Neuropathy ◽

Orbital Decompression ◽

Compressive Optic Neuropathy

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Transcaruncular Orbital Decompression: An Alternative Procedure for Graves Ophthalmopathy With Compressive Optic Neuropathy

American Journal of Ophthalmology ◽

10.1016/j.ajo.2006.07.016 ◽

2006 ◽

Vol 142 (4) ◽

pp. 711-712 ◽

Cited By ~ 2

Author(s):

C. Robert Bernardino ◽

Eli L. Chang ◽

Peter A.D. Rubin

Keyword(s):

Optic Neuropathy ◽

Orbital Decompression ◽

Alternative Procedure ◽

Compressive Optic Neuropathy ◽

Graves Ophthalmopathy

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Compressive Optic Neuropathy

Neuro-Ophthalmology ◽

10.1093/med/9780190603953.003.0004 ◽

2019 ◽

pp. 21-24

Author(s):

Matthew J. Thurtell ◽

Robert L. Tomsak

Keyword(s):

Optic Nerve ◽

Clinical Features ◽

Optic Neuropathy ◽

Vision Loss ◽

Capillary Hemangioma ◽

Optic Nerve Sheath ◽

Optic Glioma ◽

Compressive Optic Neuropathy ◽

Nerve Sheath ◽

Optic Nerve Sheath Meningioma

Optic nerve compression results in progressive, and often painless, vision loss. In this chapter, we begin by reviewing the clinical features of anterior and posterior compressive optic neuropathy. We next review the common causes of compressive optic neuropathy, which include orbital tumors (e.g., optic nerve sheath meningioma, optic glioma, and capillary hemangioma), orbital infection, orbital inflammation, intracranial tumors (e.g., pituitary macroadenoma, meningioma, and craniopharyngioma), aneurysm, and thyroid eye disease. We then review the workup for compressive optic neuropathy and discuss the various imaging options. Lastly, we discuss the clinical features, imaging findings, management options, and prognosis for visual recovery for patients with optic nerve sheath meningioma.

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Compressive Optic Neuropathy due to a Large Onodi Air Cell: A Case Report and Literature Review

Allergy & Rhinology ◽

10.2500/ar.2016.7.0178 ◽

2016 ◽

Vol 7 (4) ◽

pp. ar.2016.7.0178 ◽

Cited By ~ 2

Author(s):

Wendy Yen Nee See ◽

Kala Sumugam ◽

Visvaraja Subrayan

Keyword(s):

Visual Acuity ◽

Case Report ◽

Optic Nerve ◽

Optic Neuropathy ◽

Compressive Optic Neuropathy ◽

Loss Of Vision ◽

Counting Finger ◽

Onodi Cell ◽

Superior Margin ◽

Junior Residents

Background To report an unusual case of compressive optic neuropathy secondary to a large onodi air cell. Method Case report. Results A 50 year-old gentlemen presented to the eye clinic with left eye painless loss of vision for one day. Visual acuity was counting finger in the left eye with a positive relative afferent pupillary defect (RAPD). Dilated left fundus examination revealed a pale optic disc. A computed tomography of orbit and brain showed a large left sphenoid sinus with onodi-cell-like projection on the left superior margin of left optic canal impinging on the left optic nerve. He was referred to the otorhinolaryngology team and subsequently underwent left optic nerve decompression. Post-operatively, his left visual acuity improved to 6/60 with reversal of RAPD. Conclusion There are many causes of optic neuropathy and compressive optic neuropathy due to large onodi air cell is uncommon. Acute unilateral loss of vision heralds from a multitude of sinister causes and junior residents should be vigilant that onodi air cell pneumotisation could be one of them.

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