Endoscopic orbital decompression

Endoscopic orbital decompression allows for improved visualization of key anatomical landmarks, lower complication rate, and avoidance of external facial incisions when compared with open approaches. The most common indications for endoscopic orbital decompression are related to the symptoms of Graves orbitopathy. This technique may also be used to access orbital tumors located medial to the optic nerve, as part of anterior skull base tumor resection when tumor extends over the superomedial orbit, or in the treatment of orbital hematoma and subperiosteal abscesses. This article reviews pertinent surgical anatomy and describes the authors׳ preferred technique for orbital decompression including technical pearls that have improved our outcomes and efficiency. Although image guidance is a useful adjunct for these procedures, these operations represent advanced endoscopic techniques and should be performed by experienced endoscopic sinonasal surgeons.