ABSTRACT
Orbital decompression surgery has changed a great deal from the days when it was performed primarily by neurosurgeons or otolaryngologists (1) and was a last option for patients with end-stage, severe thyroid-related orbitopathy. I believe it is appropriate to offer orbital decompression to patients with proptosis from thyroid related orbitopathy or non-Graves’ causes (2-5). Soft tissue repositioning over proptotic globes is esthetically and functionally suboptimal (Fig. 1). Traditional orbital decompression techniques that incorporate removal of the floor and medial wall are unbalanced, and have a rate of consecutive strabismus (as much as 30%) (6,7) that is unacceptable. I utilize a stepladder approach to orbital decompression that takes advantage of the lateral wall and intraconal orbital fat removal to minimize complications and maximize gradability, and allows me to more confidently approach orbital decompression in patients with small (but significant) amounts of proptosis.
