Orbit: Two-Wall (Medial and Floor) Decompression

Thyroid eye disease causes orbital congestion and proptosis due to extraocular muscle and orbital fat enlargement with fibrosis. Proptosis, in turn, can lead to compressive optic neuropathy and exposure keratopathy. Treatment of proptosis from thyroid eye disease consists of orbital decompression, taking advantage of the adjacent sinus spaces to expand orbital volume. For cases of moderate proptosis, medial wall and floor decompression can be done, taking advantage of the adjacent ethmoid sinuses and maxillary sinus, respectively. Patients should be educated about the risks, benefits, and alternatives of the procedure including bleeding, infection, loss of vision, double vision, and need for more surgery.