Optic Neuropathy of Graves's Disease

Abstract

Patients with ophthalmopathy of Graves's disease accompanied by impaired visual acuity and visual-field defects were treated by transantral (10 patients) or transfrontal (nine patients) orbital decompression (one patient was treated by both approaches). The two procedures seemed equally effective in improving visual acuity and visual-field defects, and both induced a mean recession of proptosis of 4 mm. Diplopia developed after operation in three patients with transantral but not in any with transfrontal decompression. The transantral procedure is accomplished without an externally visible incision; the transfrontal operation requires head shaving and bilateral frontal craniotomies. Hospitalization time was shorter in the transantral (five to six days) than in the transfrontal group (10 to 12 days). The transfrontal procedure is indicated when orbital exploration is advisable. The transantral procedure is contraindicated if the sinuses are infected. Seven patients apparently were never thyrotoxic — an unexpectedly large proportion of the total group. (N Engl J Med 290:70–75, 1974)