Graded, Guided, and Guarded Ophthalmic Approaches to Endoscopic Medial Wall Orbital Decompression

This video demonstrates how endoscopic medial orbital decompression is performed using orbital instruments without a powered sinus debrider. "Graded" and "guided" (under image-guidance) bone and soft tissue removal can be tailored by surgical indications:

• limited, retrobulbar opening of lamina papyracea and periorbita for mild to moderate proptosis
• standard full medial wall removal for compressive optic neuropathy
• extended inferomedial decompression including posterior ethmoidomaxillary strut and orbital floor for additional proptosis reduction
• repeated operation opening up to anterior sphenoid sinus for persistent or recurrent optic neuropathy

Complications can be "guarded" by limiting decompression to retrobulbar (diplopia), endoscopically enlarging maxillary antrum (sinusitis), and real-time monitoring with navigation (skull-based injury).

Finally, suction punch can be used to remove orbital fat manually under direct visualization in a controlled manner.