AAO 2019 Video Program

    In this video we demonstrate how endoscopic orbital decompression (EOD) can be personalized and performed safely by ophthalmologists using orbital but not powered instruments in a graded and guided manner (under image guidance). After ethmoidectomy, medial wall and periosteum opening can be tailored by indications as follows: (1) limited, retrobulbar-only EOD for mild to moderate (2-3 mm) proptosis reduction, (2) standard EOD for compressive optic neuropathy (CON), (3) extended EOD, removing also posterior ethmoido-maxillary strut and floor for additional proptosis reduction (4-5 mm) and (4) repeated EOD up to the sphenoid sinus and inferior orbital fissure for persistent or recurrent CON. Complications can be “guarded” by limiting to retrobulbar EOD (diplopia), endoscopic maxillary antrostomy (sinusitis) and real-time navigation (skull-base injury). Finally, suction punch can be used to manually remove orbital fat under direct endoscopic visualization in a controlled manner.