THE CLINICAL AND ANATOMICAL RATIONALE OF BALANCED TRANSETHMOIDAL ENDOSCOPIC AND LATERAL ORBITAL BONE DECOMPRESSION IN THE PATIENTS PRESENTING WITH OPTIC NEUROPATHY CAUSED BY THYROID EYE DISEASE

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Aim. Of the present study was to substantiate the use of transethmoidal endoscopic orbital decompression in combination with lateral bone orbital decompression for TED. Material and Methods. We evaluated the possibility of surgicalaccess to orbital apex using the sectional material. The stage-by-stage dissection of the orbit and resection of the lateral and medialorbital walls were carried out. We studied the following factors: the extent (depth) of the created bony window; the degree of thecloseness of the bony window to the Zinn ring; the degree of mobility of orbital soft tissues; the probability of the damage to otheradjacent structures; the assessment of probable retraction of orbital fat and eye muscles surrounding soft tissues after resection of thebone orbital walls. Results and Discussion. The data obtained provided a basis for the application of bilateral (lateral and medial) bone decompression in thepatient presenting with optic neuropathy. The high effectiveness of this technique was demonstrated as apparent from the improvement of the visual functions and the reduction of exophthalmos. Conclusions. Balanced lateral and medial bony orbital decompression is shown to be the optimal method for the treatment of ON associated with TED.