Emergency Endoscopic Endonasal Optic Nerve Decompression for Graves' Orbitopathy

Graves' orbitopathy (GO) is a rare autoimmune disease that affects patients in their fourth to sixth decade, resulting in retro-orbital inflammation and hypertrophy of extraocular muscles and orbital fat. It is the most common disease affecting the orbit globally, and treatment options vary depending on the severity and activity status of the affection, ranging from local measures such as lubricating eye drops and patching, glucocorticoid eye drops, mydriatics, nonsteroid anti-inflammatory medications to systemic glucocorticoids, and emergency orbital decompression surgery. Immunotherapy and orbital radiation may as well be used as a treatment option even though their efficiency remains controversial. This paper presents the cases of two patients with GO who underwent endoscopic endonasal decompressive surgery. These patients' medical records, including symptoms and duration, clinical examination, imaging results, preoperative preparation, surgery steps, and postoperative course and outcomes, were collected from various specialties, including ophthalmologists and endocrinologists. We highlight the importance of a multidisciplinary approach to managing GO and its complications, with endoscopic endonasal techniques emerging as a minimally invasive and effective way to treat compressive optic nerve forms of the disease. However, the timing of decompression remains crucial, and early intervention is recommended to avoid sight-threatening ophthalmopathy when medical therapies are ineffective.