Pure Endoscopic Orbital Decompression in Graves’ Orbitopathy: A Comprehensive Retrospective Analysis of Objective and Subjective Outcomes

<b>Background and Objectives:</b> Graves' orbitopathy (GO) is an autoimmune disease that can cause severe visual dysfunction and cosmetic impairment. Pure endoscopic orbital decompression reduces proptosis with minimal external morbidity. However, studies integrating both objective outcomes and patient-reported quality of life remain limited. This study aimed to analyze objective and subjective outcomes of pure endoscopic orbital decompression in inactive GO. <b>Materials and Methods:</b> We retrospectively reviewed 20 consecutive patients with severe inactive GO who underwent pure endoscopic transnasal orbital decompression between 2020 and 2023. Proptosis was measured using Hertel exophthalmometry, and quality of life was assessed with the disease-specific GO-QoL (Graves' Ophthalmopathy Quality of Life) questionnaire (functional and appearance subscales). Minimum follow-up was 12 months. Pre- and postoperative changes were compared using paired <i>t</i> tests. <b>Results:</b> A total of 26 orbits were operated on. Mean proptosis decreased by 3.85 mm (<i>p</i> < 0.001). GO-QoL improved in the functional (+3.27, <i>p</i> < 0.001) and appearance (+5.77, <i>p</i> < 0.001) subscales. No complications or new/worsened diplopia were observed. <b>Conclusions:</b> Pure endoscopic orbital decompression is a safe and effective technique to reduce proptosis in inactive GO. Although quality-of-life scores improved significantly, the clinical relevance may vary, highlighting the need to integrate objective outcomes and patient perception when evaluating surgical results.