Surgical results of orbital decompression for malignant exophthalmos

During the past 75 years, several procedures for surgical correction of malignant exophthalmos have been described. In 1948, Ogura and Walsh first employed the transantral approach for decompression of the orbital contents into the ethmoid and maxillary sinuses. This technique requires controlled incision of the orbital periosteum to balance the eyes. In 120 patients described, recessions ranged from 2 to 12 mm. The eyes were balanced within 1 mm in 75 percent of patients. Preoperative visual acuity was usually preserved or improved except in patients who presented with panophthalmitis. Among the adjunctive ophthalmologic procedures required were levator tenotomy, tarsorrhaphy, entropion and ectropion repair, corneal transplants, and muscle‐balancing operations. There have been no instances of cerebrospinal fluid leak, meningitis, or optic nerve trauma. One patient bled from an aneurysm of the anterior cerebral artery during surgery. Two patients developed sinusitis postoperatively and two others required revisions in order to achieve a more satisfactory result.