The primary indication for this procedure is dysthy-roid eye disease, either for cosmetic reasons or when vision is deteriorating and steroids and radiotherapy have not controlled this (Fig. 14.40a, b). An endoscopic approach can decompress both the medial and inferior aspects of the eye. In experienced hands, it is possible to obtain better access to the orbital apex and even to decompress the optic nerve endoscopically (Gormley et al., 1997) (Fig. 14.41 a-d). Benign bony tumors can also threaten the viability of the optic nerve and justify removal.
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