Surgical treatment of Graves orbitopathy: a modified balanced technique

Surgery has a definite place in the treatment of the exophthalmos in Graves orbitopathy. Thirty-two patients with Graves orbitopathy were operated on. Twenty patients received a three-wall orbital decompression. Five patients received a two-wall orbital decompression with lipectomy and seven patients underwent a two-wall orbital decompression combined with an advancement osteotomy of the supra-, lateral- and infra-orbital rim and a lipectomy. In cases with Hertel values less than 25mm, the two-wall orbital decompression with removal of orbital fat, and in cases with Hertel values more than 25mm, the two-wall orbital decompression with lipectomy and an advancement osteostomy of the supra-, lateral- and infraorbital rim is the treatment of choice.