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. 1996 Dec;80(12):1042–1045. doi: 10.1136/bjo.80.12.1042

Retrobulbar pressures measured during surgical decompression of the orbit.

A J Otto 1, L Koornneef 1, M P Mourits 1, L Deen-van Leeuwen 1
PMCID: PMC505699  PMID: 9059266

Abstract

AIMS/BACKGROUND: In Graves' ophthalmopathy the increase in volume of intraocular muscles and fat will cause elevated intraorbital pressure. In order to investigate the pressure levels involved, intraorbital pressure, or retrobulbar pressure (RBP) was measured continuously in orbits of patients with Graves' ophthalmopathy during surgical decompression. METHODS: Retrobulbar pressure was measured before and during surgical decompression using an intraorbitally applied pressure transducer. RESULTS: In eight patients with dysthyroid optic neuropathy (DON) RBPs between 17 and 40 mm Hg were recorded. At the end of the surgical procedure the mean RBP was reduced from 28.7 mm Hg to 18.7 mm Hg, the decrease ranging from 8 to 12 mm Hg, which showed a high correlation with the starting pressures (p < 0.001). In two cases without DON, pressures were 11 and 9 mm Hg. Forces exerted by spatula manipulation usually resulted in a RBP level of more than 70 mm Hg. CONCLUSIONS: This study shows that RBPs are markedly elevated in Graves' ophthalmopathy and that surgical decompression can result in a significant reduction in the intraorbital pressure. Optic nerve dysfunction in Graves' ophthalmopathy may not be caused exclusively by the direct pressure of swollen extraocular muscles upon the optic nerve, but also by a raised RBP. It is hypothesised that the damage inflicted upon the optic nerve can be caused in consequence by RBP induced incarceration of the nerve, compressed by surrounding periosteal lined orbital fat bulging posteriorly into the entrance of the optic canal.

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Selected References

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  1. Fells P. Orbital decompression for severe dysthyroid eye disease. Br J Ophthalmol. 1987 Feb;71(2):107–111. doi: 10.1136/bjo.71.2.107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Frueh B. R., Garber F., Grill R., Musch D. C. Positional effects on exophthalmometer readings in Graves' eye disease. Arch Ophthalmol. 1985 Sep;103(9):1355–1356. doi: 10.1001/archopht.1985.01050090107043. [DOI] [PubMed] [Google Scholar]
  3. Frueh B. R., Musch D. C., Grill R., Garber F. W., Hamby S. Orbital compliance in Graves' eye disease. Ophthalmology. 1985 May;92(5):657–665. doi: 10.1016/s0161-6420(85)33990-8. [DOI] [PubMed] [Google Scholar]
  4. GROSSMANN E. E., BURNS T. A. Clinical use of orbitonometry. Am J Ophthalmol. 1954 Apr;37(4):520–528. doi: 10.1016/0002-9394(54)92202-3. [DOI] [PubMed] [Google Scholar]
  5. Hudson H. L., Levin L., Feldon S. E. Graves exophthalmos unrelated to extraocular muscle enlargement. Superior rectus muscle inflammation may induce venous obstruction. Ophthalmology. 1991 Oct;98(10):1495–1499. doi: 10.1016/s0161-6420(91)32099-2. [DOI] [PubMed] [Google Scholar]
  6. Hurwitz J. J., McGowan H. D., Gentles W., Weise R. A., Victor W. Orbitotonography, the dynamic assessment of orbital tension: 2. Results in patients with orbital disease. Can J Ophthalmol. 1988 Dec;23(7):308–310. [PubMed] [Google Scholar]
  7. Johansson J. O. Inhibition and recovery of retrograde axoplasmic transport in rat optic nerve during and after elevated IOP in vivo. Exp Eye Res. 1988 Feb;46(2):223–227. doi: 10.1016/s0014-4835(88)80079-4. [DOI] [PubMed] [Google Scholar]
  8. Johansson J. O. Retrograde axoplasmic transport in rat optic nerve in vivo. What causes blockage at increased intraocular pressure? Exp Eye Res. 1986 Oct;43(4):653–660. doi: 10.1016/s0014-4835(86)80031-8. [DOI] [PubMed] [Google Scholar]
  9. Kennerdell J. S., Maroon J. C. An orbital decompression for severe dysthyroid exophthalmos. Ophthalmology. 1982 May;89(5):467–472. doi: 10.1016/s0161-6420(82)34776-4. [DOI] [PubMed] [Google Scholar]
  10. Leone C. R., Jr, Piest K. L., Newman R. J. Medial and lateral wall decompression for thyroid ophthalmopathy. Am J Ophthalmol. 1989 Aug 15;108(2):160–166. doi: 10.1016/0002-9394(89)90011-1. [DOI] [PubMed] [Google Scholar]
  11. McCord C. D., Jr Current trends in orbital decompression. Ophthalmology. 1985 Jan;92(1):21–33. doi: 10.1016/s0161-6420(85)34079-4. [DOI] [PubMed] [Google Scholar]
  12. McCord C. D., Jr Orbital decompression for Graves' disease. Exposure through lateral canthal and inferior fornix incision. Ophthalmology. 1981 Jun;88(6):533–541. [PubMed] [Google Scholar]
  13. McCord C. D., Jr, Putnam J. R., Ugland D. N. Pressure-volume orbital measurement comparing decompression approaches. Ophthal Plast Reconstr Surg. 1985;1(1):55–63. doi: 10.1097/00002341-198501000-00009. [DOI] [PubMed] [Google Scholar]
  14. McGowan H. D., Hurwitz J. J., Gentles W. Orbitotonography, the dynamic assessment of orbital tension: 1. Results in subjects without known orbital disease. Can J Ophthalmol. 1984 Apr;19(3):122–125. [PubMed] [Google Scholar]
  15. Mourits M. P., Koornneef L., Wiersinga W. M., Prummel M. F., Berghout A., van der Gaag R. Orbital decompression for Graves' ophthalmopathy by inferomedial, by inferomedial plus lateral, and by coronal approach. Ophthalmology. 1990 May;97(5):636–641. doi: 10.1016/s0161-6420(90)32532-0. [DOI] [PubMed] [Google Scholar]
  16. Musch D. C., Frueh B. R., Landis J. R. The reliability of Hertel exophthalmometry. Observer variation between physician and lay readers. Ophthalmology. 1985 Sep;92(9):1177–1180. doi: 10.1016/s0161-6420(85)33880-0. [DOI] [PubMed] [Google Scholar]
  17. Neigel J. M., Rootman J., Belkin R. I., Nugent R. A., Drance S. M., Beattie C. W., Spinelli J. A. Dysthyroid optic neuropathy. The crowded orbital apex syndrome. Ophthalmology. 1988 Nov;95(11):1515–1521. doi: 10.1016/s0161-6420(88)32978-7. [DOI] [PubMed] [Google Scholar]
  18. Quigley H. A., Guy J., Anderson D. R. Blockade of rapid axonal transport. Effect of intraocular pressure elevation in primate optic nerve. Arch Ophthalmol. 1979 Mar;97(3):525–531. doi: 10.1001/archopht.1979.01020010269018. [DOI] [PubMed] [Google Scholar]
  19. Shorr N., Neuhaus R. W., Baylis H. I. Ocular motility problems after orbital decompression for dysthyroid ophthalmopathy. Ophthalmology. 1982 Apr;89(4):323–328. doi: 10.1016/s0161-6420(82)34793-4. [DOI] [PubMed] [Google Scholar]
  20. Simonsz H. J., Harting F., de Waal B. J., Verbeeten B. W. Sideways displacement and curved path of recti eye muscles. Arch Ophthalmol. 1985 Jan;103(1):124–128. doi: 10.1001/archopht.1985.01050010130036. [DOI] [PubMed] [Google Scholar]
  21. Stanley R. J., McCaffrey T. V., Offord K. P., DeSanto L. W. Space-occupying orbital lesions: can critical increases in intraorbital pressure be predicted clinically? Laryngoscope. 1989 Jan;99(1):19–22. doi: 10.1288/00005537-198901000-00005. [DOI] [PubMed] [Google Scholar]
  22. Strobel J., Jacobi K. W. Das Verhalten des intraorbitalen Druckes bei unterschiedlichem Volumen. Klin Monbl Augenheilkd. 1987 Dec;191(6):449–451. doi: 10.1055/s-2008-1050552. [DOI] [PubMed] [Google Scholar]
  23. Warren J. D., Spector J. G., Burde R. Long-term follow-up and recent observations on 305 cases of orbital decompression for dysthyroid orbitopathy. Laryngoscope. 1989 Jan;99(1):35–40. doi: 10.1288/00005537-198901000-00008. [DOI] [PubMed] [Google Scholar]

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