Graves’ disease may occasionally result in significant proptosis that is either cosmetically unacceptable or causes visual loss. This has traditionally been managed surgically by external decompression of the orbital bony skeleton. Trans-nasal endoscopic orbital decompression is emerging as a new minimally-invasive technique, that avoids the need for cutaneous or gingival incisions. Decompression of the medial orbital wall can be performed up to the anterior wall of the sphenoid sinus. This can be combined with resection of the medial and posterior portion of the orbital floor (preserving the infra-orbital nerve). This technique produces decompression which is comparable to external techniques.

We present a series of 10 endoscopic orbital decompressions with an average improvement of 4.4 mm in orbital proptosis. There was an improvement in visual acuity in all patients with visual impairment. Endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques.