В публикации представлена методика комбинированного подхода к декомпрессии орбиты при эндокринной офтальмопатии. Проведен анализ собственных результатов хирургических вмешательств на орбите с резекцией ее костных стенок. Пациентам выполнялась трансэтмоидальная декомпрессия орбиты эндоназальным доступом и резекция латеральной орбитальной стенки наружным доступом. Проанализированы техника операций, особенности послеоперационного ведения пациентов и результаты лечения. Продемонстрирована высокая эффективность комбинированного хирургического подхода к декомпрессивным операциям на орбите в отношении регресса экзофтальма.

Paralytic lagophthalmos (PL) is a rather common pathology dealt by ophthalmologists, neurologists, maxillofacial, and, certainly, ophthalmic plastic surgeons. This specific disease occurs in patients who underwent neurosurgery or complicated midface surgery, and in those with many other conditions [1]. PL management is based on obtaining improved eyelid closure with cosmetically acceptable narrowing of the palpebral fissure and "a stable cornea". In this review we hope to share our knowledge of a variety of details involved in planning and implementation of the surgical treatment of PL [2]. Lubrication with tear drops and other cornea wetting agents (during the day) and ointment (at night) is a cornerstone of treatment for patients with PL. The lower eyelid is elevated with plaster, if required. Since the n. petrosus superficialis major is responsible for secretory innervation of the lacrimal gland, any involvement of this nerve will drastically reduce tear production and may require temporary or permanent punctal occlusion or tarsorrhaphy. Soft contact lenses may be used for PL treatment and prevention, but due to poor lens retention and special care requirements, most patients refrain from wearing them. In severe corneal damage, moisture chambers are applied for ocular surface protection. External eyelid weights offer some convenience to the patient and can be placed by