Surgical Treatment of Thyroid Eye Disease

Abstract

Thyroid eye disease may result in exophthalmos, diplopia, and eyelid malpositions, which can be corrected with different surgical procedures. Several techniques for decompressing the orbit have been described, and the advantages and disadvantages of the techniques are discussed. Our own results of the transantral approach are briefly summarized. Eye muscle surgery should be performed after an orbital decompression, and it is not unlikely that more than one muscle operation will be needed in order to achieve single vision. A number of operative procedures for eyelid surgery have been described, and the results of the various methods are generally good.

Management of Graves' Ophthalmopathy: Reality and Perspectives

“…According to some authors (178), but not to others (140), the release of the fibrotic eye muscle may be associated with an increase in proptosis. Therefore, in patients with moderate proptosis, preliminary orbital decompression, performed before extraocular muscle surgery, may be considered (178).…”

“…The lateral approach is of limited effectiveness, because the removal of the lateral wall alone is usually associated with a limited decrease in proptosis (1). The superior (transfrontal) approach removes the roof of the orbit and is effective, but nowadays it is rarely used because of the risks associated with this procedure, i.e., intracerebral hemorrhage, damage to the frontal lobe, meningitis, and sensation of pulsation behind the globes (140).…”

“…This technique has been modified to remove also the lateral wall of the orbit, although it is mainly aimed at the floor and the medial wall of the orbit (140). In a large series from the Mayo Clinic, Garrity et al (135) reported that 402 of 453 eyes (89%) with visual acuity worse than 20/20 improved or remained the same; defects of the visual field ameliorated or regressed in 245 of 269 eyes (91%), preoperative papilledema was reduced in 99 of 105 eyes (94%), and preoperative exposure keratitis improved in 178 of 195 eyes (92%).…”

“…Removal of the floor and the medial wall can also be accomplished by an anterior approach through a transconjunctival or translid incision (140). This approach appears to be associated with a lower incidence of worsening of diplopia, because it is more difficult to remove the posterior part of the ethmoid, thus avoiding the prolapse of the posterior portion of the orbital content (140).…”

“…This approach appears to be associated with a lower incidence of worsening of diplopia, because it is more difficult to remove the posterior part of the ethmoid, thus avoiding the prolapse of the posterior portion of the orbital content (140). In a review of American ophthalmologists, this technique was associated with a 6% worsening of diplopia, compared with 41% after transantral decompression (139).…”