Update on the surgical management of Graves’ orbitopathy

Abstract

Graves’ orbitopathy (GO) is a complex autoimmune disorder of the orbit that causes the eye to appear disfigured. GO is typically associated with Graves’ disease, an inflammatory autoimmune condition that is caused by thyrotropin receptor autoantibodies. Although our knowledge of the pathophysiology of GO has improved, its exact pathogenesis remains unclear. Some patients suffer from disfigurement, double vision, and even vision loss rather than hyperthyroidism. The disease severity and activity prompt different treatments, as the signs of GO are heterogeneous, so their management can be very complex. Despite medical advances, the first-line treatment for moderate-to-severe active GO is still glucocorticoids, while surgery can be critical for the treatment of chronic inactive GO. Surgery is sometimes required in the acute phase of the disease when there is an immediate risk to vision, such as in dysthyroid optic neuropathy. Most surgeries for GO are rehabilitative and subdivided into three categories: decompression, strabismus repair, and lid surgery. This review is a basic overview of the field, with up-to-date knowledge of the surgical techniques for GO. We review and summarize recent literature on the advances in surgery for GO to provide up-to-date insights on the optimal surgical treatment for GO.

Ophthalmopathy in Graves' Disease: A Comprehensive Review

“…Beyond the clinical manifestations, the study assessed the impact of ophthalmopathy on the quality of life of affected individuals 14 . Utilizing validated questionnaires, patients with more severe ophthalmopathy reported significantly lower QoL scores, indicating a substantial burden on daily functioning and emotional well-being 15 . These findings underscore the importance of holistic management strategies that address not only the physical symptoms but also the psychosocial aspects of living with Graves' ophthalmopathy 16 .…”

“…Patients subjected to various treatment modalities, including corticosteroids, orbital radiotherapy, and novel biologics, displayed divergent responses 15 . Corticosteroids effectively mitigated inflammation in the majority of cases, yet long-term outcomes varied, prompting further investigation into optimal treatment durations and potential relapse rates 14 .…”

Differentially expressed genes in orbital adipose/connective tissue of thyroid-associated orbitopathy

“…To date, the pathogenic mechanisms of TAO have not been clearly understood. Symptomatic treatments, such as hormone pulse therapy and orbital decompression, are currently limited for patients with TAO ( Baeg et al, 2022 ). This issue emphasizes the importance of understanding the underlying mechanism(s) of and identifying therapeutic approaches for the prevention or treatment of TAO.…”

Ophthalmology and oculoplastics for the rhinologist

“…Orbital soft tissue expansion may result proptosis, diplopia, lid retraction, and compressive optic neuropathy [17,25]. Orbital decompression has been the gold standard for orbit expansion/proptosis reduction in affected patients, with endoscopic approaches giving an "invisible" approach to the medial wall [26]. In cases of optic nerve compromise, steroids are used concurrently [17].…”