En bloc resection of the lateral orbital rim to reduce exophthalmos in patients with Graves' disease

Abstract

Introduction: Today, elective surgical procedures are performed on patients with thyroid-associated orbitopathy for aesthetic and "quality-of-life" reasons and only rarely in emergency cases to prevent blindness. The surgical methods should have minimal adverse effects and reliable outcomes.

Patients and methods: En bloc resection of the lateral orbital rim and part of the orbital floor was performed on 44 patients over a 7-year period. An osteotomy was made in the inferolateral wall of the orbit via a subciliary incision and the periorbital tissues were resected. Exophthalmos reduction, postoperative changes in strabismus and extraocular muscle function, visual acuity and follow-on operations were analysed.

Results: Most patients underwent surgery for exophthalmos, conjunctival and corneal symptoms. The average exophthalmos reduction was 3.8+/-1.5mm (range 1.5-7.5mm, p<0.01). No loss of vision was noted. Overall, a reduction in diplopia was achieved, although new strabismus appeared after surgery in one patient. Nineteen patients required additional lid surgery.

Conclusion: The procedure for exophthalmos reduction is as effective as other two-wall expansion methods and it features low risks for loss of vision, new-onset diplopia and other disturbances of extraocular motility.