Orbital decompression in thyroid eye disease

Abstract

Though enlargement of the bony orbit by orbital decompression surgery has been known for about a century, surgical techniques vary all around the world mostly depending on the patient's clinical presentation but also on the institutional habits or the surgeon's skills. Ideally every surgical intervention should be tailored to the patient's specific needs. Therefore the aim of this paper is to review outcomes, hints, trends, and perspectives in orbital decompression surgery in thyroid eye disease regarding different surgical techniques.

Figure 1

Different approaches to orbital decompression.

Figure 2

Surgical technique for LWD ((a)–(n)), see text for details).

Figure 3

38-year-old female patient with significant exophthalmos and retrobulbar pressure sensation, no visual impairment. (a) Preoperatively: exophthalmos and lid retraction. (b) Postoperatively after lateral wall decompression: exophthalmos improved 5.0 mm on the right side and 4.0 mm on the left side. Additional lid surgery is needed (upper lid lengthening procedure). (c) Postoperatively: CT scan after lateral wall decompression of the right orbit (arrow: missing lateral orbital wall), coronal scan, and 3D reconstruction.

Figure 4

(a) Hertel exophthalmometer needs the lateral orbital rim as a reference point and is therefore not suitable after en bloc resection of the lateral orbital wall. (b) Naugle exophthalmometer uses the upper and lower orbital rims for fixation of the instrument.

Figure 5

51-year-old female patient. (a) Preoperatively: severe active TAO with DON (visual acuity OD 0.6; OS 0.4), no diplopia. (b) Six months after combined medial and lateral wall decompression: visual acuity improved to OD 0.8 and OS 0.6; esotropia was induced leading to double vision in all directions of gaze. (c) Postoperatively: CT scan demonstrates definite movement of the rectus muscles into the newly created space in the paranasal sinuses and temporal fossa.