Surgical treatment for Graves' disease

Abstract

The functional and esthetic consequences of Graves' disease can be corrected by surgical procedures according to a well-established methodology: (1) Orbital decompression for exophthalmos, (2) Lengthening of the levator muscle in case of palpebral retraction, (3) Lengthening of fibrotic eye muscles in case of diplopia.

Not infrequently these sequelae coincide and one or more operative sessions become necessary. The timing of these sessions is dependent on the interactions that exist between the orbit, the eyelids and the ocular motor muscles. Sometimes the treatment of one single symptom interferes with the other functions. Orbital surgery - orbital decompression or removal of bone - is primarily intended to counteract the exophthalmos. The decompression, however, may modify the function of the ocular motor muscles or of the palpebral motility.

Ocular motor surgery comes second after correction of the orbit and always must precede the surgery of eyelids because the position of the eyelids is largely dependent on the position of the eyeballs. Accordingly this palpebral surgery must come last.

In selected cases in which severe retraction of the eyelids coincides with exophthalmos, a simple lengthening of the eyelid may be sufficient to mask the exophthalmos and make the orbital decompression superfluous.

The authors give their experience in a series of 24 operated patients.

Key Words:

• Graves' ophthalmopathy
• surgical treatment
• exophthalmos
• ocular motor troubles
• palpebral retraction