Customized minimally invasive orbital decompression for thyroid eye disease

Abstract

Thyroid eye disease (TED) refers to a constellation of ophthalmic and orbital findings that are typically associated with Graves’ disease. Due to the heterogeneous expansion of orbital tissues, the resulting phenotypic spectrum ranges widely, with some patients requiring orbital decompression to reduce proptosis and exposure keratopathy or to relieve compression of the optic nerve. Orbital decompression was first described by Dollinger in 1911 and is the treatment of choice for disfiguring proptosis in patients with TED. Since its initial description, an evolution of surgical approaches has been described. Unfortunately, many surgical options are fraught with significant complications including hypoglobus and postoperative diplopia. Over the last several years, technical advancements have greatly facilitated minimally invasive bone and fat removal, significantly reducing postoperative diplopia and recovery time. These advents have expanded the indications for surgical intervention to include patients with exposure keratopathy related to proptosis, orbital pain, congestive orbitopathy and those who are expected to undergo strabismus surgery, as well as those with aesthetic indications. Considering the heterogeneity of clinical findings, these technical advancements provide a platform for customized surgical approaches to restore premorbid functional and aesthetic appearance. In this article, the authors review the customized rehabilitative approach for TED patients according to the literature, including general principles and special considerations.

Keywords::

• autoimmune
• Graves’ disease
• orbit
• orbital decompression
• thyroid eye disease