Orbital decompression in thyroid eye disease

Publication date: Available online 12 October 2018Source: Operative Techniques in Otolaryngology-Head and Neck SurgeryAuthor(s): Jane S. Kim, Jason LissAbstractThyroid eye disease is an orbital inflammatory manifestation of autoimmune thyroid disease that results in orbital congestion and can lead to significant cosmetic disfigurement, diplopia, and vision loss. Typically, there is an active, inflammatory phase that transitions into a quiescent, fibrotic state. Management of this condition consists of regulation of the underlying thyroid disease, modulation of risk factors, supportive care for symptoms, and both medical and surgical treatment of ocular sequelae. Orbital decompression is generally indicated in two main subsets of cases: in active disease that includes ulcerative keratitis from severe corneal exposure or compressive optic neuropathy that does not resolve with high-dose corticosteroids, and in quiescent cases with persistent congestive or exposure symptoms and/or cosmetic deformity. Decompression may involve the medial wall, the lateral wall, the orbital floor, and any combination thereof, and this decision is dependent on surgeon preference and the overall goal of decompression. The medial wall is commonly selected due to the ease of approach, the significant potential for orbital volume expansion, and the opportunity for direct decompression of the optic nerve in cases of compressive optic neuropathy. Various surgical approaches to the medial wall have been pr...
Source: Operative Techniques in Otolaryngology Head and Neck Surgery - Category: ENT & OMF Source Type: research