Semin Plast Surg 2017; 31(01): 040-045
DOI: 10.1055/s-0037-1598192
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Orbital Decompression for Thyroid Eye Disease

Tara L. Braun
1   Division of Ophthalmology, Baylor College of Medicine, Houston, Texas
,
Mohin A. Bhadkamkar
1   Division of Ophthalmology, Baylor College of Medicine, Houston, Texas
,
Kevin T. Jubbal
1   Division of Ophthalmology, Baylor College of Medicine, Houston, Texas
,
Adam C. Weber
1   Division of Ophthalmology, Baylor College of Medicine, Houston, Texas
,
Douglas P. Marx
1   Division of Ophthalmology, Baylor College of Medicine, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
28 February 2017 (online)

Abstract

Although most cases of thyroid eye disease (TED) can be managed medically, some refractory or severe cases are treated surgically with orbital decompression. Due to a lack of randomized controlled trials comparing surgical techniques for orbital decompression, none have been deemed superior. Thus, each case of TED is managed based on patient characteristics and surgeon experience. Surgical considerations include the extent of bony wall removal, the surgical approach, the choice of incision, and the use of fat decompression. Outcomes vary based on surgical indications and techniques; hence, vision can improve or worsen after the surgery.

 
  • References

  • 1 Victores AJ, Takashima M. Thyroid eye disease: optic neuropathy and orbital decompression. Int Ophthalmol Clin 2016; 56 (1) 069-079
  • 2 Garrity JA, Bahn RS. Pathogenesis of graves ophthalmopathy: implications for prediction, prevention, and treatment. Am J Ophthalmol 2006; 142 (1) 147-153
  • 3 Wiersinga WM, Bartalena L. Epidemiology and prevention of Graves' ophthalmopathy. Thyroid 2002; 12 (10) 855-860
  • 4 Goldberg RA. Advances in surgical rehabilitation in thyroid eye disease. Thyroid 2008; 18 (9) 989-995
  • 5 Perros P, Kendall-Taylor P. Thyroid-associated ophthalmopathy: pathogenesis and clinical management. Baillieres Clin Endocrinol Metab 1995; 9 (1) 115-135
  • 6 Weetman AP. Thyroid-associated eye disease: pathophysiology. Lancet 1991; 338 (8758): 25-28
  • 7 Naik VM, Naik MN, Goldberg RA, Smith TJ, Douglas RS. Immunopathogenesis of thyroid eye disease: emerging paradigms. Surv Ophthalmol 2010; 55 (3) 215-226
  • 8 Guthoff R, Katowitz JA In: Occuloplastics and Orbit. Heidelberg, Germany: Springer Verlag; 2006: 97-108
  • 9 Lehmann GM, Feldon SE, Smith TJ, Phipps RP. Immune mechanisms in thyroid eye disease. Thyroid 2008; 18 (9) 959-965
  • 10 Boboridis KG, Uddin J, Mikropoulos DG , et al. Critical appraisal on orbital decompression for thyroid eye disease: a systematic review and literature search. Adv Ther 2015; 32 (7) 595-611
  • 11 Boboridis KG, Bunce C. Surgical orbital decompression for thyroid eye disease. Cochrane Database Syst Rev 2011; (12) CD007630 DOI: 10.1002/14651858.CD007630.pub2.
  • 12 Jernfors M, Välimäki MJ, Setälä K, Malmberg H, Laitinen K, Pitkäranta A. Efficacy and safety of orbital decompression in treatment of thyroid-associated ophthalmopathy: long-term follow-up of 78 patients. Clin Endocrinol (Oxf) 2007; 67 (1) 101-107
  • 13 Wakelkamp IMMJ, Baldeschi L, Saeed P, Mourits MP, Prummel MF, Wiersinga WM. Surgical or medical decompression as a first-line treatment of optic neuropathy in Graves' ophthalmopathy? A randomized controlled trial. Clin Endocrinol (Oxf) 2005; 63 (3) 323-328
  • 14 Marcocci C, Bartalena L, Tanda ML , et al. Comparison of the effectiveness and tolerability of intravenous or oral glucocorticoids associated with orbital radiotherapy in the management of severe Graves' ophthalmopathy: results of a prospective, single-blind, randomized study. J Clin Endocrinol Metab 2001; 86 (8) 3562-3567
  • 15 Prummel MF, Terwee CB, Gerding MN , et al. A randomized controlled trial of orbital radiotherapy versus sham irradiation in patients with mild Graves' ophthalmopathy. J Clin Endocrinol Metab 2004; 89 (1) 15-20
  • 16 Mourits MP, van Kempen-Harteveld ML, García MB, Koppeschaar HP, Tick L, Terwee CB. Radiotherapy for Graves' orbitopathy: randomised placebo-controlled study. Lancet 2000; 355 (9214): 1505-1509
  • 17 Rajendram R, Bunce C, Lee RWJ, Morley AMS. Orbital radiotherapy for adult thyroid eye disease. Cochrane Database Syst Rev 2012; (7) CD007114 DOI: 10.1002/14651858.CD007114.pub2.
  • 18 Perumal B, Meyer DR. Treatment of severe thyroid eye disease: a survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Ophthal Plast Reconstr Surg 2015; 31 (2) 127-131
  • 19 Rao R, MacIntosh PW, Yoon MK, Lefebvre DR. Current trends in the management of thyroid eye disease. Curr Opin Ophthalmol 2015; 26 (6) 484-490
  • 20 Alsuhaibani AH, Carter KD, Policeni B, Nerad JA. Orbital volume and eye position changes after balanced orbital decompression. Ophthal Plast Reconstr Surg 2011; 27 (3) 158-163
  • 21 Thapa S, Gupta AK, Gupta A, Gupta V, Dutta P, Virk RS. Proptosis reduction by clinical vs radiological modalities and medial vs inferomedial approaches: comparison following endoscopic transnasal orbital decompression in patients with dysthyroid orbitopathy. JAMA Otolaryngol Head Neck Surg 2015; 141 (4) 329-334
  • 22 Zoumalan CI, Kazim M, Lisman RD. Endoscopic orbital decompression. Oper Tech Otolaryngol Head Neck Surg 2011; 22: 223-228
  • 23 Walsh TE, Ogura JH. Transantral orbital decompression for malignant exophthalmos. Laryngoscope 1957; 67 (6) 544-568
  • 24 Ünal M, Leri F, Konuk O, Hasanreisoğlu B. Balanced orbital decompression combined with fat removal in Graves ophthalmopathy: do we really need to remove the third wall?. Ophthal Plast Reconstr Surg 2003; 19 (2) 112-118
  • 25 Ting JY, Sindwani R. Endoscopic orbital decompression. Oper Tech Otolaryngol Head Neck Surg 2014; 25 (2) 213-217
  • 26 Prat MC, Braunstein AL, Dagi Glass LR, Kazim M. Orbital fat decompression for thyroid eye disease: retrospective case review and criteria for optimal case selection. Ophthal Plast Reconstr Surg 2015; 31 (3) 215-218
  • 27 Kingdom TT, Davies BW, Durairaj VD. Orbital decompression for the management of thyroid eye disease: an analysis of outcomes and complications. Laryngoscope 2015; 125 (9) 2034-2040
  • 28 Mourits MP, Bijl H, Altea MA , et al; European Group on Graves' Orbitopathy (EUGOGO). Outcome of orbital decompression for disfiguring proptosis in patients with Graves' orbitopathy using various surgical procedures. Br J Ophthalmol 2009; 93 (11) 1518-1523
  • 29 Wickwar S, McBain HB, Ezra DG, Hirani SP, Rose GE, Newman SP. Which factors are associated with quality of life in patients with Graves' orbitopathy presenting for orbital decompression surgery?. Eye (Lond) 2015; 29 (7) 951-957
  • 30 Wickwar S, McBain H, Ezra DG, Hirani SP, Rose GE, Newman SP. The psychosocial and clinical outcomes of orbital decompression surgery for thyroid eye disease and predictors of change in quality of life. Ophthalmology 2015; 122 (12) 2568-2576.e1
  • 31 Leong SC, Karkos PD, Macewen CJ, White PS. A systematic review of outcomes following surgical decompression for dysthyroid orbitopathy. Laryngoscope 2009; 119 (6) 1106-1115
  • 32 Mainville NP, Jordan DR. Effect of orbital decompression on diplopia in thyroid-related orbitopathy. Ophthal Plast Reconstr Surg 2014; 30 (2) 137-140