Introduction: Graves disease is an autoimmune disorder of the thyroid gland causing over-production of thyroid hormone. Although this disorder can lead to systemic changes throughout the body, the most common extrathyroid manifestation of Graves disease is ophthalmopathy. Patients can have significant ocular prominence from the increase in intraconal and extraconal fat and muscular hypertrophy. This can lead to vision changes, decreased ocular motility, and corneal injury from lid retraction. In patients that have failed medical management or patients with significant or progressive visual symptoms, surgical decompression can be a useful treatment modality.
Methods: We present a retrospective review of all patients where orbital decompression surgery was performed to treat thyroid-related ophthalmopathy from 20142017. All cases were performed by a single surgeon (T.P.). Patient age, demographics, medical history and symptomology, pre and post-operative Hertel measurements were collected. Subjective response to surgical treatment was also recorded.
Results: A total of twelve patients, ten females and two males, underwent surgical decompression surgery for Graves ophthalmopathy. Six patients underwent the surgery in both eyes, the other six underwent the surgery only for one eye. Four of the patients main complaint was dry eyes, two patients had diplopia, two patients complained of severe pain and pressure. Preoperative Hertel exophthalmometer readings ranged from 1824, with improvement ranging from 15 mm. All patients underwent decompression by removal of intra/extraconal fat in upper and lower eyelid compartments. Ten orbital floor and medial wall ostectomies were performed. Post-operatively patients reported decreased swelling, resolution of double-vision, and improved aesthestic appearance.
Conclusion: Orbital decompression surgery is a useful treatment option in patients with significant Graves ophthalmopathy, providing both a functional and aesthetic improvement of symptoms.