Surgical treatment of dysthyroid orbitopathy

Abstract

Objectives Orbital decompression for dysthyroid orbitopathy may be performed by open or transnasal endoscopic approaches; however, criteria for the selection of the appropriate surgical technique have not been well-defined. Our goal was to compare the surgical outcomes of orbital decompression techniques employed by the otolaryngology and ophthalmology services at a single institution, so as to clarify the indications and develop a rationale for optimal management. Study Design Case series with chart review. Setting Tertiary care academic medical center. Subjects and Methods Orbital decompressions on 112 orbits of 69 patients from 2001 to 2008 at a tertiary care academic medical center. Results The majority (83%) of orbital decompressions were performed primarily for proptosis, whereas the remainder was indicated for dysthyroid optic neuropathy. Maximum reduction of proptosis was achieved with an endoscopic medial and inferior orbital wall decompression combined with a lateral orbitotomy with fat removal. The average reduction in proptosis was 7.4 mm ± 2.3 mm (primary surgery for proptosis). The endoscopic approach alone provided the least average proptosis reduction but was highly successful in the treatment of dysthyroid optic neuropathy. Conclusions A three-wall decompression using a combined endoscopic and external approach provides the greatest amount of decompression. The endoscopic approach as a single modality is best suited for patients with mild proptosis and for patients with dysthyroid optic neuropathy. Cooperation between otolaryngology and ophthalmology achieves the best care for patients with thyroid eye disease who require surgical treatment.