En bloc resection of the lateral orbital rim to reduce exophthalmos in patients with Graves' disease

Summary 

Introduction

Today, elective surgical procedures are performed on patients with thyroid-associated orbitopathy for aesthetic and “quality-of-life” reasons and only rarely in emergency cases to prevent blindness. The surgical methods should have minimal adverse effects and reliable outcomes.

Patients and methods

En bloc resection of the lateral orbital rim and part of the orbital floor was performed on 44 patients over a 7-year period. An osteotomy was made in the inferolateral wall of the orbit via a subciliary incision and the periorbital tissues were resected. Exophthalmos reduction, postoperative changes in strabismus and extraocular muscle function, visual acuity and follow-on operations were analysed.

Results

Most patients underwent surgery for exophthalmos, conjunctival and corneal symptoms. The average exophthalmos reduction was 3.8±1.5mm (range 1.5–7.5mm, p<0.01). No loss of vision was noted. Overall, a reduction in diplopia was achieved, although new strabismus appeared after surgery in one patient. Nineteen patients required additional lid surgery.

Conclusion

The procedure for exophthalmos reduction is as effective as other two-wall expansion methods and it features low risks for loss of vision, new-onset diplopia and other disturbances of extraocular motility.

Keywords: ophthalmopathy, Graves' disease, exophthalmos, orbital decompression