Simultaneous Aesthetic Eyelid Surgery and Orbital Decompression for Rehabilitation of Thyroid Eye Disease: The One-Stage Approach

Bernardini, Francesco P.; Skippen, Brent; Zambelli, Alessandra; Riesco, Benjamin; Devoto, Martín H.

doi:10.1093/asj/sjy014

Cited by 29 publications

(22 citation statements)

References 17 publications

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“…In the case of upper lid retraction, correction should be delayed up to 24 months after it occurs [10]. Carrying out surgical rehabilitation procedures in gradual stages continues to be urged [21] although there are also individual reports of aesthetic lid operations combined with simultaneous orbit decompression for surgical rehabilitation [22]; however, this approach is not yet widespread. Graded full thickness blepharotomy has become accepted in recent years as the most efficient method of upper lid lengthening [11].…”

Section: Discussionmentioning

confidence: 99%

Eyelid Surgery in Gravesʼ Orbitopathy

Hintschich¹

2021

Klin Monbl Augenheilkd

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Patients with Gravesʼ orbitopathy often develop eyelid changes. These may be the result of a volume effect or a malposition. Both dermatochalasis with fat tissue increase and eyelid retraction may lead to functional or aesthetic impairment. The present article reviews indications, timing and principles for corrective eyelid surgery. If at all possible, surgical eyelid correction in Gravesʼ orbitopathy should be performed once the disease became inactive and stabile. Surgical details of eyelid lengthening procedures for upper and lower eyelid retraction are presented. Meanwhile anterior blepharotomy became the primary procedure for upper eyelid lengthening. However, there is no such standard procedure for lower eyelid lengthening, although it is recommended to use a spacer. For blepharoplasty it is mandatory to distinguish between orbital fat prolapse and subbrow fat pad. A prolapse of the lacrimal gland should not be missed and generally, skin excision performed sparingly.

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Section: Discussionmentioning

confidence: 99%

Eyelid Surgery in Gravesʼ Orbitopathy

Hintschich¹

2021

Klin Monbl Augenheilkd

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“…We focused on the change in eyelid parameters after orbital decompression because patients suffering from cosmetic rehabilitation for TED exhibited improved eyelid protrusion after orbital decompression, although cosmetic problems, such as eyelid retraction, remained [7][8][9][10][11][12]. Therefore, performing the treatment of TED in stages requires several surgeries and long-term outpatient visits to complete rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…For example, orbital decompression has been shown to be effective in the improvement of lower eyelid retraction to some extent, but studies report inconclusive results for upper eyelid retraction [3][4][5][6]. Several recent studies have reported on whether decompression surgery with various approaches combined with eyelid surgery benefits more to the patient suffering from TED with aesthetic rehabilitation [5,[7][8][9][10][11][12]. To the best of our knowledge, there is no literature comparing changes in eyelid parameters between the endoscopic and transcaruncular surgical approaches to date.…”

Section: Introductionmentioning

confidence: 99%

Changes in Eyelid Parameters after Orbital Decompression according to the Surgical Approach in Thyroid Eye Disease

Kim

Kang

2021

Korean J Ophthalmol

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To evaluate the changes in eyelid parameters after the endonasal approach compared with transcaruncular medial wall decompression combined with the transconjunctival inferior wall decompression approach with inferomedial strut preservation.Methods: In total, 71 patients with thyroid eye disease who underwent orbital decompression were retrospectively evaluated. The data collected included Hertel exophthalmometry, marginal reflex distance 1, marginal reflex distance 2, interpalpebral fissure, levator function test measures, and complications related to surgery.Results: Proptosis reduction produced a statistically significant improvement across all decompression groups. Lower eyelid retraction produced a statistically significant improvement in the two-wall decompression groups but not in the one-wall decompression groups. No statistical difference was observed in the upper eyelid retraction and levator function after surgery across all decompression groups. In the post-hoc analysis, statistical improvement was not observed in the lower eyelid retraction between the endonasal and transcaruncular approach in the one-wall and twowall decompression groups, although statistically significant exophthalmos reduction and improvement in the lower eyelid retraction was noted in the two-wall decompression subgroups compared with one-wall decompression subgroups. Conclusions:Our study showed no differences in eyelid parameters between the endonasal and transcaruncular decompression approaches in one-wall and two-wall decompression. In the two-wall decompression group, proptosis reduction was greater with the endonasal approach than with the transcaruncular approach when the strut was preserved; however, it does not lead to a significant difference in the improvement of lower eyelid retraction.

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“…Thus, a staged approach can lead to better predictability in the outcome 8 . However, a single‐stage surgical approach has also demonstrated to be effective, and no studies to date have shown inferiority in final results with a single‐staged approach 91,92 . The authors advocate for an individualized surgical plan based on the patient's clinical findings, as real‐time predictions of sequential outcomes can be performed.…”

Section: Surgical Therapymentioning

confidence: 99%

“…8 However, a singlestage surgical approach has also demonstrated to be effective, and no studies to date have shown inferiority in final results with a single-staged approach. 91,92 The authors advocate for an individualized surgical plan based on the patient's clinical findings, as real-time predictions of sequential outcomes can be performed. Even a single staged surgical approach can be fraught with significant morbidity and impact the patient's quality of life.…”

Section: Surgical Therapymentioning

confidence: 99%

Thyroid eye disease: Redefining its management—A review

Jain

Jaru-Ampornpan

Douglas

2021

Clinical Exper Ophthalmology

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Thyroid eye disease (TED) is a debilitating, vision threatening disease that dramatically alters patients' quality of life. Until recently, the management of TED is a long arduous course with supportive therapy, followed by an extensive surgical treatment plan to reverse the disease endpoints. Teprotumumab offers an early, safe therapeutic intervention to help reverse disease end points such as diplopia and proptosis and improve quality of life.

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Simultaneous Aesthetic Eyelid Surgery and Orbital Decompression for Rehabilitation of Thyroid Eye Disease: The One-Stage Approach

Cited by 29 publications

References 17 publications

Eyelid Surgery in Gravesʼ Orbitopathy

Eyelid Surgery in Gravesʼ Orbitopathy

Changes in Eyelid Parameters after Orbital Decompression according to the Surgical Approach in Thyroid Eye Disease

Thyroid eye disease: Redefining its management—A review

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