A review of combined orbital decompression and lower eyelid recession surgery for lower eyelid retraction in thyroid orbitopathy

Norris, Jonathan H.; Ross, Jonathan J.; O'Reilly, Philip; Malhotra, Raman

doi:10.1136/bjophthalmol-2011-300698

Cited by 30 publications

(12 citation statements)

References 25 publications

(37 reference statements)

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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%

“…Cumulatively, there was no improvement in upper eyelid retraction after orbital decompression and there were varied outcomes in lower eyelid retraction, depending on the number of walls on which orbital decompression was performed, with an average improvement of 0.5–1 mm. This shows that there is some correlation between lower eyelid retraction and the degree of proptosis reduction [ 5 , 7 , 8 ].…”

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%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Norris et al. 5 reported the added benefit of concurrent inferior retractors recession with orbital decompression surgery when closing a swinging-eyelid flap. Recent study by Kim et al.…”

Section: Discussionmentioning

confidence: 99%

Combined orbital decompression and lower eyelid retraction surgery

Taban

2018

Journal of Current Ophthalmology

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PurposeOrbital decompression and lower eyelid retraction surgery are traditionally performed separately in staged fashion, which may be unnecessary. Herein, we evaluate the safety and efficacy of combined orbital decompression and lower eyelid retraction surgery.MethodsRetrospective analysis of patients undergoing combined orbital decompression and lower eyelid retraction surgery in patients with or without Graves orbitopathy, by one surgeon from 2016 to 2017. Patients with previous orbital or lower eyelid surgery were excluded. Surgical technique for orbital decompression included eyelid crease lateral-wall decompression, transconjunctival inferolateral-wall decompression, or transcaruncular medial-wall decompression, or combination. Surgical technique for lower eyelid retraction surgery described previously. Analysis included 34 surgeries (19 patients). Preoperative and postoperative photographs at longest follow-up visit were standardized and analyzed.ResultsEtiologies of lower eyelid retraction included thyroid eye disease (13 patients) and inherited (6 patients). Etiologies of proptosis included thyroid eye disease (13 patients) and inherited with shallow orbits and/or poor maxilla (6 patients). All 34 eyelids demonstrated improvement of lower eyelid position. The mean improvement of marginal reflex distance was 2.4 mm (range, 1.7–2.9 mm). There was one case of mild overcorrection and once case of prolonged chemosis. The average follow-up was 9 months (range, 6 months to 1 year).ConclusionsThis study demonstrates improvement of lower lid position in patients undergoing simultaneous orbital decompression and correction of lower eyelid retraction, irrespective of the etiology of lower eyelid retraction and proptosis or orbital decompression technique. Combined procedures may reduce the number of total procedures, patient anxiety, recovery time, and costs, without compromising the results.

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“…Management of eyelid retraction in GO traditionally involves a staged lid recession surgery, although combined lid surgery at the time of orbital decompression is increasingly advocated 25. Nevertheless, a recent study reported that the lower but not upper eyelid retraction may reduce after orbital decompression surgery prior to any adjunctive lid recession procedures due to the reduction in proptosis and occasional inferior globe displacement 18 25.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of orbital fat decompression in Graves’ orbitopathy

et al. 2017

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A review of combined orbital decompression and lower eyelid recession surgery for lower eyelid retraction in thyroid orbitopathy

Abstract: Combining orbital decompression with concurrent inferior retractor recession at the time of swinging-eyelid flap closure is safe and improves lower lid height postoperatively compared to decompression alone.

Cited by 30 publications

References 25 publications

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

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

Combined orbital decompression and lower eyelid retraction surgery

Long-term outcomes of orbital fat decompression in Graves’ orbitopathy

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